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I looked over the draft blood borne virus policy. I think this is significant improvement over the previous policy, which required an excessive amount of nonsensical testing. I had in the past expressed concerns about wasting health care resources by testing hepatitis B immunity year after year in people with proof of immunity. I was very pleased to see this dealt with in the new policy.
Definitely an improvement, but still unnecessarily wastes resources and invades privacy. The new guidelines continue to ignore the fact that their primary resource, the SHEA recommendations, actually recommend AGAINST routine testing of physicians unless an event of exposure has occurred. I believe the CPSO is pandering to the public rather than using best the evidence to protect the public.
I am very supportive of the change in the frequency of testing for BBV. I believe testing every 3 years achieves the appropriate balance of protecting patients while avoiding unnecessary testing for physicians. Congratulations on the other helpful changes as well.
There are two issues with the proposed policy:
1) It mentions emergency physicians explicitly among groups that have “potential” to perform exposure-prone procedures, but does not mention rural family physicians who provide emergency department coverage, critical care specialists, or anaesthesiologists. My intention is not to suggest that these groups should be added to the list, but only to identify that many physicians practice to a scope that is determined by patient need, not predefined medical specialty. If we include all of the physicians who can see a reasonable potential that they may be involved somehow in an exposure-prone procedure, we will be including an enormous number of physicians. Be careful, and make the intended list exhaustive.
2) This whole policy places a disproportionate attention on HIV, HCV and HBV. These are serious public health problems, but not the only ones. Where are the equivalent requirements that people who have potential to work with TB patients (ie: every physician) have routine Mantoux testing and report it to the CPSO? Where is the requirement for West Nile Virus or syphilis testing among the bloodborne pathogens? Again, I am not suggesting that we should have such policies, only that the present one actually attends to HIV/HBV/HCV inappropriately.
The new policy in which testing is limited to once every three years for HIV and HCV is a huge improvement, as is the lack of a requirement to test physicians for HBV if they have proven immunity.
As an emergency physician (EP) who has been practicing at a tertiary care centre for over 25 years I have performed an ED thoracotomy for penentrating trauma on one occasion. This is really the only type of EPP in which there would be a significant risk of me transmitting a BBV. I believe that it would be more appropriate to ask EPs to be tested if and when they perform such a procedure and to maintain their vigilance whenever they are exposed to patients’ bodily fluids. Such exposures should be followed by serological testing to rule out infection in the physician.
For some EPs, testing in association with the performance of an EPP might be on a regular basis,(or once every 3 years based on this policy), for many it would be once or twice in a 30 year career, and for many it would be never. Such a policy would eliminate the need for a lot of the testing this new policy still mandates.
Please explicitly clarify whether this policy applies to anatomical, general, and forensic pathologists, who only handle pathological specimens and autopsy material. Specifically:
1) Is an autopsy an exposure prone procedure?
2) If yes, as there is no risk of patient transmission, does this policy apply to pathologists?
I disagree with the mandatory testing of health care providers every 3 years. The SHEA guidelines expressly recommend against routine testing. This is a waste of time and health care resources. Providers should only be tested after an exposure incident, or in accordance with their exposure risk in their personal lives, as is the case with all patients.
I’m an orthopaedic surgeon in Ontario. This policy does not conform to the world guidelines from experts. The CPSO believed that their guidelines have protected patients.
This policy has been in place for at least 2 years. Can you provide data to demonstrate how this policy has protected patients? I think this will provide some direction in an evidence based manner.
College of Medical Laboratory Technologists of OntarioResponse in PDF format.
Good for both the public and physician , but emphasize more on a secure confidential pathway through which physician get tested and followed up.
Professional Association of Residents of OntarioResponse in PDF format.
College of Physicians and Surgeons of AlbertaResponse in PDF format.
Public Health OntarioResponse in PDF format.