1. 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

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

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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. Thanks you