Addendum to HSG(93)40: Protecting Health Care Workers and Patients from Hepatitis B | National Resource for Infection Control (NRIC)

Addendum to HSG(93)40: Protecting Health Care Workers and Patients from Hepatitis B

Best practice, Policy
Abstract: 
The addendum and its accompanying annexes gives further guidance on implementation of HSG(93)40 following the expiry of target dates set out for immunisation and testing of all health care workers. Health care workers who perform exposure prone procedures and who have not yet been immunised should be tested for evidence of current infection as soon as possible. The recommendation that carriers of the hepatitis B virus who are known to be e-antigen positive must not carry out procedures where there is a risk that injury to themselves will result in their blood contaminating a patient’s open tissues remains unchanged. Annex A: Addendum to HSG (93)40 Implementation of guidance on protecting health care workers and their patients from hepatitis B. This annex contains information on target dates, response to vaccine, restricting practise of e-antigen positive carriers of hepatitis B, testing for e-markers, treatment with alpha-interferon, security of establishing immunity/infectivity and investigation of possible cases of transmission of BBV’s from health care workers. Annex B: · Protocol for the investigation of health care workers who perform exposure prone procedures and who are apparent non-responders to hepatitis B vaccine. Includes information on post immunisation testing, investigation of HBsAg positive health care workers · Algorithm for Investigation of Health Care Workers who perform Exposure Prone procedures and who show no response to hepatitis B immunisation. · Protocol for the investigation of health care workers who perform exposure prone procedures and who have not yet been immunised. Contains information on testing, investigation of HBsAg positive health care workers · Algorithm for Investigation of health care workers who perform exposure prone procedures and who have not yet received hepatitis B immunisation
Authors: 
Department of Health (DH)
Category: 
Control
Investigation
Management
Prevention
Public information

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Summary:
The addendum and its accompanying annexes gives further guidance on implementation of HSG(93)40 following the expiry of target dates set out for immunisation and testing of all health care workers.Health care workers who perform exposure prone procedures and who have not yet been immunised should be tested for evidence of current infection as soon as possible.The recommendation that carriers of the hepatitis B virus who are known to be e-antigen positive must not carry out procedures where there is a risk that injury to themselves will result in their blood contaminating a patient’s open tissues remains unchanged.Annex A: Addendum to HSG (93)40 Implementation of guidance on protecting health care workers and their patients from hepatitis B. This annex contains information on target dates, response to vaccine, restricting practise of e-antigen positive carriers of hepatitis B, testing for e-markers, treatment with alpha-interferon, security of establishing immunity/infectivity and investigation of possible cases of transmission of BBV’s from health care workers.Annex B: · Protocol for the investigation of health care workers who perform exposure prone procedures and who are apparent non-responders to hepatitis B vaccine. Includes information on post immunisation testing, investigation of HBsAg positive health care workers· Algorithm for Investigation of Health Care Workers who perform Exposure Prone procedures and who show no response to hepatitis B immunisation.· Protocol for the investigation of health care workers who perform exposure prone procedures and who have not yet been immunised. Contains information on testing, investigation of HBsAg positive health care workers· Algorithm for Investigation of health care workers who perform exposure prone procedures and who have not yet received hepatitis B immunisation
Questions Addressed:
This addendum and its annexes concern the implementation of guidance in HSG (93)40 and complements obligations under Health and Safety legislation and existing guidance on immunisation of health care workers and other staff at risk of acquiring hepatitis B (Green Book)
Type of Study:
Guidance document
Methods Valid:
Yes
Methods Valid Detail:

should be read with HSG (93)40 and accompanying booklet Protecting Health Care Workers and patients from Hepatitis B August 1993 (see references)

Results Reliability:
Yes
Problems or Biases:

None noted

Relevant Studies:

1. Health Service Circular (HSC) 2000/020 Hepatitis B Infected Health Care Workers, Department of Health http://www.dh.gov.uk/PublicationsAndStatistics/LettersAndCirculars/Healt.... Hepatitis B infected health care workers: guidance on implementation of Health Service Circular 2000/020 (23/06/2000) Department of Health http://www.dh.gov.uk/PublicationsAndStatistics/Publications/Publications.... Health Service Guidelines HSG (93)40 Protecting health care workers and patients from hepatitis B - 18 August 1993 Department of Health http://www.dh.gov.uk/PublicationsAndStatistics/LettersAndCirculars/Healt... 4. Accompanying booklet to HSG(93)40: Protecting health care workers and patients from hepatitis B August 1993 http://www.dh.gov.uk/PublicationsAndStatistics/LettersAndCirculars/Healt.... Health Service Circular HSC 1998/063: Guidance for clinical health care workers: protection against infection with blood-borne viruses http://www.dh.gov.uk/PublicationsAndStatistics/LettersAndCirculars/Healt.... Health Service Circular HSC 1998/226: Guidance on the management of AIDS/HIV infected health care workers and patient notification http://www.dh.gov.uk/PublicationsAndStatistics/LettersAndCirculars/Healt.... Hepatitis B key documents http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Hepatit...

Keywords:
hepatitis B healthcare workers transmission exposure prone procedures working practice viral load HBsAg positive HBsAg negative immunisation
Reviewer Name:
Sue Wiseman
Reviewer Post:
Nurse Consultant –Infection Control, DH
Reviewer Affiliations:
Member Advisory Committee on Dangerous Pathogens Health Protection Adviser Royal College of Nursing P/T Member Infection Control Nurses Association