Examples of serious infections that are cause for concern:
(1) HIV, especially with high viral loads
(2) hepatitis B, e antigen positive
(3) hepatitis C
(4) multi-drug resistant organisms
Consultation with a specialist in Occupational Health or Infection Control should be done to determine the potential risks for transmission and suitable compensatory behaviors:
(1) adherence to routine infection control measures, including optimum use of personal protective equipment for self and others
(2) not engage in any activity that has an identified risk of disease transmission to others
(3) modification and adjustment of work practices to minimize chance of transmission
(4) re-assignment or restriction to other duties with acceptable risks
Factors influencing decisions:
(1) duration of practitioner's infectivity
(2) manner of spread for the infectious agent
(3) probable duration and potential seriousness of infection if transmitted
(4) susceptibility of patient to infection
(5) presence of effective therapeutic agents
(6) ability to identify transmission by laboratory tests or other means
(7) compliance of practitioner to recommended infection control procedures
(8) criteria for removal of restrictions
Areas of particular concern:
(1) performance of invasive and exposure-prone procedures
(2) adjustments during periods with an increased chance for transmission, such as large areas of broken skin or bleeding
(3) adjustment during episodes of concurrent infections
Procedures not considered exposure prone provided routine infection control measures are adhered to at all times:
(1) procedures where the hands and fingertips of the practitioner are visible and outside of the patient at all times
(2) internal examinations or procedures that do not require the use of sharp instruments
Other concerns:
(1) need for informed consent from patients if a certain risk threshhold might be exceeded
(2) maintaining the confidentiality of the infected practitioner's medical information
