Letter in Response to the New SHEA Guideline for Healthcare Workers with Hepatitis B Virus, Hepatitis C Virus, and/or Human Immunodeficiency Virus; Saag, et al, Infection Control and Hospital Epidemiology, Vol. 31, No. 10 (October 2010)

The Society for Healthcare Epidemiology of America (SHEA) revised their guidelines for the Management of Health Workers Who are Infected with Hepatitis B Virus, Hepatitis C Virus, and/or Human Immunodeficiency Virus, which are designed to help ensure patient safety. In response to these changes, the Executive Committee of the HIV Medicine Association (HIVMA) expressed both praise and concern. The guidelines stipulate that only healthcare workers living with “well-managed” HIV can perform invasive procedures, and only if they meet strict criteria including signing an explicit contract. HIVMA argues that in addition to creating a narrow pathway of opportunity for people with HIV, it leaves room for legal complications, tenuous work environments, and discriminatory policies; all of which will have negative implications for both workers and patients.  HIVMA encouraged SHEA to amend their guidelines to align with universal precautions and existing transmission data. HIVMA recommended SHEA also include a statute of personal responsibility that can be held to all health care workers, making each person responsible for their own health status.

The response from SHEA explains that while they agree to allow “virologically suppressed” health care workers to perform invasive procedures, additional measures beyond universal precautions are necessary to ensure the well-being of patients. SHEA supports an approach they cite as commonplace across the health care industry, in which discussion includes the worker, their physician, and key hospital experts. SHEA states that the conditions surrounding each health care worker are unique and warrant a case-by-case review. SHEA insists that their guidelines are far more progressive than those of the United States Public Health Service, which require patient notification, and bar health care workers living with HIV or Hepatitis B from performing many tasks and procedures. SHEA notes that the kind of evidence HIVMA suggests be used to form guidelines does not currently exist and guidelines similar to theirs have been effectively implemented across the country.