Strategies for Managing Providers Infected with Bloodborne Pathogens

Background: In 1991 CDC issued guidelines designed to reduce the risks for provider-to-patient transmission of bloodborne pathogens. These guidelines have remained unchanged since 1991, despite substantial progress in our understanding of the epidemiology and pathogenesis of infection caused by these agents and despite substantial modifications of guidelines in other developed countries. The 1991 US guidelines recommend management strategies for hepatitis B ‘e' antigen-positive providers and for providers who are infected with the human immunodeficiency virus; they do not address providers infected with hepatitis C. Objective: To summarize current practices in all 50 states and to conduct a survey of a convenience sample of State Health Departments to determine: 1) whether individual state policies had been modified to incorporate new scientific knowledge since 1991; 2) to assess whether existing State guidelines require prospective patient notification about a provider's bloodborne pathogen infection prior to the conduct of interventional procedures; and 3) to determine the extent to which in 2009 these issues surface as problems requiring management by the State Health Departments. Methods: We reviewed all 50 States' existing laws and guidelines to determine current requirements and practices and conducted a telephone survey of a convenience sample of 15% of State Epidemiologists to assess the extent to which these issues are encountered. Results: Our review of existing guidelines revealed that none of the current State laws or guidelines incorporate information about providers' viral burdens. Only 3 of 50 States have modified their policies or laws since their initial passage; none of the three guidelines that were modified incorporated information about providers' viral burdens; only one of the three modified guidelines addressed hepatitis C. Contrary to the CDC guidelines, only 15 of 50 of the State guidelines require prospective notification of a provider's bloodborne pathogen infection; and only 1/50 (2)%) discuss management of providers infected with HCV. Our suruvery of State Epidemiologists revealed that only 20% of state health department officials identified these issues as requiring significant departmental effort. Conclusions: These results identify a need for incorporating updated scientific information into existing guidelines and also suggest that problems with infected providers are either not being detected, are not occurring commonly, or that they are being managed successfully at levels below the State Health Department level.