Blood Borne Virus Policy Rescinded
New insights, medical advances since policy’s introduction
CPSO’s Blood Borne Virus policy was introduced when the health care landscape and the spread of HIV and AIDs was a significant public health concern. The policy required routine testing for all physicians who perform or could potentially perform exposure-prone procedures (EPP). The policy required physicians to report if they are seropositive for hepatitis B virus (HBV), hepatitis C virus (HCV), and/or human immunodeficiency virus (HIV).
CPSO Council considered the ongoing need for this policy in light of the inherently low risk of transmission and how effective antiretroviral therapy can now fully suppress HIV making it non-infectious. There have been no documented cases of HIV transmission in the U.S. from physician to patient since the 2010 SHEA guidelines were published. Current medical therapy successfully suppresses HBV and has made HCV a curable disease in almost all health care workers.
At the most recent meeting, Council made the decision to rescind the policy after determining the risk of harm being mitigated was extremely low and its requirements for seropositive physicians was inconsistent with CPSO’s management of other physician health issues. Council determined that new insights and medical advances have changed the landscape dramatically since the policy was first introduced in 1998.
The decision to rescind reflects how different the landscape is now, many years after our policy was first introduced, said Dr. Anil Chopra, a medical advisor at the College.
“As this policy evolved over the years, a cautious approach was taken,” he said. “Now, 25 years after this issue was initially explored, we know that the risk of transmission is extraordinarily low, and routine practices are commonplace that help to protect both providers and patients. Advances in medical treatment also help seropositive physicians manage their health and reduce their viral loads to nearly negligible levels.”
Guidance on the assessment and management of infected health care workers (HCW) is provided by several agencies. The Public Health Agency of Canada (PHAC) Guideline identifies ongoing awareness of one’s serologic status as an essential responsibility for HCWs who perform EPPs.
The Blood-Borne Diseases Surveillance Protocol for Ontario Hospitals provides direction to hospitals to prevent the transmission of blood borne viruses to HCWs and patients, including setting out procedures for when a HCW is exposed to blood borne viruses, including testing and reporting requirements.
A 2022 SHEA White Paper states hospitals and health care facilities should ensure health care providers who perform or assist with EPPs are aware of the ethical obligation to know their HBV, HCV and HIV serologic status. And similarly, CPSO continues to expect all physicians who perform exposure-prone procedures monitor their own serologic status on an ongoing basis.