Skip to main content Accessibility help
Hostname: page-component-768dbb666b-tcprc Total loading time: 0.66 Render date: 2023-02-03T23:22:20.778Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

SHEA Guideline for Management of Healthcare Workers Who Are Infected with Hepatitis B Virus, Hepatitis C Virus, and/or Human Immunodeficiency Virus

Published online by Cambridge University Press:  02 January 2015

David K. Henderson*
National Institutes of Health Clinical Center, Bethesda, Maryland
Louise Dembry
Department of Quality Improvement Support Services, Yale–New Haven HospitalNew Haven, Connecticut
Neil O. Fishman
Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Christine Grady
Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland
Tammy Lundstrom
Section of Infectious Diseases, Providence Hospitaland Medical Center, Southfield, Detroit, Michigan
Tara N. Palmore
Infectious Disease Fellowship Training Program, National Institutes of Health Clinical Center, Bethesda, Maryland
Kent A. Sepkowitz
Infectious Diseases Service, Memorial Sloan-Kettering Cancer Center, New York, New York
David J. Weber
Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
Deputy Director for Clinical Care, Clinical Center, National Institutes of Health, Bldg. 10, Rm. 6-1480, 10 Center Dr., MSC 1504, Bethesda, MD 20892-1504 (


This guideline provides the updated recommendations of the Society for Healthcare Epidemiology of America (SHEA) regarding the management of healthcare providers who are infected with hepatitis B virus (HBV), hepatitis C virus (HCV), and/or the human immunodeficiency virus (HIV). For the reasons cited in the guideline, SHEA continues to recommend that, although some aspects of the approach to and administrative management of each of these infectious syndromes in healthcare providers are similar, separate management strategies for healthcare workers who are infected with these unrelated viruses remain appropriate. As we did in both prior iterations of this document, SHEA emphasizes the use of appropriate infection control procedures to minimize exposure of patients or providers to blood, emphasizes that transfers of blood from patients to providers and from providers to patients should be avoided, and recommends that infected healthcare providers should not be totally prohibited from participating in patient-care activities solely on the basis of a bloodborne pathogen infection. The types of procedures assessed by the panel as associated with an increased risk for provider-to-patient transmission of these pathogens are discussed in detail. For each pathogen, recommendations are graduated according to the relative viral load level of the infected provider (Tables 1 and 2). However, SHEA emphasizes that, because of the complexity of these cases, each such case will be slightly different from the next, and each should be independently considered in context.

SHEA Guideline
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


1.Reitsma, AM, Closen, ML, Cunningham, M, et al.Infected physicians and invasive procedures: safe practice management. Clin Infect Dis 2005;40:16651672.CrossRefGoogle Scholar
2.Kohn, WG; Collins, AS, Cleveland, JL, Harte, JA, Eklund, KJ, Malvitz, DM. Guidelines for infection control in dental health-care settings–2003. MMWR Recomm Rep 2003;52:161.Google Scholar
3.Centers for Disease Control and Prevention. Possible transmission of human immunodeficiency virus to a patient during an invasive dental procedure. MMWR Morb Mortal Wkly Rep 1990;39:489493.Google Scholar
4.Centers for Disease Control and Prevention. Update: Transmission of HIV infection during an invasive dental procedure—Florida. MMWR Morb Mortal Wkly Rep 1991;40:2133.Google Scholar
5.Centers for Disease Control and Prevention. Update: investigations of patients who have been treated by HIV-infected health care workers. MMWR Morb Mortal Wkly Rep 1992;41:344346.Google Scholar
6.Ciesielski, C, Marianos, D, Ou, C-Y, et al.Transmission of human immunodeficiency virus in a dental practice. Ann Intern Med 1992;116:798805.CrossRefGoogle Scholar
7.Ciesielski, CA, Bell, DM, Marianos, DW. Transmission of HIV from infected health-care workers to patients. AIDS 1991;5:S93S97.CrossRefGoogle ScholarPubMed
