Ali Hashtroudi Guy’s & St Thomas’ NHS OHS FOM Representative to UKAP EPP Clearance HEOPS 12/01/2018 Ali Hashtroudi Guy’s & St Thomas’ NHS OHS FOM Representative to UKAP

Patient safety ~ Restriction Background Exposure prone procedure Bleed back = inside AND not see AND sharp Purpose Patient safety ~ Restriction

New Guidance HBV Natural history Different markers Acute vs. chronic HBsAg HBsAb HBeAg HBeAb HBcAb HBV DNA

Review HBV HBsAg + =infected HBsAb >10 =immune HBeAg + = highly infective HBeAb useless HBcAb + = past exposure HBV DNA VL = the higher VL the more infective geq/ mL ~ IU/mL, conversion 3 to 5

Existing Guidance HBV New HBsAg -, cleared HBsAg + ↓ HBeAg +, can’t do EPP HBeAg – HBV DNA VL <103 geq 103 and 105 >105

Existing Guidance HBV New HBV DNA VL ↓ <103 geq 103 and 105 >105 ↓ ↓ ↓ Cleared Annual HBV DNA VL, 2 samples by the ref labs Antiviral treatment VL <103 Cleared Quarterly HBV DNA VL 1 sample by the ref labs Can’t do EPP

Existing Guidance HBV New HBsAg -, cleared HBsAg + ↓ HBeAg +, can’t do EPP HBeAg – HBV DNA VL <103 geq 103 and 105 >105 HBsAg -, cleared HBsAg + ↓ HBeAg, role? HBV DNA VL <103 geq (200 IU) >103

Existing Guidance HBV New HBV DNA VL ↓ <103 geq 103 and 105 >105 ↓ ↓ ↓ HBV DNA VL ↓ <103 geq >103 ↓ ↓ Cleared Annual HBV DNA VL, 2 samples by the ref labs Can’t do EPP Antiviral treatment When VL <103 cleared for EPP Quarterly HBV DNA VL 1 sample by the ref labs Can’t do EPP Cleared Annual HBV DNA VL, 2 samples by local lab Can’t do EPP Antiviral treatment Can do EPP when VL <103 Quarterly HBV DNA VL 1 sample by local lab

New Guidance HBV Treatment is only to allow EPP Not clinically indicated Guidance on how to deal with increasing HBV DNA Reference lab if >60 Designated hepatologist ?? 4 weeks between two initial samples to clear Specialist OHP UKAP Register New system of reminders

HIV HIV Ag/Ab-, cleared HIV Ag/Ab + ↓ HIV RNA VL <200 >200 ↓ ↓ <200 >200 ↓ ↓ Can do EPP Elite controller Quarterly monitoring local lab Can’t do EPP ART Can do EPP when VL <200 Quarterly monitoring local lab

Guidance HIV Action points at 50 (consider repeat) and 200 (repeat) and 1000 (stop, repeat, risk assess) Liaison with HIV specialist IVS?? Three month (12 to 16 weeks) between two initial samples to clear Quarterly (10 to 14 weeks) monitoring Specialist OHP UKAP Register New system of reminders

HCV HCV Ab-, cleared HCV Ab + ↓ HCV RNA PCR Negative Positive ↓ ↓ ↓ ↓ Cleared (Hx) No monitoring Can’t do EPP Antiviral treatment Can do EPP when PCR negative for 6/12 post treatment, one additional review 6/12 later (one year post treatment), no further monitoring

Others Consolidated guidance is Green Book style Look back exercise Transfer Plan how to deal with BFE Recall system, new UKAPOHR reminder Conditions = consent to communicate/ attendance / reporting accidents / reporting change in health / adherent to treatment

Thanks you Aliasad.hashtroudi@gstt.nhs.uk