Hepatitis C Virus (HCV): Protecting Employees and Patients
Version
4
Name of responsible (ratifying) committee
Health and Safety Committee
Date ratified
25 February 2015
Document Manager (job title)
Consultant Occupational Health Physician
Date issued
09 March 2015
Review date
28 February 2018
Electronic location
Health and Safety policies
Related Procedural Documents
Hepatitis B Virus: Protecting Employees & Patients;
HIV infected health care workers. Guidance on
management & patient notification; Prevention and
Management of Needlestick Injuries & Contamination
Incidents
Key Words (to aid with searching)
Occupational health; exposure prone procedure; preemployment health assessment; hepatitis C virus
Version Tracking
Version
Date Ratified
Brief Summary of Changes
Author
4
25.02.2015
No material changes to policy.
Dr S Harvey.
Hepatitis C Virus (HCV): Protecting Employees and Patients
Version: 4
Issue Date: 09 March 2015
Review date: 28 February 2018 (unless requirements change)
Page 1 of 8
CONTENTS
Quick Reference Guide…………………………………………………………….page 3
1. Introduction…………………………………………………………………………..page 4
2. Purpose……………………………………………………………………………….page 4
3. Scope………………………………………………………………………………....page 4
4. Definitions…………………………………………………………………………….page 4
5. Duties and responsibilities……………………………………………………………page 5
6. Process………………………………………………………………………………..page 6
7. Training requirements………………………………………………………………..page 6
8. References and associated documents…………………………………………….page 7
9. Equality Impact Statement………………………………………………….………page 7
10. Monitoring Compliance………………………………………………………….. page 8
Hepatitis C Virus (HCV): Protecting Employees and Patients
Version: 4
Issue Date: 09 March 2015
Review date: 28 February 2018 (unless requirements change)
Page 2 of 8
QUICK REFERENCE GUIDE
For quick reference the guide below is a summary of actions required. This does not negate the need
for the document author and others involved in the process to be aware of and follow the detail of this
policy.
1. Hepatitis C virus (HCV) is a blood borne virus which causes inflammation of the liver. Many
people who are infected have no symptoms and are unaware that they are carrying the virus.
2. Following Department Health recommendations in 2007 and as part of the Work Health
Assessment process carried out by Occupational Health, HCV is screened for in Healthcare
Workers (HCW) who are new to the NHS and who will be performing Exposure Prone
Procedures (EPP) or new to (EPP).
3. For HCW who commenced their post prior to 2007 the requirements are that those who know
that they are carriers of HCV must refrain from EPP; those with hepatitis C antibodies must be
tested for HCV RNA; those intending to undertake professional training for a career that relies
upon the performance of EPP must be tested for HCV, and those who perform EPP and who
believe they could have been exposed to HCV must seek professional advice on whether
they should be tested.
4. Employment restrictions are required for HCW who are carriers of HCV and who wish to
perform EPP. HCW who are treated for HCV with appropriate anti-viral medication and who
remain hepatitis C virus RNA negative 6 months after cessation of treatment will be allowed to
return to performing EPP at that time. As a further check, they must be shown still to be RNA
negative 6 months later.
5. Transmission of HCV can occur in the occupational setting e.g. after Needlestick injury from
an infected source patient. It is therefore essential that all Needlestick injuries and
contamination incidents are managed as per the Trust policy on the correct management of
Needlestick injuries and contamination incidents.
6. In the occupational setting, general measures to prevent infection from HCV, as well as other
blood borne viruses such as hepatitis B and HIV, include: use of personal protective
equipment (gloves, face visors etc.) to minimise exposure to blood or body fluids; safe
handling and disposal of sharps and good adherence to appropriate hand hygiene policies.
7. With regard to Patient Notification exercises: whenever a transmission of HCV from an
infected HCW to a patient is detected, notification of other patients of that HCW who have
undergone EPP, with the offer of serological testing, should normally follow. The UK Advisory
Panel for Healthcare Workers Infected with Blood-borne Viruses (UKAP) should be
approached for advice whenever patient notification is being considered, and before
preparations for such an exercise are put in place.
