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Hepatitis C exposure management in the UK

 

Clinical bottom line

In early 2000 UK institutions had differing policies on testing and treatment after possible occupational exposure to hepatitis C.


Reference

DW Wareham, J Breuer. Management of occupational exposure to hepatitis C: survey of United Kingdom practice. Communicable Disease and Public Health 2000 3: 295-296.

Methods

This was a survey of 208 institutions (early 2000) varying from district general microbiology laboratories to teaching hospitals relating to actions that would be taken following a needlestick injury from a potential hepatitis C (HCV) positive patient.

Results

There were 149 responses to the questionnaire (72%). A quarter (24%) of responding institutions had no written policy for the management of needlestick injuries involving HCV positive patients. Almost all recommended storage of recipient serum, but testing of the source patient varied, with 40% always testing, 50% testing in high risk patients, and 10% never testing. Most responding institutions used either an anti-HCV or HCV-RNA test of recipients (Table 1) at three and six months.

Table 1: Percentage of responding institutions testing recipients for HCV

Recipient testing for HCV

Yes

No

Anti-HCV

86

14

HCV-RNA

66

34

Treatment options also varied, between use of normal immunoglobulin (9/149) or interferon (38). Three-quarters did not recommend the use of interferon, but one in five would refer to a gastroenterologist. Referral or interferon treatment was an option in only 41% of responding institutions.

Comment

The picture is a mixed one, with different policies and procedures, at least in early 2000. This snapshot of UK practice may well have changed, with new or updated guidelines and evidence. It highlights the need to regularly update policies to ensure that they are consistent with best current standards.

How should we interpret the fact that almost 3 in 10 institutions failed to respond to the questionnaire? The pessimistic view would be that policies may have had even greater variability than this survey showed.