Caro

At press time Vemiont, like most states,
was still working to meet a federally
mandated deadline of October 28 for de-
velopment of guidelines regarding HIV
positive health care workers. State guide-
lines must be similar to those issued by
the Centers for Disease Control
(CDC).Deterring many states from acting
on the mandate is that two sets of guide-
lines come into play, one much more re-
strictive than the other.

The first set of guidelines, issued in July
1991, stopped short of requiring man-
datory testing, but said that HIV positive
health care workers who perform “ex-
posure-prone”procedures should submit
to a “expert review panel” which would
determine whether they could continue to
perform their jobs. If they received panel
approval to continue working, workers
would be required to inform all patients
of their HIV-positive status. President
Bush supported these recommendations
in October 1991, by signing a law re-
quiring‘ states to develop “equivalent”
guidelines within one year.

In December the CDC responded to sharp
criticism of the restrictions by an-
nouncing their intent to develop new
guidelines. Vermont was among a num-
ber of states that postponed action while
awaiting the new guidelines.

A much less restrictive set of guidelines
was issued in June 1992. The compilation
of a list of “exposure-prone” procedures
was deleted as well as the recommenda-
tion that HIV-positive heath care workers

inform their patients. Instead of officially
releasing the new guidelines, the CDC
wrote to state health departments re-
minding them of their obligation to be
consistent with the original guidelines of
July 1991. However, in this and other
communications to state health de-
partments the CDC has indicated that
states may develop less restrictive guide-
lines. In reviewing the guidelines de-
veloped by New York State, CDC Di-
rector William Roper found them to be in
compliance. This is significant in that
New York’s policy is among the least re-
strictive and holds that “HIV or HBV in-
fection alone does not justify lirriiting a
health care worker's professional duties.”

Although Vermont’s policy is at press
time still being drafted, Richard Steen of
the Vermont State Health Department
stated that they have drawn heavily from
guidelines developed by New York and
Michigan (outlined below). Universal
precautions (taking the same precautions
with all patients, regardless of type of in-
fection) is an important part of the pol-
icy.

Highlights of Michigan’s Guidelines:

All health care workers required to ad-
here to universal precautions.

Routine or mandatory testing of health
care workers is opposed.

In general, limiting the practice of HIV-
infected health care workers is in-
appropriate, given the extremely low risk

November 1992

Vermont’s Response to HIV Guidelines

of HIV transmission from worker to pa-
tient as well as the negative consequences
of practice restrictions.

Infected health care workers who perform
invasive or exposure-prone procedures
should continue practicing only after con-
sultation with their personal physician.
The personal physician may wish to con-
sult public health officials or health care
panels.

Highlights of New York’s Guidelines:
Mandatory screening is opposed.

All licensed health care professionals
must undergo formal training infection
control. Health care professionals and in-
stitutions must ensure compliance with
appropriate infection control techniques.
Medical and dental offices are subject to
investigation.

Health care facilities should develop a
mechanism to evaluate HIV or HBV in-
fected health care workers. Evaluation
should be based on the premise that HIV
or HBV infection alone is not sufficient
justification to limit a health care work-
er’s professional duties.

The state health department will establish
a mechanism to provide guidance to
health care workers who voluntarily seek
consultation.

HIV-infected health care workers are not
required to disclose their HIV status to
patients or employers. V

 

EDWARD FLANAGAN

...Because the community counts

“As Vermont’s Auditor, my friend Ed Flanagan will fight to protect the rights of
women and the funds meant to support us.”

“Flanagan is creative and a fighter. He’ll be a strong advocate for human rights in
every office of state government. We need his commitment and talents.”

“Edward Flanagan will invigorate this office_with a fresh, critical and professional
approach. I enthusiastically endorse his candidacy.”

- STATE AUDITOR

Senator Sally Conrad
Governor Philip Hoff '

Governor Howard Dean