8.Ou, CY, Ciesielski, CA, Myers, G, et al.Molecular epidemiology of HIV transmission in a dental practice. Science 1992;256:11652271.CrossRefGoogle Scholar
9.Rhame, FS, Pitt, H, Tapper, ML, et al.Position paper: The HIV-infected health care worker. Infect Control Hosp Epidemiol 1990;11:647656.Google Scholar
10.Henderson, DK, The AIDS/Tuberculosis Subcommittee of the Society for Healthcare Epidemiology of America. Management of healthcare workers infected with hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or other bloodborne pathogens. AIDS/TB Committee of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 1997;18:349363.Google Scholar
11.Bell, D, Shapiro, CN, Chamberland, ME, CA, C. Preventing bloodborne pathogen transmission from health-care workers to patients: the CDC perspective. Surg Clin North Am 1995;75:11891203.CrossRefGoogle ScholarPubMed
12.Harpaz, R, Von Seidlein, L, Averhoff, FM, et al.Transmission of hepatitis B virus to multiple patients from a surgeon without evidence of inadequate infection control. N Engl J Med 1996;334:549554.CrossRefGoogle ScholarPubMed
13.Johnston, B, Langille, D, LeBlanc, J, et al.Transmission of hepatitis B related to orthopedic surgery [abstract]. Infect Control Hosp Epidemiol 1994;15:352.Google Scholar
14.Incident Investigation Teams and others. Transmission of hepatitis B to patients from four infected surgeons without hepatitis B e antigen. N Engl J Med 1997;336:178184.CrossRefGoogle ScholarPubMed
15.Laurenson, IF, Jones, DG, Hallam, NF, Saunders, CJ, Fraser, DM, Carman, WF. Transmission of hepatitis B virus from a vaccinated healthcare worker. J Hosp Infect 2007;66:393394.CrossRefGoogle ScholarPubMed
16.Hepatitis B Outbreak Investigation Team. An outbreak of hepatitis B associated with reusable subdermal electroencephalogram electrodes. CMAJ 2000;162:11271131.Google ScholarPubMed
17.Alter, MJ. Healthcare should not be a vehicle for transmission of hepatitis C virus. J Hepatol 2008;48:24.CrossRefGoogle Scholar
18.Bosch, X. Hepatitis C outbreak astounds Spain. Lancet April 8, 2005.Google Scholar
19.Brown, P. Surgeon infects patient with hepatitis C. BMJ (Clinical research ed.) 1999;319(7219):1219.CrossRefGoogle ScholarPubMed
20.Cody, SH, Nainan, OV, Garfein, RS, et al.Hepatitis C virus transmission from an anesthesiologist to a patient. Arch Intern Med 2002;162:345350.CrossRefGoogle ScholarPubMed
21.Duckworth, GJ, Heptonstall, J, Aitken, C. Transmission of hepatitis C virus from a surgeon to a patient. The Incident Control Team. Commun Dis Public Health 1999;2:188192.Google ScholarPubMed
22.Esteban, JI, Gomez, J, Martell, M, et al.Transmission of hepatitis C virus by a cardiac surgeon. N Engl J Med 1996;334:555560.CrossRefGoogle ScholarPubMed
23.Public Health Laboratory Service. Hepatitis C transmission from health care worker to patient. Commun Dis Rep CDR Wkly 1995;5:121.Google ScholarPubMed
24.Public Health Laboratory Service. Transmission of hepatitis C virus from surgeon to patient prompts lookback. Commun Dis Rep CDR Wkly 1999;9:387.Google ScholarPubMed
25.Public Health Laboratory Service. Hepatitis C lookback exercise. Commun Dis Rep CDR Wkly 2000;10:203, 206.Google ScholarPubMed
26.Public Health Laboratory Service. Two hepatitis C lookback exercises—national and in London. Commun Dis Rep CDR Wkly 2000;10:125, 128.Google Scholar
27. Hepatitis C lookback in two trusts in the south of England. Public Health Laboratory Service, 2002. Accessed November 14, 2002.Google Scholar
28.Ross, RS, Viazov, S, Roggendorf, M. Phylogenetic analysis indicates transmission of hepatitis C virus from an infected orthopedic surgeon to a patient. J Med Virol 2002;66:461467.CrossRefGoogle ScholarPubMed
29.Ross, RS, Viazov, S, Thormahlen, M, et al.Risk of hepatitis C virus transmission from an infected gynecologist to patients: results of a 7-year retrospective investigation. Arch Intern Med 2002;162:805810.CrossRefGoogle ScholarPubMed
30.Williams, IT, Perz, JF, Bell, BP. Viral hepatitis transmission in ambulatory health care settings. Clin Infect Dis 2004;38:15921598.CrossRefGoogle ScholarPubMed
