HIV TESTING FOR DOCTORS IN PUBLIC HOSPITALS

HIV TESTING FOR DOCTORS IN PUBLIC HOSPITALS: * * *

30.

Mdm Halimah Yacob asked the Minister for Health (a) what is the percentage of doctors in the public hospitals who have gone for HIV testing; (b) if a doctor declines to go for HIV testing and is subsequently found to be HIV positive, what measures will be taken to ascertain whether he has infected any patients; and (c) how will the Ministry trace the patients who have come into contact with such a doctor.

Mr Khaw Boon Wan: Our public hospitals are at different stages of starting voluntary HIV testing for doctors who perform exposure-prone procedures. These are invasive procedures in which injury to the healthcare worker may result in the worker’s blood contaminating a patient’s open tissues. Changi General Hospital was the first to do so when, in August 2007, they included voluntary HIV testing in their annual health screening exercise for all their staff. 57% of their doctors underwent HIV screening. KK Hospital followed suit in October 2007. 30% of their doctors participated. The other hospitals are beginning to implement a similar policy.

The policy is based on the principle that healthcare workers have an ethical obligation to protect the health and safety of their patients. Although the risk of HIV transmission to patients from doctors is tiny, and the risk can be further reduced through stringent infection control measures, we recommend that those who perform exposure-prone procedures should know their HIV status.

The risk has been estimated as in the order of two to 24 per million. In more than 25 years of the HIV epidemic, there have only been three reported cases worldwide of infected healthcare workers transmitting HIV to their patients. In contrast, the risk of transmission from an infected patient to a healthcare worker during an invasive procedure is many times higher, at three per 1000.

Regardless of the source of transmission, the most effective way to prevent HIV transmission in the healthcare setting is to strictly adhere to appropriate infection control

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measures. This would reduce the opportunity of direct exposure to blood and body fluids for both healthcare workers and patients. All healthcare institutions must ensure that their staff practice such standard precautions. Voluntary HIV screening of doctors enhances the prevention strategy as we can then redeploy any HIV infected doctor away from exposure-prone procedures.

If a doctor is found to be HIV-positive, there are several factors to consider when deciding whether his patients have been put at risk: (a) whether the doctor performs exposure-prone procedures, (b) whether there was compliance with infection control precautions, and (c) the clinical status and viral load of the infected doctor.

In line with international best practice, the decision to contact trace and notify the patients of an infected doctor will have to be made on a case-by-case basis. An expert committee will be set up to assess the specific risk in each case. A decision will then be taken based on the committee’s assessment and recommendation.

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