Blood-borne viruses and performing exposure-prone procedures
The responsibility of registrants
Blood-borne viruses (BBVs) refer specifically to the following:
- hepatitis B virus (HBV)
- hepatitis C virus (HCV)
- human immunodeficiency virus (HIV)
The College’s expectations
The College’s Blood-borne Viruses in Registrants practice standard outlines registrants’ responsibilities to safeguard the health of both patients and other health-care workers.
Registrants must minimize the risk of transmitting blood-borne viruses during the provision of medical care. It applies to all registrants who perform or assist in performing exposure-prone procedures (EPPs).
The College expects all registrants to:
- maintain their own wellness
- know their own serological and infectious status and be tested every three years
- be appropriately immunized
- receive treatment
- only perform or assist in performing EPPs when their health and viral loads make it safe
- follow relevant post-exposure protocols of the BC Centre for Disease Control
What are exposure-prone procedures?
Exposure-prone procedures are invasive procedures where there is a higher than average risk that injury to the health-care worker may result in the exposure of the patient’s open tissues to the blood or body fluid of the worker.
These procedures include those where the health-care worker’s hands (whether gloved or not) may be in contact with sharp instruments, needle tips or sharp tissues (spicules of bone or teeth) inside a patient’s open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times.
Exposure-prone procedures include (but are not limited to):
including nephrectomy, small bowel resection, cholecystectomy, subtotal thyroidectomy other elective open abdominal surgery
including surgical extractions, hard and soft tissue biopsy (if more extensive and/or having difficult access for suturing), apicoectomy, root amputation, gingivectomy, periodontal curettage, mucogingival and osseous surgery, alveoplasty or alveoectomy, and endosseous implant surgery
including valve replacement, coronary artery bypass grafting, other bypass surgery, heart transplantation, repair of congenital heart defects, thymectomy, and open-lung biopsy
involving bones, including oncological procedures
including craniotomy, other intracranial procedures, and open-spine surgery
including open resuscitation efforts, deep suturing to arrest hemorrhage, and internal cardiac massage
including Caesarean delivery, hysterectomy, forceps delivery, episiotomy and repair, cone biopsy, and ovarian cyst removal, and other transvaginal obstetrical and gynecological procedures involving hand-guided sharps
including total knee arthroplasty, total hip arthroplasty, major joint replacement surgery, open spine surgery, and open pelvic surgery
including extensive cosmetic procedures (eg, abdominoplasty and thoracoplasty)
except skin and corneal transplantation
including open head injuries, facial and jaw fracture reductions, extensive soft-tissue trauma, and ophthalmic trauma
Note: Non-exposure prone situations can quickly escalate to involve exposure prone procedures for example a trauma resuscitation, or code blue resuscitation requiring cardiac massage, etc. Emergency department staff, and health-care workers who work in rural or remote areas who may be pressed into these situations should consider themselves clinicians who perform EPPs
for example, interactions with violent patients or patients experiencing an epileptic seizure
any surgical procedure necessitating glove change
Health monitoring of registrants infected with a BBV
Registrants infected with BBV can continue to perform or assist in performing EPPs if the College determines it does not compromise patient safety. The Blood Borne Communicable Diseases Committee reviews the registrant's health information in an anonymous process that protects the privacy of the registrant.
Registrants infected with a BBV who wish to perform or assist in performing EPPs must consent to health monitoring by the College. This will include their consent to being under the care of an approved treating physician, including monitoring of their viral loads, as recommended by their treating physician and the committee.