Medicine Today Internal Medicine Webcast Series

Hepatitis C Management:

Management of Special Groups:
Healthcare Workers Exposed to HCV

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Key Points

  • Prophylactic therapy with immunoglobulins is not recommended following acute exposure to HCV.

  • Periodic monitoring after HCV exposure is recommended.

  • HCV-infected healthcare workers need not be restricted from performing invasive procedures, provided that comprehensive infection-control practices are in place.

Transmission of blood-borne pathogens poses a serious risk to healthcare workers. HCV is transmitted efficiently by a large exposure to blood, such as a transfusion from an infected donor. Overt percutaneous exposure to HCV has also been documented as a less efficient means of HCV transmission.

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Risk of Occupational Exposure to HCV

The risk of transmission of HCV appears to be related to the type and size of the inoculum, the route of transmission, and the titer of the virus. The average incidence of anti-HCV seroconversion after needlestick or exposure to contaminated sharp instruments from a known anti-HCV-positive source patient is 1.8% (range, 0% to 7%). HCV RNA can be detected in serum within days following exposure and several weeks before the onset of an increase in the ALT level.138 Anti-HCV may be detected within 5 to 6 weeks after the onset of infection.

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Institutional Protocols for Postexposure Management

The Centers for Disease Control and Prevention (CDC) recommends that individual health care institutions have in place written policies and procedures for follow-up for HCV infection after percutaneous or permucosal exposures to blood.7 These policies should begin with instructions to report the exposure. They should then call for baseline testing of the source patient for anti-HCV as well as testing of the exposed person for anti-HCV and for alanine aminotransferase activity at baseline and on a periodic follow-up basis. The policies also should provide for counseling of exposed healthcare workers to address their concerns, discuss likely outcomes, and explain treatment and management options.

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Postexposure Prophylaxis

There is no support for the use of immunoglobulins as postexposure prophylaxis for hepatitis C, and no controlled study has assessed the effectiveness of IFN or any other antiviral agent. Therefore, prophylactic therapy with IFN with or without ribavirin is not recommended.139 Instead, postexposure management involves follow-up testing (as outlined immediately above) to allow early identification of chronic HCV infection and, if present, referral for evaluation of treatment options (see "Management of Special Groups: Patients with Acute HCV Infection" later in this monograph).

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Guidance for HCV-Infected Health Care Workers

The CDC does not recommend that HCV-infected healthcare workers be restricted from performing invasive procedures, provided that standard infection-control practices are followed. The CDC recommends that surgeons, dentists, and others who perform invasive procedures follow good infection control practices to prevent transmission to and from their patients—eg, double-gloving during invasive procedures, wearing other appropriate protective barriers (gowns, masks), sterilizing and disinfecting all instruments, properly disposing of sharp instruments, and treating all bodily fluids as if they were infectious.7

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