Management of HIV Infected Healthcare Workers (HCWs)

15/08/2014

This Healthwork alert will be most relevant to NHS trusts although other Healthwork clients may also find it of interest and relevance.

We are often asked to advise about the management of HIV infected health care workers particularly in relation to their fitness to perform Exposure Prone Procedures (EPP).  Recently, Public Health England have produced updated guidance  on this:
The Management of HIV infected Healthcare Workers who perform exposure prone procedures : updated Guidance, January 2014.  Public Health England Publications January 2014.  Downloadable at http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317140704390

Summary of Guidelines

Either

a) be on effective combination antiretroviral therapy (cART), and 
b) have a plasma viral load <200 copies/ml 

Or 

c) be an elite controller (see the guidelines for definition)

And 

d) be subject to plasma viral load monitoring every three months and 
e) be under joint supervision of a consultant OHP and their treating physician, and 
f) be registered with the UKAP Occupational Health Monitoring Register (UKAP-OHR) 

 

• For HIV infected HCWs new or returning to the NHS who wish to perform EPPs, two IVS (identified and validated samples) taken no less than 3 months apart and with viral loads below 200 copies/ml are required to ensure viral load stability.   
• HIV infected HCWs who are cleared to perform EPPs need to be monitored 3 monthly and can perform EPPs if the viral load remains below 200.  If the viral load rises above 200, the test needs repeating in 10 days and if still above 200, the HCW needs to be restricted from performing EPPs.  Any result over 1000 should lead to immediate cessation of performing EPPs.

Implications for Practice

1. NHS trusts should have policies in place for the management of HIV infected HCWs.
2. It is very important that all blood samples relating to HIV infected HCWs are processed as IVS (Identified and Validated Sample).    See footnote 5 of the guidelines.
3. 3 monthly blood testing of all HIV infected HCWs who perform EPPs should be done.
4. All HIV infected HCWs should be registered with the UKAP Occupational Health Monitoring Register (UKAP-OHR).

Healthwork can help and assist NHS trusts to develop policies to manage HIV infected HCWs.  Please contact us if you need any more information.