Blood-borne Virus Screening Information

1. Exposure prone procedures (EPPs) are those invasive procedures where there is a risk that injury to the HCW 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, should also be avoided by HCWs who are restricted from performing EPPs.
2. When there is any doubt about whether a procedure is exposure prone or not, expert 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 HCWs Infected with Blood-borne Viruses (UKAP). Some examples below of advice given by UKAP may serve as a guide but cannot be seen as necessarily generally applicable due to the fact that the working practices of individual HCWs vary.

Non-EPPs

1. 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 that routine infection control procedures are adhered to at all times.
2. Examples of procedures that are not exposure prone include:

• taking blood (venepuncture);
• setting up and maintaining IV lines or central lines (provided that 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.

1. The decision whether an hepatitis B, hepatitis C or HIV 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 EPP; only reasonably predictable complications need to be considered in this context.

The information below to provide you with answers to the questions you may have about the screening programme and the required information needed for you to decide whether you give informed consent to being tested for hepatitis B, hepatitis C and HIV infection.

Why are EPP workers required to have this additional health screening?

The Department of Health and Social Care (DHSC) introduced requirements stating that all new HCWs, who participate in exposure prone procedures (EPPs), must undergo testing for hepatitis B, hepatitis C and HIV. This testing is being offered by oh Occupational Health and Wellbeing so that the organisation is compliant with these guidelines.

Hepatitis B and C can cause a chronic infection of the liver, which over time can lead to cirrhosis and death from liver failure or liver cancer. A person may be a carrier of hepatitis B (have antigen) even though they appear to have a satisfactory antibody level. For this reason, both hepatitis B antibody and hepatitis B antigen are tested. Hepatitis B and C can sometimes be eradicated with medication.

HIV infection is a chronic condition which over a period of years progressively damages a person’s immune system, eventually causing AIDS. There is no cure for HIV at present, but treatment with anti-viral drugs can suppress viral replication enough to prevent or slow down the damage to the immune system.

A blood-borne virus carrier may be unaware that they are infected with a blood-borne virus. If a HCW who is infected with a blood-borne virus injures themselves during an EPP, this could allow the virus to be transmitted to the patient. In accordance with DHSC requirements, new HCWs who wish to participate in EPPs must first be tested for hepatitis B, hepatitis C and HIV.

If you are found to be a carrier of a blood-borne virus, you must receive and comply with occupational health advice. You will not be allowed to assist with, or undertake, any EPPs until specific criteria are met and clearance has been granted by a Consultant Occupational Health Physician. Ongoing clearance to undertake EPPs will be subject to ongoing monitoring and review by Occupational Health.

The DHSC recommends that all new HCWs, whether undertaking EPPs or not, should be offered the opportunity of having tests for hepatitis B, hepatitis C and HIV carrier status.

Will I require re-screening?

If initial screening results are negative, routine re-screening of HCWs in the UK will not normally be required. However, HCWs will still be bound by their professional obligation to inform Occupational Health if, post screening, they have been exposed to a risk of contracting a blood-borne virus. Based on an individual risk assessment, further testing may be advised. Detectable antibodies to blood-borne viruses may not develop until some weeks after infection, so a test carried out in the first three months post an exposure may be unreliable. A test carried out after this time will be accurate. A non-exhaustive list of examples of risk factors for blood-borne viral disease and carrier status include:

• You have ever injected drugs using equipment shared with someone else
• You have been accidentally exposed to blood of a person infected with hepatitis B, hepatitis C or HIV (e.g. a needlestick injury or other exposure to blood)
• You have received a blood transfusion where blood has not been effectively screened for blood-borne viruses
• You have had unprotected penetrative sex (i.e. without using a condom)
• You have had a tattoo or body piercing in places with poor procedures for sterilising equipment or materials.
• You have received medical or dental treatment in a country where hepatitis B, hepatitis C or HIV are more prevalent.

What are the advantages of being tested for blood-borne viruses?

Advantages include:

• You’ll be able to plan your career. If you are negative, the whole range of careers will be open to you. You will be able to participate in EPPs. EPPs comprise part of the normal work of a significant number of clinicians and there is a national requirement for a substantial proportion of the postgraduate medical workforce to be competent in EPPs.
• If positive for infection, then some careers, particularly in surgical specialties, will not be open to you, unless you have treatment to successfully suppress or eradicate the infection. Early diagnosis is of proven benefit. For hepatitis B and C, it is easier to treat an infection in the earlier stages. For HIV, once diagnosed, a person can be monitored and anti-viral treatment started before irreversible damage to the immune system occurs.
• You will be complying with your professional duty to be tested if you have been at risk.
• If you have been worrying about possibly being infected, a test can give you certainty. If negative, it can provide you with peace of mind. If positive, you can be referred for specialist advice and take steps to limit the risk of transmission to others, including sexual partners.

