At its meeting in late March, the College Council approved a new policy “Blood-borne Viruses:  Screening, Reporting and Monitoring of Physicians/Medical Students” and Bylaw 24.1 “Reporting of Blood-borne viruses”.  The policy will come into force on the date when the amended Bylaw 24.1 is published in the Saskatchewan Gazette, anticipated to be sometime in June 2021.

Background

The College recognized that its existing policy “Hepatitis B/C/HIV-Infected Physicians/Medical Students and Physician/Medicals Students With AIDS ” and bylaw 24.1 “Reporting of Blood Borne Infections” were outdated and needed to be brought in line with current privacy and human rights principles.  While the College has a statutory mandate to ensure public protection including protection from the risk of transmission of blood-borne viruses (BBVs) by a physician/medical student, it must balance that requirement with the interests of physicians/medical students in practising their profession and maintaining the confidentiality of their personal health information.  As such, the College recognized that it does not need to collect information about physician status for BBVs unless that physician’s practice includes some potential risk for transmission.  The new policy and amended bylaw are therefore designed to be less intrusive into physicians’ personal health.

This work was delayed as the College awaited publication of the Public Health Agency of Canada (PHAC) Guideline on the Prevention of Transmission of Bloodborne Viruses from Infected Healthcare Workers in Healthcare Settings, 2019[1].  In addition to the PHAC document, guidance was also drawn from the Society for Healthcare Epidemiology of America (SHEA)[2]  and the UK Advisory Panel (UKAP) guidance BBVs in healthcare workers: health clearance and management.[3]

Primary changes in approach,

Consistent with the existing policy and bylaw, physicians and medical students who perform or may perform exposure prone procedures (EPPs), or who assist or may assist in performing exposure-prone procedures (EPPs) as defined in the policy are responsible to know their status, and to report their seropositive status.  The primary changes that will come with the new policy and amended bylaw are threefold:

1. 1. Monitoring- This will be performed on an arm’s length basis by the Physician Health Program (PHP), rather than through the Registrar’s office. The PHP will apply guidelines agreed upon by the Expert Advisory Committee on Blood Borne Communicable Diseases (EAC), or will consult as needed on a non-nominal basis with the EAC. The PHP will provide written instructions to the reporting physician/medical student and will require a written commitment of compliance. Provided the physician/medical student remains compliant with the treatment protocol directed by their treating physician and the PHP instructions, and their viral loads remain the safe range as designated by the EAC, there will be no further College involvement aside from annual reporting at licence renewal.
   
2. 2. Testing schedule - Instead of the general responsibility that physicians/medical students who perform or assist in performing EPPs know their status (as included in the current policy), a specific testing schedule has now been established: annually for HBV (unless confirmed to be immune), q3 yearly for HCV and HIV. This schedule is consistent with those of several other Canadian medical regulators who have similar policies.
   
3. 3. Reporting - Reporting of seropositive status is only required for physicians/medical students who perform or may perform / assist or may assist in performing EPPs. This is a change from the current bylaw which requires reporting by every seropositive physician, whether or not their practice includes EPPs.
   

EPPs

As noted above, the application of the testing and reporting requirements depends on whether a physician or medical student’s practice includes (or could include) performing or assisting in performing EPPs.  While the policy includes a more detailed definition of EPPs, the overarching principles are as follows:

Exposure-prone procedures (EPPs) are interventions where there is a risk that injury to the physician may result in the exposure of the patient’s open tissues to the physician’s blood or body fluid.

The College recommends that physicians discuss this within their various departments and then to consider it in the context of their own individual practice.  Physicians will need to apply their medical judgment in determining whether their practice includes or may include EPPs.

Going forward

The Council Committee on Physician Health is now focused on updating the health-related licensure renewal questions to bring those in line with the new policy and bylaw 24.1  This will ultimately result in an amendment to bylaw 3.1.  While this work is underway, any changes will not be approved by the Ministry in sufficient time to incorporate them in the renewal platform prior to the 2021-2022 renewal process. 

We will circulate an opportunity for feedback on the proposed updated health-related renewal questions in due course, and we would welcome your participation in that process.