The Occupational Health Physician will obtain written informed consent for the initial testing for markers of hepatitis B infection. Subsequent testing may be performed by suitably trained occupational health nurses.
GLOSSARY OF TERMS:
Annual re-testing for markers of hepatitis B infection will be required for these health care workers who are involved in EPPs or clinical duties in Renal Units, and are non-responders to the hepatitis B vaccine. Appointments for subsequent annual testing may be made with the occupational health nurse, unless the client specifically requests an appointment with the Occupational Health Physician.
SEE ANNEX A
Testing arrangements for hepatitis B infected health care workers without the e-antigen who carry out exposure prone procedures or clinical duties in renal units. To be read in conjunction with "Guidance on Implementation of Health Service Circular 2000/020".
1. Two laboratories have been designated to carry out the testing to ensure consistency of results. The lead laboratory for Northern & Yorkshire Region is:
Contact: Dr Sheila Cameron Tel. 0141 211 0080 or Dr Carman Tel. 07775 783743 Fax: 0141 211 0082
2. Two samples of a minimum of 10ml of clotted blood should be taken from the health care worker a week apart, and should be sent separately and as soon as possible after sampling to the lead laboratory.
3. The blood samples will be appropriately packaged and despatched via the local Microbiology Department. Prior to arranging the 2 appointments for the health care worker with the Occupational Health Physician, blood sample despatch details and arrangements should be checked with the local hospital Microbiology Department. The aim is for samples to arrive within 24 hours of despatch and on a working day, taking account of national and local holidays in the receiving laboratory.
4. Two appointments should be arranged for the health care worker, a week apart, with the Occupational Health Physician. Appointments should be arranged at a time and day of the week to take account of 3. above.
5. The Occupational Health Physician will take a blood sample of a minimum of 10ml of clotted blood, after obtaining informed consent. The laboratory request form should note whether or not the health care worker has been treated with interferon or antiviral therapy within the last 12 months. Note: The Occupational Health Physician should refer to paragraph 15 in "Guidance on Implementation of Health Circular HSC 2000/020" if the health care worker is currently being treated or has been treated within the last 12 months with interferon or antiviral therapy. Hepatitis B infected health care workers without the e-antigen who refuse to have their viral load tested should have their practice restricted in the future.
6. A photocopy should be taken of the completed laboratory request form, and included in the client's OH record.
7. A member of the OH team should deliver the blood sample, by hand, to the local Microbiology Dept, with details of where it should be sent (see 1).
8. The OHN/OHP will telephone or fax the lead laboratory to inform them that a specimen for testing has been despatched.
9. The lead laboratory will confirm receipt of the sample by fax. This should be included in the client's OH record.
10. Steps 5 - 8 should be repeated for the second blood sample.
11. The lead laboratory will arrange for the two samples to be tested in both designated laboratories, and will provide test results to the occupational health department within 4 weeks from receipt of the samples. Results will be reviewed by the Occupational Health Physician, who will advise on restrictions to practice, requirement for annual testing, or further action required as appropriate.
12. Where annual testing is required, the health care worker should be advised when their next test is due. The necessary arrangements should be made to recall the health care worker for re-testing, to ensure that results would be obtained within 12 months from the date of the preceding test. Appointments for annual testing of viral load (hepatitis B virus DNA) should be made with the Occupational Health Physician. TOP
INVESTIGATION OF HEPATITIS B INFECTED HEALTH CARE WORKERS (HEPATITIS B SURFACE ANTIGEN (HbsAg) POSITIVE) WHO PERFORM EXPOSURE PRONE PROCEDURES
Test for HBsAg
DNA exceeding 10³ HBV: RESTRICTED PRACTICE
DNA not exceeding 10³ Genome equivalents per ml: genome equivalents per ml: practice not restricted but subject to annual testing.
HBsAg negative: no restrictions. But subject to annual testing in absence of satisfactoryevidence of immunity to hepatitis B.
Any hepatitis B infected health care worker associated with transmission of infection to a patient should cease performing exposure prone procedures. From: "Guidance on Implementation of Health Circular HSC 2000/020".