[MCOH-EH] Hep C positive HCW

[Buchta, William G., M.D.]

Barb,
Reasonable question, but no, digital palpation refers to a surgeon's hands in a deep cavity, using her/his hand rather than line of sight to locate a suture tip.  A risky procedure (tho common) that is a far cry from starting an IV.  The SHEA guidelines were intended for a pretty discreet population of HCWs, a very small minority.  As we often do, we have gotten way too inclusive.
Seen the recent data showing the virtual elimination of HCWs being infected from BBP exposures in the workplace since we instituted PEP?  Pretty amazing occupational medicine success.  HCW-to-patient infections are almost as rare and are usually due to gross violation of generally accepted infection control measures.  We really don't need to go overboard with restricting and monitoring our colleagues.

Regards,

Bill Buchta

William G. Buchta, MD, MS, MPH
Assistant Professor, Mayo Clinic College of Medicine
Mayo Clinic, Division of Preventive, Occupational, and Aerospace Medicine
200 First St,SW,Rochester, MN 55905
Phone: 507-266-0354 Fax: 507-284-4251
Mayo Clinic, a mission-driven worldwide leader in health care for 150 years
http://150years.mayoclinic.org



From: Barb K. Grabenbauer [mailto:BGrabenbauer at marshmed.com]
Sent: Friday, January 16, 2015 2:49 PM
To: MCOH/EH
Subject: [MCOH-EH] Hep C positive HCW


Do you allow Hep C positive HCW's start IV's?

Is that fall into: Digital palpation of a needle tip in a body cavity


Thank you!
Barb Grabenbauer, RN
Quality Director
Marshalltown Medical & Surgical Center
Marshalltown, IA 50158
________________________________
From: MCOH-EH [mcoh-eh-bounces at mylist.net] on behalf of Brenda Kantner [bkantner at schuylkillhealth.com]
Sent: Wednesday, September 24, 2014 8:44 AM
To: MCOH/EH
Subject: Re: [MCOH-EH] Hepatitis B and titers
It is unfortunate that even though there were new 2013 CDC recommendations, there are still so many individual decisions that need to be made with regard to Hep B for healthcare workers. Nothing is ever totally clear-cut, but there are still so many questions.

We still struggle with many new hires not having documentation of their Hep B vaccines given in the past. Previously, we would titer new hires
if the employee "was sure" they completed the series in the past. In most cases now, based on the newest recommendations, we repeat the series or get a declination rather than titer if there is no documentation of the three vaccines.


Brenda Kantner RN COHN-S/CM
Employee Health Coordinator
Schuylkill Medical Center
700 East Norwegian St
Pottsville, PA 17901
Phone 570-621-4351
Fax   570-621-4257
bkantner at schuylkillhealth.com<mailto:bkantner at schuylkillhealth.com>
________________________________
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Adamo, Philip
Sent: Wednesday, September 24, 2014 8:40 AM
To: 'mcoh-eh at mylist.net'
Subject: Re: [MCOH-EH] Hepatitis B and titers

Good morning all:
I am interested in how your institution handles Hep B titers at pre-placement
The 2013 CDC recommendations state:
"All HCP recently vaccinated or recently completing HepB vaccination who are at risk for occupational blood or body fluid exposure should undergo anti-HBs testing. Anti-HBs testing should be performed 1-2 months after administration of the last dose of the vaccine series when possible. HCP with documentation of a complete ≥3-dose HepB vaccine series but no documentation of anti-HBs ≥10 mIU/mL who are at risk for occupational blood or body fluid exposure might undergo anti-HBs testing upon hire or matriculation. Testing should use a quantitative method that allows detection of the protective concentration of anti-HBs (≥10 mIU/mL) (e.g., enzyme-linked immunosorbent assay [ELISA])."
The word "might" is not good especially when mid level providers work off protocols. This is also different then what figure 6 implies.We also know and the literature supports that the measurement of immunity wanes over time. My recall is that after 7 years it is difficult to measure the immunity greater than 10. There is also literature that those who receive the vaccine in infancy have undetected immunity in adulthood; however, they are immune to Hep b.
Based on this information, I have in previous hospitals set a standard of giving a booster for those with documented 3 doses and more than 7 years and then checking the immunity with a titer rather than checking a  titer, getting an non immune response, administering a booster and checking again. Any thoughts on this?

Thanks,
Phil


Philip Adamo, M.D., MPH, FACOEM
Associate Vice President and
Medical Director, Employee Health &
Occupational Injury Care and Wellness
UMass Memorial Medical Center
Hahnemann Campus Suite 201
291 Lincoln Street
Worcester, MA 01605
Phone: 508-334-6179
FAX: 508-334-6433
cell 508-713-3993
philip.adamo at umassmemorial.org<mailto:philip.adamo at umassmemorial.org>

"THE GREAT USE OF LIFE is to spend it for something that will outlast it."
William James



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