"THERE HAS BEEN CONSIDERABLE DEBATE ABOUT THE NEED for mandatory serologic testing
of individuals who are the source of bloodborne pathogen exposures in health care
and other occupational settings. The transmission of hepatitis B (HBV), hepatitis C
(HCV) and HIV between patients and health care workers (HCWs) is related to the
frequency of exposures capable of allowing transmission, the prevalence of disease
in the source populations, the risk of transmission given exposure to an infected
source and the effectiveness of postexposure management. Transmission of HBV
from patients to HCWs has been substantially reduced by vaccination and universal
precautions. The transmission of HCV and HIV to HCWs does occur, although
postexposure prophylaxis (PEP) is available to reduce the risk of HIV transmission.
Transmission of bloodborne pathogens from infected HCWs to patients has also
been documented. Policy-making concerning the mandatory postexposure testing
of patients who may be the source of infection must weigh the relative infrequency
of patients’ refusals to be tested and the consequences for PEP recommendations
with the ethical and legal considerations of bypassing informed consent and
mandating testing. Mandatory postexposure testing of HCWs who are the source of
infection will have a limited impact on reducing transmission because of the lack
of recognition and reporting of exposures. Comprehensive approaches have been
recommended to reduce the risk of transmission of bloodborne virus infections."
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