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Occupational Exposure to Bloodborne Pathogens

Michael L. Landrum, MD; Robert J. O'Connell, MD; and Gregory A. Deye, MD
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From Wilford Hall Medical Center, Lackland Air Force Base, TX 78236, and Landstuhl Regional Medical Center, 66849 Landstuhl/Kirchberg, Germany.

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Ann Intern Med. 2004;141(6):487. doi:10.7326/0003-4819-141-6-200409210-00031
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Occupational exposure and worker's rights.
Posted on January 7, 2005
Nicola Magnavita
Catholic University School of Medicine
Conflict of Interest: None Declared

The commentaries (1,2) of Dr. Seibert's body fluid exposure (3) points out that only a part of health care workers (HCWs) in developed countries depend on efficient surveillance programs at the workplace. The failure of some hospitals to put on effective infection control procedures and training of staff is hardly justified. Moreover, work organization in hospital is often the root-cause of occupational injuries. It is well known that sleep deprivation and shift work have deleterious effect on level of alertness and performance, and increase the frequency of occupational injuries. However, current regulations allow hospital scheduling that can result in too much time on task, no concessions for time-of-day effect related to work and sleep times, and no concessions for schedules that result in increasing sleep debt. It is worth of note that, once infected by bloodborne pathogens, HCWs are not entitled to the same level of civil rights of people. Federal laws, State statutes, and court decisions, in the intention of attain best protection of the public, often encourage violation of confidence when impaired HCWs are at issue. A recent Opinion of the Council on Ethical and Judicial Affairs (CEJA) (4) states that each physician has an ethical duty to investigate on colleague's health, even if the first report of colleague's illness had been submitted anonymously. According to current recommendations (5), expert panels decide if infected HCWs may continue to perform their practice. In the absence of precise guidelines, such judgement might me vulnerable to the particular biases and experiences of the members of the panel, as well as to conflict of interest of colleagues sitting on such a committee. While the first ethical duty is unquestionably to protect the patient, compromising HCWs' rights could deter them from reporting injuries or undergo serological testing. An intense lobbing action is requested, to balance society's and patient's interests and HCWs rights.

Nicola Magnavita, M.D. Italian Study Group on Hazardous Workers Institute of Occupational Medicine Catholic University School of Medicine, Rome, Italy nmagnavita@rm.unicatt.it nicolamagnavita@tiscali.it


1. Landrum ML, O'Connell RJ, Deye G. Occupational exposure to bloodborne pathogens. Ann Intern Med 2004; 141: 487 2. Behrman AJ, Allan DA. Occupational exposure to bloodborne pathogens. Ann Intern Med 2004; 140: 492 3. Seibert C. Stuck. Ann Intern Med 2003; 138: 765-6 4. Council of Ethical and Judicial Affairs (CEJA): Reporting impaired, incompetent, or unethical colleagues, Amendment. CEJA Opinion 5-A-04. Available at: http://www.ama- assn.org/ama1/pub/upload/mm/369/rprtcolleag_ceja_a04.pdf 5. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposure to HBV, HCV, and HIV and Recommendation for Postexposure Prophylaxis. Centers for Disease Control and Prevention. 29 June 2001. Available at www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm

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Conflict of Interest:

None declared

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