Management of healthcare workers living with a blood borne virus

Overview of the guidelines and key recommendations

The Australian national guidelines for the management of healthcare workers living with blood borne viruses and healthcare workers who perform exposure prone procedures at risk of exposure to blood borne viruses (the national guidelines) provide advice for all healthcare workers (HCW), and particular advice for HCW living with a blood borne virus (BBV), HCW who perform exposure prone procedures, and doctors treating HCW with a BBV. The national guidelines include recommendations for the conditions under which HCWs living with a blood borne virus may perform exposure prone procedures.

Some of the key recommendations of the national guidelines are below.

All healthcare workers:

  • should be encouraged to undertake regular testing for BBVs
  • have the right to access confidential testing, counselling, support and treatment
  • should be vaccinated against HBV.

HCW who perform EPPs:

  • must take reasonable steps to know their BBV status and should be tested for BBVs at least once every 3 years
  • must declare when applying for renewal of registration that they are complying with, and have been tested in accordance with the national guidelines
  • should understand their obligation to report their BBV status, if required, under jurisdictional legislation and/or policies
  • should understand their obligation to report all sharps injuries, whether or not there was a risk of patient exposure.

HCW living with a BBV:

  • must have appropriate and ongoing medical care
  • must be tested for the BBV viral load levels, as well as for other BBVs, in accordance with the national guidelines
  • further information is provided below about testing requirements.

The national guidelines define exposure prone procedures (EPPs) as “procedures where there is a risk of injury to the healthcare worker resulting in exposure of the patient’s open tissues to the blood of the healthcare worker. These procedures include those where the healthcare worker’s 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 where the hands or fingertips may not be completely visible at all times.”

BBV testing requirements for HCWs who perform EPPs (CDNA 2018)

    1. Stops performing EPPs immediately
    2. If under care of specialist and viral load <200IU/mL (2 tests no less than 3 months apart)
    3. Resume EPPs (re-tested every 6 months if on treatment, 3 months if not on treatment)
    1. Stops performing EPPs immediately
    2. If under care of specialist, HCV negative (if untreated) or sustained virologic response (SVR) (measured 12 weeks after treatment completion)
    3. Resume EPPs (re-tested for BBVs according to guidelines)
    1. Stops performing EPPs immediately
    2. If under care of specialist, on effective cART and viral load <200 copies/mL (or elite controller)
    3. Resume EPPs (re-tested every 3 months)
    1. Continues to perform EPPs
    2. Re-tested for BBVs according to guidelines

Department of Health Expert Advisory Committee

Routine management of workers who perform exposure prone procedures is outlined in the national guidelines.

An Expert Advisory Committee (the Committee) has been established to:

  • provide expert advice where there is a complex situation or a dispute over the ability of a worker living with a blood borne virus to continue with all or part of their duties.
  • The worker must not perform exposure prone procedures pending advice of the Committee but is able to perform duties that do not include exposure prone procedures and practice within the infection control requirements of the Australian Guidelines for the Prevention and Control of Infection in Healthcare.
  • undertake an investigation or conduct a lookback exercise.

Referral to the Committee

Referral to the Committee should only be made after consultation with the guideline. Please use the referral checklist to help determine if the referral is appropriate.

Who may consult the Committee?

  • A designated representative of the employer of the infected worker.
  • The treating doctor of the infected worker or student.

In what circumstances?

Initial clearance for individual healthcare workers who have been previously excluded from work involving exposure prone procedures is the responsibility of the treating doctor. However, with more complex situations, the treating doctor may choose to consult with the Communicable Diseases Branch of the Department of Health, who may then also refer the request onto the Committee.

An example of a complex situation may include where other considerations apart from virological response are present and further advice may be required. These additional considerations include recency of practice, evidence of behaviour which could have affected the workers standard of practice, individual work variances etc.

How to refer to the Expert Advisory Committee

To make a referral to the Committee, email HCWBBVpanel@health.qld.gov.au or phone 07 3328 9754 during business hours, Monday to Friday.

Please do not include the healthcare worker’s name or any other identifying information relating to the healthcare worker with a BBV in the referral.

If the conduct of the healthcare worker places others or the public at risk, obligations related to notifying the Office of the Health Ombudsman or the Australian Health Practitioner Regulation Authority must be considered and is the responsibility of the referrer.

Supporting Documents

Last updated: 20 December 2023