Hepatitis C Virus (HCV): Protecting Employees and Patients
Version: 4
Issue Date: 09 March 2015
Review date: 28 February 2018 (unless requirements change)
Page 3 of 8
1. INTRODUCTION
Hepatitis C virus is a blood borne virus which causes inflammation of the liver. Many people
who are infected have no symptoms and are unaware that they are carrying the virus. The
World Health Organization estimates that there are 170 million carriers of HCV worldwide. The
United Kingdom is considered to be a relatively low prevalence country with a prevalence of
chronic hepatitis C infection in England of around 0.4%.
Today, injecting drug use is the most common way to acquire HCV. Individuals who inject
drugs acquire their infections when they share contaminated injecting equipment. In the UK
blood donations have been screened for HCV since September 1999, but prior to this, and in
countries that do not screen donor blood, it was possible to acquire the virus through
contaminated blood transfusions.
HCV can also be acquired during body piercing, tattooing, and acupuncture if sterile needles
are not used. The risk of sexual transmission is relatively rare.
Transmission can occur in the occupational setting e.g. after Needlestick injury from a
contaminated source patient.
There is no vaccine available to prevent HCV infection. Treatment can be undertaken with a
combination of interferon and ribavirin. Employment restrictions are required for HCW who are
carriers of HCV and who wish to EPP.
In the occupational setting, general measures to prevent infection from HCV, as well as other
blood borne viruses such as hepatitis B and HIV, include: use of personal protective equipment
(gloves, face visors etc) to minimise exposure to blood or body fluids; safe handling and
disposal of sharps and good adherence to appropriate hand hygiene policies.
2. PURPOSE
This policy has been developed to inform the Trust’s employees of the background and risks of
hepatitis C virus infection in the workplace and the requirements needed in terms of safe
working and the protection of staff and patients.
3. SCOPE
This policy applies to all staff of Portsmouth Hospitals NHS Trust, the MDHU (Portsmouth) and
Carillion, including bank, agency and locum, whilst acknowledging for staff other than those of
the Trust the appropriate line management or chain of command will be followed. Whilst the
policy outlines how the Trust will manage hepatitis C in employees, implementation does not
replace the personal accountability of all staff in this regard.
‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises
that it may not be possible to adhere to all aspects of this document. In such circumstances,
staff should take advice from their manager and all possible action must be taken to
maintain ongoing patient and staff safety’
4. DEFINITIONS
HCV: hepatitis C virus
HIV: Human Immunodeficiency virus
Health Care Worker (HCW): Includes all staff working in hospitals and primary care who have
direct patient contact, e.g. domestics on wards, some catering staff, ambulance staff, some
reception and clerical staff, as well as medical and nursing staff.
Exposure Prone Procedures (EPP): 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 or sharp tissues (e.g. spiccules 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. Other situations, such as pre-hospital trauma care
should be avoided by health care workers restricted from performing exposure prone
Hepatitis C Virus (HCV): Protecting Employees and Patients
Version: 4
Issue Date: 09 March 2015
Review date: 28 February 2018 (unless requirements change)
Page 4 of 8
procedures, as they could also result in the exposure of the patient’s open tissue to the blood of
the worker.
Non-exposure Prone Procedures: where the hands and finger tips of the worker are visible
and outside the patient’s body at all times, and internal examinations or procedures that do not
involve possible injury to the worker’s gloved hands from sharp instruments and/or tissues, are
considered not to be exposure prone provided routine infection control procedures are adhered
to at all times.
