本帖最后由 StephenW 于 2012-7-6 07:00 编辑
Updated CDC Recommendations for the Management of Hepatitis B Virus–Infected Health-Care Providers and StudentsRecommendations and ReportsJuly 6, 2012 / 61(RR03);1-12
Prepared by Scott D. Holmberg, MD Anil Suryaprasad, MD John W. Ward, MD Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
The material in this report originated in the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Kevin Fenton, MD, PhD, Director, and the Division of Viral Hepatitis, John W. Ward, MD, Director.
Corresponding preparer: Scott D. Holmberg, MD, Division of Viral Hepatitis, 1600 Clifton Rd, NE, MS G-37, Atlanta, GA 30329. Telephone: 404-718-8550; Fax: 404-718-8585; E-mail: [email protected].
Summary
his report updates the 1991 CDC recommendations for the management of hepatitis B virus (HBV)–infected health-care providers and students to reduce risk for transmitting HBV to patients during the conduct of exposure-prone invasive procedures (CDC. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR 1991;40[No. RR-8]). This update reflects changes in the epidemiology of HBV infection in the United States and advances in the medical management of chronic HBV infection and policy directives issued by health authorities since 1991.
The primary goal of this report is to promote patient safety while providing risk management and practice guidance to HBV-infected health-care providers and students, particularly those performing exposure-prone procedures such as certain types of surgery. Because percutaneous injuries sustained by health-care personnel during certain surgical, obstetrical, and dental procedures provide a potential route of HBV transmission to patients as well as providers, this report emphasizes prevention of operator injuries and blood exposures during exposure-prone surgical, obstetrical, and dental procedures.
These updated recommendations reaffirm the 1991 CDC recommendation that HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields. The previous recommendations have been updated to include the following changes: no prenotification of patients of a health-care provider's or student's HBV status; use of HBV DNA serum levels rather than hepatitis B e-antigen status to monitor infectivity; and, for those health-care professionals requiring oversight, specific suggestions for composition of expert review panels and threshold value of serum HBV DNA considered "safe" for practice (<1,000 IU/ml). These recommendations also explicitly address the issue of medical and dental students who are discovered to have chronic HBV infection. For most chronically HBV-infected providers and students who conform to current standards for infection control, HBV infection status alone does not require any curtailing of their practices or supervised learning experiences. These updated recommendations outline the criteria for safe clinical practice of HBV-infected providers and students that can be used by the appropriate occupational or student health authorities to develop their own institutional policies. These recommendations also can be used by an institutional expert panel that monitors providers who perform exposure-prone procedures.
更新为B型肝炎病毒感染的卫生保健提供者和学生管理的疾病预防控制中心的建议
建议和报告
7月6日,2012/61(RR03); 1-12
编写
斯科特D.霍姆伯格,MD
阿尼尔Suryaprasad,MD
约翰·W·沃德博士
病毒性肝炎,国家中心,为艾滋病毒/艾滋病,病毒性肝炎,性病和结核病防治处
本报告中的起源中心在艾滋病毒/艾滋病,病毒性肝炎,性病,结核病防治,凯文·芬顿博士,主任,的病毒性肝炎司,约翰·W·沃德博士,主任的材料。
相应的配制:斯科特D霍姆伯格,医师,病毒性肝炎部,1600克利夫顿路,东北,MS的G-37,亚特兰大,遗传30329。电话:404-718-8550传真:404-718-8585电子邮件:[email protected]。
总结
本报告更新管理为B型肝炎病毒(HBV)的感染的卫生保健提供者和学生1991年疾病预防控制中心建议,以减少对乙肝病人的转递易暴露的侵入性程序的行为(CDC.建议,为防止传输过程中的风险人类免疫缺陷病毒和乙肝病毒1991年在容易暴露的侵入性手术的病人MMWR; 40 [编号:RR-8)。此更新反映在美国和先进的医疗管理的慢性乙肝病毒感染和政策自1991年以来,由卫生行政部门发出的指令乙肝病毒感染的流行病学的变化。
本报告的主要目标是促进病人的安全,同时提供风险管理和实践指导,乙肝病毒感染的卫生保健提供者和学生,特别是那些容易进行曝光,程序,如某些类型的手术。因为保健人员维持在一定的外科,产科,牙科手术,经皮受伤的病人,以及为供应商提供的乙肝病毒传播的潜在途径,该报告强调在易暴露的操作员受伤和血液暴露的预防外科,产科,牙科手术。
这些更新的建议,重申1991年CDC的建议,仅乙肝病毒感染,不应该从实践或研究手术,牙科,中医,专职医疗领域的感染者取消资格。以往的建议已更新包括以下变化:没有1卫生保健提供者的或学生的乙肝病毒状态的患者预先通知使用乙肝病毒DNA的血清水平,而不是肝炎乙e抗原状态,以监视传染性和,这些健康保健专业人员需要监督,组成专家评审小组和血清HBV DNA的门槛值,认为“安全”为实践(<1,000 IU /毫升)的具体建议。这些建议还明确解决的医疗及牙科学生,被发现有慢性乙肝病毒感染的问题。对于HBV感染的最长期的供应商,并符合现行标准的感染控制的学生,乙肝病毒感染状况单独并不需要任何削减他们的做法,或监督的学习经验。这些更新的建议概括为乙肝病毒感染,可以通过适当的职业或学生卫生当局用于发展自己的体制政策的供应商和学生安全的临床实践的标准。这些建议也可以由一个机构的专家小组,监察执行程序容易暴露的供应商。
|