31.Mawdsley, J, Teo, CG, Kyi, M, Anderson, M. Anesthetist to patient transmission of hepatitis C virus associated with non exposure-prone procedures. J Med Virol 2005;75:399401.CrossRefGoogle Scholar
32.Shemer-Avni, Y, Cohen, M, Keren-Naus, A, et al.Iatrogenic transmission of hepatitis C virus (HCV) by an anesthesiologist: comparative molecular analysis of the HCV-E1 and HCV-E2 hypervariable regions. Clin Infect Dis 2007;45:e32e38.CrossRefGoogle ScholarPubMed
33.Public Health Laboratory Service. New guidelines on post exposure prophylaxis for HIV. Commun Dis Rep CDR Wkly 2000;10:311, 314.Google ScholarPubMed
34.Pugliese, G. Data lacking for postexposure prophylaxis with immune serum globulin following HCV exposure. Infect Control Hosp Epidemiol 1994;15:212.Google Scholar
35.Pugliese, G, Favero, MS. Healthcare Worker-to-Patient Transmission of HCV in the UK. Infect Control Hosp Epidemiol 2000;21:619.Google Scholar
36.Ross, RS, Viazov, S, Gross, T, Hofmann, F, Seipp, HM, Roggendorf, M. Transmission of hepatitis C virus from a patient to an anesthesiology assistant to five patients. N Engl J Med 2000;343:18511854.CrossRefGoogle Scholar
37.Sehulster, L, Taylor, J, Hendricks, K, VanEgdom, M, Whitely, S, Manning, S. Hepatitis C outbreak linked to narcotic tampering in an ambulatory surgical center. In: Proceedings of the Interscience Conference on Antimicrobial Agents and Chemotherapy; 1997. Washington, D.C.: American Society for Microbiology; 1997:293.Google Scholar
38.Centers for Disease Control and Prevention. Transmission of hepatitis C virus infection associated with home infusion therapy for hemophilia. MMWR Morb Mortal Wkly Rep 1997;46:597599.Google ScholarPubMed
39.Williams, IT, Perz, JF, Bell, BP. Hepatitis C virus transmission from healthcare workers to patients in the United States [abstract]. J Clin Virol 2006;36:S43S44.CrossRefGoogle Scholar
40.Bosch, X. Newspaper apportions blame in Spanish hepatitis C scandal. Lancet 2000;355:818.CrossRefGoogle ScholarPubMed
41.Astagneau, P, Lot, F, Bouvet, E, et al.Lookback investigation of patients potentially exposed to HIV type 1 after a nurse-to-patient transmission. Am J Infect Control 2002;30:242245.CrossRefGoogle ScholarPubMed
42.Blanchard, A, Ferris, S, Chamaret, S, Guetard, D, Montagnier, L. Molecular evidence for nosocomial transmission of human immunodeficiency virus from a surgeon to one of his patients. J Virol 1998;72:45374540.Google ScholarPubMed
43.Bosch, X. Second case of doctor-to-patient HIV transmission. Lancet Infect Dis 2003;3:261.CrossRefGoogle ScholarPubMed
44.Goujon, CP, Schneider, VM, Grofti, J, et al.Phylogenetic analyses indicate an atypical nurse-to-patient transmission of human immunodeficiency virus type 1. J Virol 2000;74:25252532.CrossRefGoogle ScholarPubMed
45.Lot, F, Seguier, JC, Fegueux, S, et al.Probable transmission of HIV from an orthopedic surgeon to a patient in France. Ann Intern Med 1999;130:16.CrossRefGoogle ScholarPubMed
46.Armstrong, FP, Miner, JC, Wolfe, WH. Investigation of a health care worker with symptomatic human immunodeficiency virus infection: an epidemiological approach. Military Medicine 1987;152:414418.Google Scholar
47.Centers for Disease Control and Prevention. Update: Investigations of persons treated by HIV-infected health-care workers—United States. MMWR Morb Mortal Wkly Rep 1993;42:329331.Google ScholarPubMed
48.Danila, RN, MacDonald, KL, Rhame, FS, et al.A look-back investigation of patients of an HIV-infected physician: public health implications. N Engl J Med 1991;325:14061411.CrossRefGoogle ScholarPubMed
49.Dickinson, GM, Morhart, RE, Klimas, NG, Bandea, CI, Laracuente, JM, Bisno, AL. Absence of HIV transmission from an infected dentist to his patients: an epidemiologic and DNA sequence analysis. JAMA 1993;269:18021806.CrossRefGoogle ScholarPubMed
50.Mishu, B, Schaffner, W, Horan, JM, Wood, LH, Hutcheson, RH, McNabb, PC. A surgeon with AIDS: lack of evidence of transmission to patients. JAMA 1990;264:467470.CrossRefGoogle ScholarPubMed
51.Porter, JD, Cruickshank, JG, Gentle, PH, Robinson, RG, Gill, ON. Management of patients treated by surgeon with HIV infection. Lancet 1990;335:113114.CrossRefGoogle ScholarPubMed
