The U.S. Centers for Disease Control and Prevention (CDC) has released new safety guidelines for health care providers living with chronic hepatitis B virus (HBV).

Detailed in the agency’s Morbidity and Mortality Report on July 6, the guidelines update those last published in 1991, based on changes in the epidemiology of hep B in the United States, along with advances in the medical management of the disease and policy directives issued by health authorities during the past 20 years.

The primary goal of the guidelines is to promote patient safety while providing risk management and practice guidance to health care providers and students living with chronic hepatitis B, particularly those performing exposure-prone procedures such as certain types of surgery. Because needlestick injuries and other wounds 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, the guidelines emphasize prevention of such injuries.  

Among the updates is the recommendation that patients do not need to be notified of a health care provider’s HBV status.

The revised guidelines also suggest using HBV viral load levels, instead of hepatitis B e-antigen status, to monitor infectivity. And for those health care professionals requiring oversight—such as surgeons, oral surgeons, obstetricians, gynecologists and surgical residents—the guidelines make specific suggestions for expert review panels and an HBV viral load level considered “safe” for practice (under 1,000).

The recommendations also explicitly address the issue of medical and dental students who are discovered to have chronic HBV infection. For most providers and students living with chronic HBV who conform to current standards for infection control—such as double-gloving during invasive surgical procedures—their hep B status alone does not require them to curtail their practices or undergo supervised learning.

Importantly, the guidelines also state that health care providers and students should receive the HBV vaccine according to current CDC recommendations.

They also reaffirm that HBV infection alone should not disqualify people from the practice or study of surgery, dentistry, medicine or allied health fields.