[MCOH-EH] [EXTERNAL] Re: Hep c testing for pre employment clearance

[Winters, Tom (BIDMC - Occupational Health)]

No, not at any Harvard teaching hospitals. Good public health , PCP mission.

Tom Winters


On Jul 3, 2023, at 12:44 PM, Swift, Melanie D., M.D., MPH via MCOH-EH <mcoh-eh at mylist.net> wrote:


Hi Jakub, there is no recommendation to test all new staff for bloodborne infections but it is important to have a policy whereby they must self-report if they have BBP infection and perform procedures on patients. Training on BBP exposures and the policy can direct them to report to OH if applicable. Often they are identified when discussing onboarding immunizations (e.g. live virus vaccine recommendations for someone with HIV) or at the baseline testing performed for a needlestick (usually HCV.)

If a HCW reports a BBP infection, the occupational health clinician needs to determine whether they perform higher risk procedures. HCP performing these procedures generally comprise a small minority of the overall employee population – surgeons and first assistants, emergency med docs, OB/GYNs, dentists and dental hygienists. Most HCP at risk of occupational needlestick do not have their fingers inside a confined or poorly visualized body cavity in proximity to a sharp.

It’s also important to ensure that all who self-report are connected to medical care and optimally treated, even if they do not perform higher risk procedures.

SHEA guidelines were updated recently (online 2019/print 2020) and are attached. I recommend reviewing this in concert with the prior guidelines from 2010 because the list of exposure-prone procedures was not changed or reprinted with the 2020 update.

In the 2020 update the viral load cutoffs were lowered, and the emphasis on privacy was highlighted. For instance the expert panel review is now recommended to be minimal – the occupational health physician and hospital epidemiologist would be adequate for most reviews. They also provide criteria to discontinue monitoring for treated HBV and HCV.

It is important to have a monitoring agreement with infected HCP who do perform exposure prone procedures. That is where you specify the frequency of monitoring and the plan for viral loads that are over the “safe level.” You need to have a procedure to issue work restrictions and conduct short term follow-up and authorization to communicate with their treating provider so they can optimize treatment and hopefully get the viral load back down quickly.

The availability of highly effective treatment has made these cases much easier to manage.

Good luck!

Melanie

Melanie Swift, MD, MPH
(she/her)
Vice Chair, Division of Public Health, Infectious Diseases and Occupational Medicine
Medical Director, Mayo Clinic Physician Health Center<https://urldefense.com/v3/__https://www.mayoclinic.org/departments-centers/preventive-occupational-aerospace-medicine/physician-health-center/referrals__;!!AIv8Mrc!-6zB8-FnUPoKjCWebbNdDrArftPoWZ6kwVufPx-j85gsR-6B2QSymQrAevL2v4Ie8NME5-cNQClna5XM3BJf5FXG$>
Associate Medical Director, Occupational Health Service
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905

From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Jakub Furmaga via MCOH-EH
Sent: Sunday, July 2, 2023 9:11 AM
To: MCOH-EH <mcoh-eh at mylist.net>
Cc: Jakub Furmaga <jfurmaga at me.com>
Subject: [EXTERNAL] Re: [MCOH-EH] Hep c testing for pre employment clearance


In our Dallas hospital, all pre-employment/onboarding visits for those with patient contact or who might have exposure to blood or body fluids (BBF) receive:

1.  Basic visual acuity testing

2. Color vision testing

3. Urine drug testing

4. Immunization updates/titers (this includes MMR, varicella, Hep B)



We do not test or ask about pre-existing infections. If there is a BBF exposure, we do Hep C, Hep B, and HIV testing on both the employee and the source and then ensure any appropriate follow-up.



I heard some places have monitoring programs for employees with Hep C, Hep B, and HIV, where viral loads are checked regularly to ensure they would not pose a risk to patients during BBF reverse exposures. Still, we have not implemented anything like that yet. If someone has, I would also love to hear how you deal with the following:

1. Identification of these employees

2. Who makes up the committee/group in charge of meeting with these employees to ensure compliance

3. Guidance about restrictions if viral loads are not “under control.”



Jakub



Jakub Furmaga, MD

Medical Director of Occupational Health

UT Southwestern


On Jul 1, 2023, at 2:10 PM, Enass Awad <umhaneen at gmail.com<mailto:umhaneen at gmail.com>> wrote:
Good afternoon everyone:
   I was wondering if any of you include Hepatitis C testing as part of your pre-employment checks for new hires !
 If you do , are you doing this across the board or only in jobs that have a much higher risk of exposure like dialysis techs !!
  Thanks so much and look forward to hearing from you!
Enass
--
Enass Awad A/Rahman,MD,MPH
Department of Occupational Medicine
Mercy Medical Group
3000 Q Street
Sacramento,CA,95816
Tel: 916-733-3390


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<13-2020 SHEA Infected HCW Guidelines.pdf>
<2010 SHEA Infected HCW Guidelines.pdf>
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The MCOH-EH List has always been moderated by members of the ACOEM Medical Center Occupational Health Section. It is currently moderated by Joe Fanucchi MD FACOEM.
List membership is free, but only subscribers may post to the list.
To post send messages to: mcoh-eh at mylist.net
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