52.Pretty, IA, Anderson, GS, Sweet, DJ. Human bites and the risk of human immunodeficiency virus transmission. Am J Forensic Med Pathol 1999;20:232239.CrossRefGoogle ScholarPubMed
53.Robert, LM, Chamberland, ME, Cleveland, JL, et al.Investigations of patients of health care workers infected with HIV: the Centers for Disease Control and Prevention database. Ann Intern Med 1995;122:653657.CrossRefGoogle ScholarPubMed
54.Rogers, AS, Froggatt, JW, Townsend, T, et al.Investigation of potential HIV transmission to the patients of an HIV-infected surgeon. JAMA 1993;269:17951801.CrossRefGoogle ScholarPubMed
55.Sacks, JJ. AIDS in a surgeon. N Engl J Med 1985;313:10171018.Google Scholar
56.Mascioli, SR. More on AIDS in a surgeon. N Engl J Med 1986;314:1190.Google Scholar
57.von Reyn, CF, Gilbert, TT, Shaw, FE Jr, Parsonnet, KC, Abramson, JE, Smith, MG. Absence of HIV transmission from an infected orthopedic surgeon: a 13-year look-back study. JAMA 1993;269:18071811.CrossRefGoogle ScholarPubMed
58.Chant, K, Lowe, D, Rubin, G, et al.Patient-to-patient transmission of HIV in private surgical consulting rooms. Lancet 1993;342:15481549.CrossRefGoogle ScholarPubMed
59.Alter, HJ. Hepatitis B and the health worker: prospective studies in perspective. Ann Intern Med 1976;85:971972.CrossRefGoogle ScholarPubMed
60.Alter, HJ, Chalmers, TC. The HBsAg Positive health worker revisited. Hepatology 1981;1:467370.CrossRefGoogle ScholarPubMed
61.Alter, HJ, Chalmers, TC, Freeman, BM, et al.Health-care workers positive for hepatitis B surface antigen: are their contacts at risk? N Engl J Med 1975;292:454457.CrossRefGoogle ScholarPubMed
62.Meyers, J, Stamm, W, Kwerr, M, Counts, GW. Lack of transmission of hepatitis B after surgical exposure. JAMA 1978;240:17251727.CrossRefGoogle ScholarPubMed
63.Williams, S, Pattison, C, Berquist, KR. Dental infection with hepatitis B. JAMA 1975;232:12311233.CrossRefGoogle ScholarPubMed
64.Campos, J, Gonzalez, A, Esteban, JI, Genesca, J, Esteban, R, Guardia, J. Towards zero risk of posttransfusion hepatitis with 2nd generation anti-HCV screening of blood donors (abstract 413). Hepatology 1994;20:200A.Google Scholar
65.Henderson, DK. Managing occupational risks for hepatitis C transmission in the healthcare setting. Clin Microbiol Rev 2003;16:546568.CrossRefGoogle Scholar
66. New guidance on hepatitis C infected health care workers. Public Health Laboratory Service, 2002. Accessed November 15, 2002.Google Scholar
67.Robert, LM, Bell, DM. HIV transmission in the health-care setting. Risks to health-care workers and patients. Infect Dis Clin North Am 1994;8:319329.Google Scholar
68.Seeff, LB, Wright, EC, Zimmerman, HJ, Alter, HJ, et al.Type B hepatitis after needlestick exposure: prevention with hepatitis B immune globulin: final report of the Veterans' Administration Cooperative Study. Ann Intern Med 1978;88:285293.CrossRefGoogle Scholar
69.Werner, BJ, Grady, GF. Accidental hepatitis-B-surface-antigen–positive inoculations: use of “e” antigen to estimate infectivity. Ann Intern Med 1982;97:367369.CrossRefGoogle ScholarPubMed
70.Henderson, DK. Human immunodeficiency virus in the healthcare setting. In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. New York, NY: Elsevier; 2010: in press.Google Scholar
71.Gerberding, JL, Littell, C, Tarkington, A, Brown, A, Schecter, WP. Risk of exposure of surgical personnel to patients' blood during surgery at San Francisco General Hospital. N Engl J Med 1990;322:17881793.CrossRefGoogle ScholarPubMed
72.Gerberding, JL, Ramiro, N, Perlman, J, Rose, D. Intraoperative blood exposures at San Francisco General Hospital: provider injuries and patient recontacts. In: Program and abstracts of the 31st Annual Meeting of the Infectious Diseases Society of America; New Orleans, Louisiana; 1993.Google Scholar
73.Gerberding, JL, Rose, DA, Ramiro, NZ, Perlman, JL, Schecter, WP. Intra-operative provider injuries and potential patient recontacts at San Francisco General Hospital [abstract]. Infect Control Hosp Epidemiol 1994;15:20.Google Scholar
74.Lowenfels, AB, Mehta, V, Levi, DA, Montecalvo, MA, Savino, JA, Wormser, GP. Reduced frequency of percutaneous injuries in surgeons: 1993 versus 1988. AIDS 1995;9:199202.CrossRefGoogle ScholarPubMed