What are the disadvantages of being tested for blood-borne viruses?

There are some potential disadvantages to being tested which you should be aware of. These include:

• Discovering that you are infected with blood-borne viruses can be stressful.
• If you are infected, you may have difficulty obtaining life insurance. Of note, insurance companies do not impose higher premiums simply because a person has had a test for HIV or hepatitis.
• Some countries will not grant visas to foreign nationals infected with HIV.
• You may encounter prejudicial behaviour from others if they discover you are hepatitis B, hepatitis C or HIV positive.
• If you have had unsafe sex in the past, a negative test may give a false sense of security and tempt you to continue this risky behaviour.
• If you have been at risk of exposure in the past 12 weeks, a test now may be falsely negative. You should defer testing until 12 weeks after your last risk.

What will happen if I do not agree to be tested?

Testing is voluntary. If you do not agree to be tested, oh Occupational Health and Wellbeing will inform your manager that you have not been cleared for participation in EPPs.

How will the tests be carried out?

The DHSC has strict requirements for the management and quality control of testing and these will be met by oh Occupational Health and Wellbeing.

These include:

• validation of identity by photographic proof at the time the sample is taken. This aims to ensure blood is taken in standardised conditions.
• use of an accredited laboratory i.e., one holding full or provisional accreditation status issued by Clinical Pathology Accreditation UK Ltd which is experienced in performing the necessary tests and which participates in appropriate external quality assurance schemes.

What pre-test counselling will be offered?

The principal method of pre-test counselling will be the provision of the written information contained in this fact sheet. However, should you have any queries or require further information prior to being tested, you can contact a clinical member of staff from oh Occupational Health and Wellbeing via telephone 01223 216767 or via email: add-tr.ohhelpline@nhs.net. Where indicated, or requested, an appointment with an Occupational Health Physician will be arranged.

What post-test counselling will be offered?

For individuals whose tests are negative, no further counselling will be routinely offered but is available upon request. A copy of the laboratory report will be provided in addition to a complete set of immunisation/blood test details taken, although due to the time it takes for the laboratory to process the samples, this will not normally be for 2-3 weeks after the blood test. Workers who test positive will be seen and advised by an Occupational Health Physician who will facilitate referral to an appropriate specialist, in full consultation with your general practitioner.

What should I do if I am concerned that I may have risk factors placing me at higher risk of a positive test?

If you believe that you are at higher risk of having a blood-borne virus infection, you may undertake screening as planned. However, you may wish to seek advice and personal counselling from oh Occupational Health and Wellbeing, and/or from another health professional, prior to testing. If you have had exposure to risk within the preceding twelve weeks, you should contact oh Occupational Health and Wellbeing for advice.

Can I undertake testing for health clearance through an alternative route?

In order to meet the administrative and quality standards required by the DHSC, only testing managed by a UK occupational health service that meets the quality standards will be accepted for health clearance.

UK Health Security Agency (2024). Integrated guidance on health clearance of HCWs and the management of HCWs living with blood-borne viruses (hepatitis B, hepatitis C and HIV) UK Advisory Panel for HCWs Living with Blood-borne Viruses (UKAP). [online] Available at: https://assets.publishing.service.gov.uk/media/6627a9b0d29479e036a7e622/integrated-guidance-for-management-of-BBV-in-HCW-April-2024-update.pdf (opens in a new tab)

Cambridge University Hospitals policy: Staff immunisation and infection screening can be accessed here: Staff immunisation and infection screening policy (opens in a new tab). Alternatively, search staff immunisation and infection screening on Merlin.

Regulatory bodies for statements on professional responsibilities:

• General Medical Council (opens in a new tab) – Good medical practice: specifically, Domain 3: Colleagues, culture and safety
• General Dental Council (opens in a new tab) – Standards for the dental team: specifically, standards 1, 6, 7, 8, and 9
• Nursing & Midwifery Council (opens in a new tab) – The Code for nurses and midwives: specifically, standards 5, 8, 16, 17, 19 and 23
• Health and Care Professions Council (opens in a new tab)– Standards of conduct, performance and ethics: specifically, standards 1, 6 and 7