Do all health care workers need to be routinely tested for hepatitis C?
May 2003
No. Currently, the assessed risk of transmission of hepatitis C from a healthcare worker of unknown hepatitis C status during exposure prone procedures (EPPs) is low and routine testing is not advised.
Department of Health guidelines for hepatitis C focus more specifically on health care workers performing EPPs. EPPs are those invasive procedures where there is a risk that injury to the worker may result in the exposure of the patient’s open tissues to the blood of the worker (bleed-back).
These include procedures where the worker’s gloved hands may be in contact with sharp instruments, needle tips and sharp tissues (such as 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 [Go to reference 1]
Department of Health guidelines on Hepatitis C infected Healthcare Workers issues guidelines to certain groups of doctors who may have become infected by the virus, as follows:
- Health care workers who know they have been infected with the virus and who carry out EPPs
Table 1 summarises the action that should be taken under various scenarios.
Table 1 – Guidelines for health care workers who know they have been infected with virus
| HCV status | Tests advised | Action |
| Has antibodies to the virus but HCV RNA statusunknown | Test for HCV RNA | If positive for HCV RNA restrict from EPPs and refer for specialist treatment |
| Known to be HCV RNA positive | No further tests advised. Refer for specialist treatment | Restrict from EPPs until successful response to treatment |
| Has antibodies to HCV but is HCV RNA negative | Retest for HCV RNA at 6 months after initial negative test | Can continue performing EPPs |
- Health care workers who perform EPPs and who may have been exposed to hepatitis C infection
Any HCW who performs EPPs and who believes that they may have been at risk of acquiring hepatitis C should promptly seek professional advice from their occupational health department.
The occupational health consultant should provide advice on whether testing for hepatitis C is appropriate and also discuss the implications of a positive test. This advice applies to both occupational and non-occupational exposure to the virus.
Major risk factors for hepatitis C
- Health care workers intending to begin professional training for a career that relies on the performance of EPPs
Department of Health guidelines state: ‘Health care workers intending to embark upon careers that rely upon the performance of exposure prone procedures should be tested for antibodies to hepatitis C virus, and if positive, for hepatitis C virus RNA. Those found to be hepatitis C virus RNA positive should not commence training for such careers unless they have a sustained virological response to treatment’.
This includes healthcare workers newly recruited or working in the NHS for the first time, including students.
1. Department of Health HIV Infected Health Care Workers (2002)