75.Lowenfels, AB, Wormser, GP. Frequency of puncture injuries in surgeons and estimated risk of HIV infection. Arch Surg 1989;124:12841286.CrossRefGoogle ScholarPubMed
76.Panlilio, AL, Foy, DR, Edwards, JR, et al.Blood contacts during surgical procedures. JAMA 1991;265:15331537.CrossRefGoogle ScholarPubMed
77.Panlilio, AL, Welch, BA, Bell, DM, et al.Blood and amniotic fluid contact sustained by obstetric personnel during deliveries. Am J Obstet Gynecol 1992;167:703708.CrossRefGoogle ScholarPubMed
78.Popejoy, SL, Fry, DE. Blood contact and exposure in the operating room. Surg Gynecol Obstet 1991;172:480483.Google Scholar
79.Tokars, JI, Bell, DM, Culver, DH, et al.Percutaneous injuries during surgical procedures. JAMA 1992;267:28992904.CrossRefGoogle ScholarPubMed
80.Elder, A, Paterson, C. Sharps injuries in UK health care: a review of injury rates, viral transmission and potential efficacy of safety devices. Occup Med (Lond) 2006;56:566574.CrossRefGoogle ScholarPubMed
81.Sohn, S, Eagan, J, Sepkowitz, KA, Zuccotti, G. Effect of implementing safety-engineered devices on percutaneous injury epidemiology. Infect Control Hosp Epidemiol 2004;25:536542.CrossRefGoogle ScholarPubMed
82.Mendelson, MH, Lin-Chen, BY, Solomon, R, Bailey, E, Kogan, G, Goldbold, J. Evaluation of a safety resheathable winged steel needle for prevention of percutaneous injuries associated with intravascular-access procedures among healthcare workers. Infect Control Hosp Epidemiol 2003;24:105112.CrossRefGoogle ScholarPubMed
83.Alvarado-Ramy, F, Beltrami, EM, Short, LJ, et al.A comprehensive approach to percutaneous injury prevention during phlebotomy: results of a multicenter study, 1993–1995. Infect Control Hosp Epidemiol 2003;24:97104.CrossRefGoogle Scholar
84.Aarnio, P, Laine, T. Glove perforation rate in vascular surgery—a comparison between single and double gloving. VASA 2001;30:122124.CrossRefGoogle ScholarPubMed
85.Centers for Disease Control and Prevention. Evaluation of safety devices for preventing percutaneous injuries among health-care workers during phlebotomy procedures—Minneapolis-St. Paul, New York City, and San Francisco, 1993–1995. MMWR Morb Mortal Wkly Rep 1997;46:2125.Google ScholarPubMed
86.Centers for Disease Control and Prevention. Evaluation of blunt suture needles in preventing percutaneous injuries among health-care workers during gynecologic surgical procedures—New York City, March 1993–June 1994. MMWR Morb Mortal Wkly Rep 1997;46:2529.Google Scholar
87.Tarantola, A, Golliot, F, L'Heriteau, F, et al.Assessment of preventive measures for accidental blood exposure in operating theaters: a survey of 20 hospitals in Northern France. Am J Infect Control 2006;34:376382.CrossRefGoogle ScholarPubMed
88.Wicker, S, Jung, J, Allwinn, R, Gottschalk, R, Rabenau, HF. Prevalence and prevention of needlestick injuries among health care workers in a German university hospital. Int Arch Occup Environ Health 2008;81:347354.CrossRefGoogle Scholar
89.Akduman, D, Kim, LE, Parks, RL, et al.Use of personal protective equipment and operating room behaviors in four surgical subspecialties: personal protective equipment and behaviors in surgery. Infect Control Hosp Epidemiol 1999;20:110114.CrossRefGoogle ScholarPubMed
90.Comer, RW, Myers, DR, Steadman, CD, Carter, MJ, Rissing, JP, Tedesco, FJ. Management considerations for an HIV-positive dental student. J Dent Educ 1991;55:187191.Google ScholarPubMed
91.Alrawi, SJ, Houshan, I, Zanial, SA, Cunningham, JN Jr., Acinapura, AJ, Raju, R. Cardiac surgical procedures and glove reinforcements. Heart Surg Forum 2002;5:6668.Google ScholarPubMed
92.Weber, LW. Evaluation of the rate, location, and morphology of perforations in surgical gloves worn in urological operations. Appl Occup Environ Hyg 2003;18:6573.CrossRefGoogle ScholarPubMed
93.Bebbington, MW, Treissman, MJ. The use of a surgical assist device to reduce glove perforations in postdelivery vaginal repair: a randomized controlled trial. Am J Obstet Gynecol 1996;175:862866.CrossRefGoogle Scholar
