The Reproductive Care of Women Living With Hepatitis C Infection

IX. Occupational Exposure, Universal Precautions and Infection Control

A. Occupationaly Acquired Infection in Health Care Workers

The epidemiology and magnitude of risk for acquiring HCV infection occupationally are not fully known.

Cases of occupationally acquired infection in health care workers have been reported after diverse medical procedures. Most of the reported infections among health care workers from occupational exposure^127,128 are thought to be secondary to needle stick accidents, although two reports of infection following conjunctival splashes have recently been published (Table XII).¹²⁷ Some studies seem to indicate a higher prevalence of HCV infection in health care workers and report seroprevalence rates of between two and 4.4 percent, which may suggest an increased risk of acquiring infection occupationally. A prospective American study examining clinical cases reported a threefold increase in incidence of HCV in health care workers compared to the general population over a two year period. However, a recent European study of 5,064 employees from 22 general hospitals reported a seroprevalence of 0.41 percent, lower than that of the general population. There was a strong association in these health care workers with previous blood transfusion and clinically overt hepatitis.¹²⁹

Estimates of post-exposure risk vary from study to study. ^127,130,131 Studies prospectively following patients to six months post-exposure report no seroconversion in 24 health care workers exposed by needle stick to 25 viremic patients: three out of 50 and two out of 53 exposed by needle stick became anti-HCV positive at six months.

A French study, using a model based on very similar HCV prevalence rates to Canada's, estimated the probability of HCV transmission from an infected patient to an uninfected surgeon during any single exposure prone procedure to vary between one in 2,381 to one in 23,810. The annual cumulative risk was calculated as ranging from 0.01 percent to 0.1 percent.¹³² Between two and 21 surgeons out of a total of 20,000 are estimated to acquire HCV infection annually through their occupation.

The best protection against bloodborne pathogens is prevention. This is particularly true for hepatitis C, since no vaccine or immunoglobulin prophylaxis as yet exists. Universal precautions should be applied to all patients to eliminate the need for special identification and isolation of patients (Table XIII).

B. The Infected Health Care Worker

There is much controversy surrounding this issue. Although several instances of transmission from health care worker to patient have been reported, overall the recorded risk is incredibly low.¹³³ As long as exposure prone procedures are not performed, an infected health care worker can probably continue to participate in patient care. Health care workers do not need to be screened routinely for hepatitis C.

• TABLE XII : RISK OF ACQUIRING BLOODBORNE INFECTION FOLLOWING NEEDLE STICK INJURY
  Source of infection	Risk (%)
  HBe Ag positive	30
  HCV	1.8
  HIV	0.3

  
  

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