Journal of Clinical Virology 52 (2011) 4–10 Contents lists available at ScienceDirect Journal of Clinical Virology jo u r n al hom epage: www.elsevier.com/locate/jcv Review Blood-borne viruses in health care workers: Prevention and management S. Deuffic-Burban a,b,∗ , E. Delarocque-Astagneau c , D. Abiteboul d,e , E. Bouvet d,e , Y. Yazdanpanah a,b,d,f a ATIP-AVENIR, Inserm U995, Université Lille Nord de France, 152 rue du Docteur Yersin, 59120 Loos, France b EA2694, Université Lille Nord de France, 1 place de Verdun, 59045 Lille Cedex, France c Institut Pasteur, 25–28 rue du Dr Roux, 75724 Paris Cedex 15, France g d Groupe d’Etude sur le Risque d’Exposition au Sang (GERES), Université Paris Diderot – Paris 7, UFR de Médecine – site Bichat, 16 rue Henri Huchard, 75890 Paris Cedex 18, France h e Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75877 Paris, France i f Service des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, 135 rue du Président Coty, B.P. 619, 59208 Tourcoing, France j a r t i c l e i n f o Article history: Received 7 January 2011 Received in revised form 15 May 2011 Accepted 18 May 2011 Keywords: Blood-borne pathogens Infectious disease transmission Patient-to-professional Professional-to-patient Management risk Prevention and control a b s t r a c t Three pathogens account for most cases of occupationally acquired blood-borne infection: hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The highest proportion of occupational transmission is due to percutaneous injury (PI) via hollow-bore needles with vascular access. We briefly review prevention and management of blood-borne pathogens in health care workers (HCWs) in developed countries. HCW compliance with standard precautions is necessary for prevention of PI. Safety-engineered devices are now being increasingly promoted as an approach to decreasing the rate of PI. Prevention of HBV transmission requires HCW immunization through vaccination against HBV. In non-vaccinated HCWs (or HCWs with an unknown antibody response to vaccination) exposed to an HbsAg-positive or an untested source patient, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible. Although no available prophylaxis exists for HCV, it is crucial to identify HCV exposure and infection in health care settings and to consequently pro- pose early treatment when transmission occurs. Following occupational exposure with potential for HIV transmission, use of antiretroviral post-exposure prophylaxis must be evaluated. Patients need to be pro- tected from blood-borne pathogen-infected HCWs, and especially surgeons performing exposure-prone procedures (EPPs) with risk of transmission to the patient. However, HCWs not performing EPPs should be protected from arbitrary administrative decisions that would restrict their practice rights. Finally, it must be emphasized that occupational blood exposure is of great concern in developing countries, with higher risk of exposure to blood-borne viruses because of a higher prevalence of the latter than in devel- oped countries, re-use of needles and syringes and greater risk of sustaining PI, since injection routes are more frequently used for drug administration than in developed countries. © 2011 Elsevier B.V. All rights reserved. Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2. Occupational risk of exposure to and transmission of blood-borne pathogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 3. Preventing PI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 4. HBV vaccination of HCWs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 5. Management of HCWs exposed to blood-borne pathogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Abbreviations: ALT, alanine aminotransferase; HCW, health care worker; EPP, exposure-prone procedure; HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus; PI, percutaneous injury; PEP, post-exposure prophylaxis; SED, safety-engineered device. ∗ Corresponding author at: ATIP-AVENIR, Inserm U995, Université Lille Nord de France, 152 rue du Docteur Yersin, 59120 Loos, France. Tel.: +33 3 20 44 59 62/35128; fax: +33 3 20 96 86 62. E-mail addresses: sylvie.burban@neuf.fr (S. Deuffic-Burban), edelaroc@pasteur.fr (E. Delarocque-Astagneau), dominique.abiteboul@bch.aphp.fr (D. Abiteboul), elisabeth.bouvet@bch.aphp.fr (E. Bouvet), yyazdan@yahoo.com (Y. Yazdanpanah) . g Tel.: +33 1 40 61 37 66; fax: +33 1 45 68 88 76. h Tel.: +33 1 57 27 78 70; fax: +33 1 57 27 77 01. i Tel.: +33 1 40 25 80 80; fax: +33 1 40 25 83 05. j Tel.: +33 3 20 69 46 16; fax: +33 3 20 69 46 15. 1386-6532/$ – see front matter © 2011 Elsevier B.V. All rights reserved. doi:10.1016/j.jcv.2011.05.016