94.Leslie, LF, Woods, JA, Thacker, JG, Morgan, RF, McGregor, W, Edlich, RF. Needle puncture resistance of surgical gloves, finger guards, and glove liners. J Biomed Mater Res 1996;33:4116.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
95.Salkin, JA, Stuchin, SA, Kummer, FJ, Reininger, R. The effectiveness of cut-proof glove liners: cut and puncture resistance, dexterity, and sensibility. Orthopedics 1995;18:10671071.Google ScholarPubMed
96.Woods, JA, Leslie, LF, Drake, DB, Edlich, RF. Effect of puncture resistant surgical gloves, finger guards, and glove liners on cutaneous sensibility and surgical psychomotor skills. J Biomed Mater Res 1996;33:4751.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
97.Hartley, JE, Ahmed, S, Milkins, R, Naylor, G, Monson, JR, Lee, PW. Randomized trial of blunt-tipped versus cutting needles to reduce glove puncture during mass closure of the abdomen. Br J Surg 1996;83:11561157.CrossRefGoogle ScholarPubMed
98.Mingoli, A, Sapienza, P, Sgarzini, G, et al.Influence of blunt needles on surgical glove perforation and safety for the surgeon. Am J Surg 1996;172:512516.CrossRefGoogle ScholarPubMed
99.Wright, KU, Moran, CG, Briggs, PJ. Glove perforation during hip arthroplasty: a randomised prospective study of a new taperpoint needle. J Bone Joint Surg Br 1993;75:918920.Google ScholarPubMed
100.Bennett, NT, Howard, RJ. Quantity of blood inoculated in a needlestick injury from suture needles. J Am Coll Surg 1994;178:107110.Google Scholar
101.Harpaz, R, Van Seidlein, L, Averhoff, F, et al.Hepatitis B virus transmission associated with cardiothoracic surgery. In: Proceedings of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy; 1993; New Orleans, Louisiana: American Society for Microbiology; 1993.Google Scholar
102.Centers for Disease Control and Prevention. Summary and recommendations for preventing transmission of infection with human T-lymphotropic virus type III/lymphadenopathy- associated virus in the workplace. MMWR Morb Mortal Wkly Rep 1985;34:681686, 91–95.Google Scholar
103.Gioananni, P, Sinicco, A, Cariti, G, Lucchini, A, Paggi, G, Giachino, O. HIV infection acquired by a nurse. Eur J Epidemiol 1988;4:119120.CrossRefGoogle Scholar
104.Fahey, BJ, Koziol, DE, Banks, SM, Henderson, DK. Frequency of non-parenteral occupational exposures to blood and body fluids before and after universal precautions training. Am J Med 1991;90:145153.CrossRefGoogle Scholar
105.Centers for Disease Control and Prevention. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR Morb Mortal Wkly Rep 1991;40:19. Accessed January 8, 2010.Google ScholarPubMed
106.Tarantola, A, Abiteboul, D, Rachline, A. Infection risks following accidental exposure to blood or body fluids in health care workers: a review of pathogens transmitted in published cases. Am J Infect Control 2006;34:367375.CrossRefGoogle ScholarPubMed
107.Sundkvist, T, Hamilton, GR, Rimmer, D, Evans, BG, Teo, CG. Fatal outcome of transmission of hepatitis B from an e antigen negative surgeon. Commun Dis Public Health 1998;1:4850.Google Scholar
108.Hoofhagle, JH, Doo, E, Liang, TJ, Fleischer, R, Lok, AS. Management of hepatitis B: summary of a clinical research workshop. Hepatology 2007;45:10561075.CrossRefGoogle Scholar
109. UK Department of Health. Hepatitis C infected health care workers. 2002. Accessed January 26, 2009.Google Scholar
110.Dienstag, JL, McHutchison, JG. American Gastroenterological Association technical review on the management of hepatitis C. Gastroenterology 2006;130:231264.CrossRefGoogle ScholarPubMed
111.Seeff, LB, Hoofnagle, JH. National Institutes of Health Consensus Development Conference: management of hepatitis C: 2002. Hepatology 2002;36:S1S2.CrossRefGoogle ScholarPubMed
112.Strader, DB, Wright, T, Thomas, DL, Seeff, LB. Diagnosis, management, and treatment of hepatitis C. Hepatology 2004;39:11471171.CrossRefGoogle ScholarPubMed
113.Alberti, A, Boccato, S, Vario, A, Benvegnu, L. Therapy of acute hepatitis C. Hepatology 2002;36:S195S200.CrossRefGoogle ScholarPubMed
114.Jaeckel, E, Cornberg, M, Wedemeyer, H, et al.Treatment of acute hepatitis C with interferon alfa-2b. N Engl J Med 2001;345:14521457.CrossRefGoogle ScholarPubMed