Examples of non-EPP:
 Taking blood
 Setting up and maintaining intravenous lines or central lines (provided any skin
tunneling procedure used for the latter is performed in a non-exposure prone manner)
 Minor surface suturing
 Incision of external abscesses
 Routine vaginal or rectal examinations
 Simple endoscopic procedures
Obstetric/ intrapartum care:
Normal vaginal delivery in itself is not an Exposure Prone Procedure but an infected health care
worker must not perform procedures involving the use of sharp instruments such as infiltrating
local anaesthetic or suturing of a tear or episiotomy, since the fingertips may not be visible at all
times. Neither can they perform an instrumental delivery requiring forceps or suction if
infiltration of local anaesthetic or internal suturing is required.
Renal Dialysis/ Transplantation Units
Activities undertaken on renal units are not regarded as EPP. However the possibility of
transmission of Hepatitis B virus cannot be entirely ruled out. Therefore HCW who are HBeAg
positive or HBeAg negative with a hepatitis B virus DNA level exceeding 10³ genome
equivalents per ml should not undertake clinical duties on renal units. HIV and HCV infected
HCWs may continue to perform clinical duties on renal units.
5. DUTIES AND RESPONSIBILITIES
Trust Board and Executive Directors
The Trust Board and Executive Directors are responsible for effective risk management within
the Trust and recognise the need for appropriate prevention and management of hepatitis C in
employees in the organisation.
Line Managers
Line Managers are responsible for ensuring that hepatitis C infected staff are managed
appropriately as set out in this policy and that staff attend Occupational Health as required after
the pre—placement work health assessment process.
Occupational Health Department: responsible for:
 Ensuring HCV risks to employees and patients are managed appropriately as set out in
the Process section of this policy
 Giving health clearance for EPP work after the pre-placement Work health Assessment
process and for the administration of all relevant and required immunisations or other
processes
Healthcare Workers: have ethical and legal obligations to take all proper steps to safeguard
the interests of their patients and this includes ensuring all appropriate steps are taken to
protect patients from transmission of infection; HCW must ensure that they are safe to practice
and must inform Occupational Health in confidence if they believe they may be carriers of any
blood borne virus, including HCV. Blood exposure incidents to both HCW and patients must be
Hepatitis C Virus (HCV): Protecting Employees and Patients
Version: 4
Issue Date: 09 March 2015
Review date: 28 February 2018 (unless requirements change)
Page 5 of 8
managed appropriately as set out in the relevant Trust policy (Prevention and Management of
Needlestick (‘sharps’) Injuries and Contamination Incidents).
6. PROCESS
In March 2007, it became a requirement of the Department of Health that HCW who are new to
the NHS and who will perform EPP, and existing HCW who are new to EPP, are required to
have HIV and HCV screening blood tests in addition to the standard pre-employment health
checks.
For HCW who commenced their post prior to 2007 the requirements are that those who know
that they are carriers of HCV must refrain from EPP; those with hepatitis c antibodies must be
tested for HCV RNA; those intending to undertake professional training for a career that relies
upon the performance of EPP must be tested for HCV, and those who perform EPP and who
believe they could have been exposed to HCV must seek professional advice on whether they
should be tested.
The blood tests will be carried out by Occupational Health with appropriate pre test discussion
and consent. Employees with positive HCV antibody tests will be further tested for ongoing
HCV carrier status in the blood. HCW with confirmed on-going carrier status (hepatitis C virus
RNA positive) will be restricted from performing EPP.
HCW who are treated for HCV with appropriate anti-viral medication and who remain hepatitis
C virus RNA negative 6 months after cessation of treatment will be allowed to return to
performing EPP at that time. As a further check, they must be shown still to be RNA negative 6
months later.
Blood tests for hepatitis B, HCV and HIV must be Identified Validated Samples (IVS) i.e. the
HCW must show proof of identity with a photograph (e.g. Trust ID card, new drivers license,
passport) when the sample is taken; blood should be taken in the occupational health
department and be delivered to the lab in usual way (i.e. not carried by the HCW).
