HEPATITIS C INFECTED HEALTH CARE WORKERS
ANNEX A: EXPOSURE PRONE PROCEDURES
1 Exposure prone procedures 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. These include procedures where the worker's gloved hands may be in contact with sharp instruments, needle tips or sharp tissues (e.g. 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. However, other situations, such as pre-hospital trauma care and care of patients where the risk of biting is regular and predictable, should be avoided by health care workers restricted from performing exposure prone procedures.
2 When there is any doubt about whether a procedure is exposure prone or not, advice should be sought in the first instance from a consultant occupational health physician who may in turn wish to consult the UK Advisory Panel for Health Care Workers Infected with Blood-borne Viruses (UKAP). Some examples of advice given by UKAP about exposure prone procedures are provided in Guidance on the management of HIV/AIDS infected health care workers and patient notification(issued in Scotland under cover of NHS MEL (1999) 29). 16 These may serve as a guide but cannot be seen as necessarily generally applicable as the working practices of individual health care workers vary.
3 Procedures where the hands and fingertips 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.
4 Examples of procedures that are not exposure prone include:
taking blood (venepuncture);
setting up and maintaining IV lines or central lines (provided any skin tunnelling procedure used for the latter is performed in a non-exposure prone manner i.e. without the operator's fingers being at any time concealed in the patient's tissues in the presence of a sharp instrument);
minor surface suturing;
the incision of external abscesses;
routine vaginal or rectal examinations;
simple endoscopic procedures.
5 The decision whether a hepatitis C infected worker should continue to perform a procedure which itself is not exposure prone should take into account the risk of complications arising which necessitate the performance of an exposure prone procedure; only reasonably predictable complications need to be considered in this context.