Blood-borne Virus Infections in Health Care Workers: Victorian Lookback Experiences Dr Jessica Rotty, Dr Brett Sutton, Dr Mihaela Ivan, Adam Hamilton, Jay Healy, Nasra Higgins, Rachel Coutts, Rachel M Chan, Dr I-Hao Cheng, Nick McColgan, Donna Cameron, Dr Simon Crouch, Dr Finn Romanes Communicable Disease Control Conference 2017, Melbourne Outline 1. Briefly outline the current National Guidelines for the management of Health Care Workers (HCWs) known to be infected with blood-borne viruses (BBVs) 2. Present findings from 3 Victorian patient lookback exercises 3. Discuss the lessons learnt 1
Australian National Guidelines for the management of HCWs known to be infected with BBVs (CDNA 2012) All HCWs are expected to protect the health and safety of their patients. This includes preventing transmission of BBVs from themselves to their patients All HCWs infected with a BBV should remain under regular medical specialist supervision and care HCWs who perform exposure prone procedures (EPPs) SHOULD know their BBV status and be encouraged and supported to undergo regular testing Exposure Prone Procedures (EPPs) What are EPPs? Procedures where a risk of injury to HCW can result in exposure of the patient s open tissues to the blood of the HCW 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 3 levels of risk for EPPs. Highest risk where the hands or fingertips may not be completely visible at all times 2
2012 CDNA Guidelines for HCWs with BBVs (currently being revised) HCWs must not perform EPPs if they are: 1. HIV antibody positive 2. Hepatitis C RNA positive 3. Hepatitis B DNA positive HCWs with BBV infection What happens when a notification for a BBV infection in a HCW is received? All jurisdictions should have policies for managing HCWs infected with a BBV Careful risk assessment is performed (e.g. EPPs, breaches in infection control practices, evidence of transmission) Decision whether to proceed with a lookback is made in consultation with an Expert Advisory Committee after careful assessment of risks and benefits 3
What is a lookback? A lookback is the process of: identifying, tracing, recalling, counselling and testing patients who may have been exposed to an infection in a health care setting E.g. it involves: - Obtaining list of EPPs conducted by HCW during the risk period - Obtaining patient contact details with need to verify addresses - Contacting patients - Providing a call centre informing patients of risks and the process for testing. Providing a counselling service for patients - Review and follow up test results Victorian Lookbacks (2012-2016) A total of 3 lookbacks were undertaken: o o o One for HIV One for Hep B One for Hep C At time of notification there was no evidence of any HCW to patient transmission or breaches in infection control practices All 3 HCWs had performed EPPs whilst infectious 4
Lookback 1: HCW with HIV infection (2014) Lookback 1 Number of patients potentially exposed 402 % of patients contacted 96% % of test results received (as a total of contacted) 87 % (n=336) Resources 33 of DHHS staff 18 additional staff employed DHHS operated a call centre for a 2 week period, established a testing clinic and samples were all tested at VIDRL Transmissions identified None Lookback 2: HCW with Hep C infection (2015) Lookback 2 Number of patients potentially exposed 145 % of patients contacted 76% % of test results received (as a total of contacted) 27 % (n=30) Resources 31 of DHHS staff 4 additional staff employed DHHS operated call centre for 2 weeks Testing and results through GPs Transmissions identified None 5
Lookback 3: HCW with Hep B infection (2016) Lookback 3 Number of patients potentially exposed 654 % of patients contacted 84% % of test results received (as a total of contacted) 58 % (n=319) Resources 20 of DHHS staff 16 additional staff employed DHHS operated a call centre for 5 weeks Testing and results through GPs Transmissions identified None Lookback Experiences Impact on patients: Potentially at risk patients were informed Lookback caused anxiety & distress in some patients Over 650 Melbourne patients facing hepatitis B scare. Have you received a letter? Let us know at news@heraldsun.com.au 6
Lookback Experiences: Impact on HCWs Negative impact on emotional wellbeing of all three HCWs Negative impact on medical career Confidentiality of HCWs, health services and patients was maintained by the department in all 3 lookbacks HIV scare for hundreds of dental patients in eastern Victoria Lookback Experiences Awareness Gap Opportunity for improvement o 2 of the affected HCWs were unaware of their obligations under the Guidelines o Diagnosing GPs seemed unaware of the Guidelines o HCWs were not under specialist care at time of notification 7
Conclusions/Recommendations Our findings are an important contribution to the current evidence base that HWC to patient transmissions are extremely rare in the absence of any infection control breaches Decisions when to proceed with a lookback must carefully consider benefits and harms Highlight the need for supportive and more robust processes for HCWs infected with BBVs and screening of HCWs Education and awareness for Health Professionals and their Employers regarding the National Guidelines should be improved Release of the New National Guidelines (2017) could offer a great opportunity Acknowledgements I would like to thank everybody involved in the lookbacks for all their hard and great work: - Colleagues from the Emergency Management Branch - Communicable Disease Prevention & Control - Epidemiology and Surveillance - Media and Communications Unit - Victorian Infectious Disease Reference Laboratory Time for questions 8