Managers and recruitment personnel will be informed of employees who are not cleared to
perform EPP, although the specific reason may not be given, if requested by the employee.
HCW who apply for a post or training which may involve EPP and who decline to be tested for
HIV, hepatitis B and HCV will not be cleared to perform these procedures.
Occupational Health will refer HCV infected HCW to their General Practitioners for onward
referral to a liver specialist for clinical assessment and treatment where indicated, since there is
evidence to suggest that early treatment of acute hepatitis C infection may prevent chronic
hepatitis C infection.
With regard to Patient Notification exercises: whenever a transmission of HCV from an infected
HCW to a patient is detected, notification of other patients of that HCW who have undergone
EPP, with the offer of serological testing, should normally follow. Most new infections with HCV
are asymptomatic. It has yet to be determined whether there is a need for patient notification
exercises when a HCV carrier HCW is identified in the absence of evidence of transmission.
Until more precise indications for patient notification in this situation can be defined, the UK
Advisory Panel for Healthcare Workers Infected with Blood-borne Viruses (UKAP) should be
approached for advice whenever patient notification is being considered, and before
preparations for such an exercise are put in place.
7. TRAINING REQUIREMENTS
The Occupational Health Department provides relevant training on prevention and
management of blood borne viruses, including hepatitis C infection, at staff and junior doctor
Hepatitis C Virus (HCV): Protecting Employees and Patients
Version: 4
Issue Date: 09 March 2015
Review date: 28 February 2018 (unless requirements change)
Page 6 of 8
inductions and by provision of leaflets and written information during pre-placement work health
assessments.
Training in hand hygiene, use of personal protective equipment, safe handling and disposal of
sharps and reporting of Needlestick injuries is provided in Health and Safety and Infection
Control regular training packages and updates.
8. REFERENCES AND ASSOCIATED DOCUMENTATION
Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New healthcare workers.
London: Department of Health, March 2007.
Hepatitis C Infected Care Workers: Health Service Circular; HSC 2002/010. London:
Department of Health, 14 August 2002.
Hepatitis C Infected Health Care Workers. Department of Health, August 2002.
Guidance for Clinical Healthcare Workers: Protection against Infection with Blood-born Viruses.
London: UK Health Departments, 1998.
9. EQUALITY IMPACT STATEMENT
Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably
practicable, the way we provide services to the public and the way we treat our staff reflects
their individual needs and does not discriminate against individuals or groups on any grounds.
This policy has been assessed accordingly
Our values are the core of what Portsmouth Hospitals NHS Trust is and what we cherish. They
are beliefs that manifest in the behaviours our employees display in the workplace.
Our Values were developed after listening to our staff. They bring the Trust closer to its vision
to be the best hospital, providing the best care by the best people and ensure that our patients
are at the centre of all we do.
We are committed to promoting a culture founded on these values which form the ‘heart’ of our
Trust:
Respect and dignity
Quality of care
Working together
No waste
This policy should be read and implemented with the Trust Values in mind at all times.
Hepatitis C Virus (HCV): Protecting Employees and Patients
Version: 4
Issue Date: 09 March 2015
Review date: 28 February 2018 (unless requirements change)
Page 7 of 8
10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS
Minimum
requirement
to be
monitored
Lead
Tool
Compliance
with preplacement
health
assessment
Consultant
OH
physician
Audit of
Occupational
Health notes
Compliance
with correct
management of
Needlestick
injuries
Consultant
OH
physician
Audit of
Occupational
Health notes
Frequency of Report
of Compliance
Reporting
arrangements
Lead(s) for acting on
Recommendations
Annually
Occupational Health
Team
Consultant OH physician.
Annually
Occupational Health
Team
Consultant OH physician.
This document will be monitored to ensure it is effective and to assurance
compliance.
Hepatitis C Virus (HCV): Protecting Employees and Patients
Version: 4
Issue Date: 09 March 2015
Review date: 28 February 2018 (unless requirements change)
Page 8 of 8