115.Wiegand, J, Deterding, K, Cornberg, M, Wedemeyer, H. Treatment of acute hepatitis C: the success of monotherapy with (pegylated) interferon alpha. J Antimicrob Chemother 2008;62:860865.CrossRefGoogle ScholarPubMed
116.Fabris, P. Acute hepatitis C: epidemiology, pathogenesis and therapy. Curr Pharm Des 2008;14:16441645.CrossRefGoogle ScholarPubMed
117.UK Department of Health. HIV Infected Health Care Workers: Guidance on Management and Patient Notification. 2005. Accessed January 26, 2009.Google Scholar
118.Tuboku-Metzger, J, Chiarello, L, Sinkowitz-Cochran, RL, Casano-Dickerson, A, Cardo, D. Public attitudes and opinions toward physicians and dentists infected with bloodborne viruses: results of a national survey. Am J Infect Control 2005;33:299303.CrossRefGoogle ScholarPubMed
119.Closen, ML. HIV-AIDS, infected surgeons and dentists, and the medical profession's betrayal of its responsibility to patients. NY Law Sch Law Rev 1996;41:57139.Google ScholarPubMed
120.DiMaggio, SL. State regulations and the HIV-positive health care professional: a response to a problem that does not exist. Am J Law Med 1993;19:497522.Google Scholar
121.UK Department of Health. Hepatitis B Infected Health Care Workers: guidance on Implementation of Health Service Circular 2000/020. 2000. Accessed January 26, 2009.Google Scholar
122.UK Department of Health. Hepatitis B infected healthcare workers and antiviral therapy. 2007. Accessed January 26, 2009.Google Scholar
123.Gunson, RN, Shouval, D, Roggendorf, M, et al.Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in health care workers (HCWs): guidelines for prevention of transmission of HBV and HCV from HCW to patients. J Clin Virol 2003;27:213230.CrossRefGoogle Scholar
124.Buster, EH, van der Eijk, AA, Schalm, SW. Doctor to patient transmission of hepatitis B virus: implications of HBV DNA levels and potential new solutions. Antiviral Res 2003;60:7985.CrossRefGoogle ScholarPubMed
125.van der Eijk, AA, de Man, RA, Niesters, HG, Schalm, SW, Zaaijer, HL. Hepatitis B virus (HBV) DNA levels and the management of HBV-infected health care workers. J Viral Hepat 2006;13:24.CrossRefGoogle ScholarPubMed
126.FitzSimons, D, Francois, G, De Carli, G, et al.Hepatitis B virus, hepatitis C virus and other blood-borne infections in healthcare workers: guide-lines for prevention and management in industrialised countries. Occup Environ Med 2008;65:446451.CrossRefGoogle Scholar
127.UK Department of Health. Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New healthcare workers. 2007. Accessed January 26, 2009.Google Scholar
128.Centers for Disease Control and Prevention. Recommendations for prevention of HIV transmission in health-care settings. MMWR Morb Mortal Wkly Rep 1987;36(Suppl 2):1S18S.Google ScholarPubMed
129.Do, AN, Ciesielski, CA, Metier, RP, Hammett, TA, Li, J, Fleming, PL. Occupationally acquired human immunodeficiency virus (HIV) infection: national case surveillance data during 20 years of the HIV epidemic in the United States. Infect Control Hosp Epidemiol 2003;24:8696.CrossRefGoogle ScholarPubMed
130.Centers for Disease Control and Prevention. Recommendations for preventing transmission of infection with human T-lymphotropic virus type III/lymphadenopathy-associated virus during invasive procedures. MMWR Morb Mortal Wkly Rep 1986;35:221223.Google ScholarPubMed
131.Centers for Disease Control and Prevention. Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. MMWR Morb Mortal Wkly Rep 1988;37:377382.Google ScholarPubMed
132.Centers for Disease Control and Prevention. Public Health Service statement on management of occupational exposure to human immuno-deficiency virus, including considerations regarding zidovudine post-exposure use. MMWR Morb Mortal Wkly Rep 1990;39:114.Google Scholar
133.Centers for Disease Control and Prevention, Division of Safety, National Institutes of Health. Occupationally acquired human immunodeficiency virus infections in laboratories producing virus concentrates in large quantities: conclusions and recommendations of an expert team convened by the Director of the National Institutes of Health (NIH). MMWR Morb Mortal Wkly Rep 1988;37(Suppl 4):1922.Google Scholar
134.Gross, PA, Barrett, TI, Dellinger, EP, et al.Purpose of quality standards for infectious diseases. Clin Infect Dis 1994;18:421.CrossRefGoogle ScholarPubMed
135.The periodic health examination. Canadian Task Force on the Periodic Health Examination. Can Med Assoc J 1979;121:11931254.Google ScholarPubMed
136.Alter, HJ, Seeff, LB, Kaplan, PM, et al.Type B hepatitis: the infectivity of blood positive for e antigen and DNA polymerase after accidental needlestick exposure. N Engl J Med 1976;295:909913.CrossRefGoogle Scholar
137.Ippolito, G, Puro, V, Heptonstall, J, Jagger, J, De Carli, G, Petrosillo, N. Occupational human immunodeficiency virus infection in health care workers: worldwide cases through September 1997. Clin Infect Dis 1999;28:365383.CrossRefGoogle Scholar
138.Puro, V, Petrosillo, N, Ippolito, G. Risk of hepatitis C seroconversion after occupational exposures in health care workers. Italian Study Group on Occupational Risk of HIV and Other Bloodborne Infections. Am J Infect Control 1995;23:273277.CrossRefGoogle Scholar
139.Bell, DM, Shapiro, CN, Culver, DH, Martone, WJ, Curran, JW, Hughes, JM. Risk of hepatitis B and human immunodeficiency virus transmission to a patient from an infected surgeon due to percutaneous injury during an invasive procedure: estimates based on a model. Infect Agents Dis 1992;1:263269.Google ScholarPubMed
140.Henderson, DK, Saah, AJ, Zak, BJ, et al.Risk of nosocomial infection with human T-cell lymphotropic virus type III/lymphadenopathy-associated virus in a large cohort of intensively exposed health care workers. Ann Intern Med 1986;104:644647.CrossRefGoogle Scholar
141.Corden, S, Ballard, AL, Ijaz, S, et al.HBV DNA levels and transmission of hepatitis B by health care workers. J Clin Virol 2003;27:5258.CrossRefGoogle ScholarPubMed
142.Stringer, B, Haines, T. Hands-free technique: preventing occupational exposure during surgery. J Perioper Pract 2006;16:495500.Google ScholarPubMed
143.Buster, EH, van der Eijk, AA, de Man, RA, Janssen, HL, Schalm, SW. Prolonged antiviral therapy for hepatitis B virus-infected health care workers: a feasible option to prevent work restriction without jeopardizing patient safety. J Viral Hepat 2007;14:350354.CrossRefGoogle ScholarPubMed
144.Stringer, B, Infante-Rivard, C, Hanley, JA. Effectiveness of the hands-free technique in reducing operating theatre injuries. Occup Environ Med 2002;59:703707.CrossRefGoogle ScholarPubMed
145.Nash, KL, Bentley, I, Hirschfield, GM. Managing hepatitis C virus infection. BMJ 2009;338:b2366.CrossRefGoogle ScholarPubMed
146.Manns, MP, McHutchison, JG, Gordon, SC, et al.Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 2001;358(9286):958965.CrossRefGoogle ScholarPubMed
147.Fried, MW, Shiftman, ML, Reddy, KR, et al.Peginterferon alfa–2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med 2002;347(13):975982.CrossRefGoogle ScholarPubMed
148.Gerbert, B, Bleecker, T, Berlin, M, Coates, TJ. HIV-infected health care professionals: public opinion about testing, disclosing, and switching. Arch Intern Med 1993;153:313320.CrossRefGoogle ScholarPubMed
149.Gerbert, B, Maguire, B, Hulley, S, Coates, T. Physicians and acquired immunodeficiency syndrome: What patients think about human immunodeficiency virus in medical practice. JAMA 1989;262:19691972.CrossRefGoogle ScholarPubMed
150.American Hospital Association (AHA). Patients' bill of rights. Chicago, IL: AHA; 1975.Google ScholarPubMed
151.American Hospital Association (AHA). Management of HIV infection in the hospital. 3rd ed. Chicago, IL: AHA; 1988.Google ScholarPubMed
152.American Medical Association (AMA). Current opinions of the Council on Ethical and Judicial Affairs of the American Medical Association. Chicago, IL: AMA; 1986.Google ScholarPubMed
153.Panlilio, AL, Cardo, DM, Grohskopf, LA, Heneine, W, Ross, CS. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2005;54:117.Google ScholarPubMed
154.Centers for Disease Control and Prevention. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR Morb Mortal Wkly Rep 2001;50:152.Google Scholar
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

SHEA Guideline for Management of Healthcare Workers Who Are Infected with Hepatitis B Virus, Hepatitis C Virus, and/or Human Immunodeficiency Virus