UK policy

Current UK Department of Health policy¹ states that all healthcare workers are under ethical and legal duties to protect the health and safety of their patients. Nonetheless, provided infection control precautions are adhered to, the majority of procedures in the healthcare setting pose no risk of HIV transmission from an infected healthcare worker to a patient.

The policy states that transmission could only take place during ‘exposure-prone procedures’ in which injury to the healthcare worker could result in the worker’s blood contaminating the patient’s open tissues. These procedures involve a combination of sharps (scalpels, needles, etc.) and the worker’s hands being in a body cavity. As the mouth is included as a body cavity, many dental procedures are defined as 'exposure-prone'.

There is a total ban on HIV-positive healthcare workers performing exposure-prone activities, a position which is regarded by many experts as unjustified.

Exposure-prone procedures are defined as those invasive procedures where there is a risk that injury to the worker may result in the exposure of the patient’s open tissues to the blood of the worker. (This is described as 'bleed-back'.) These include procedures where the worker’s gloved hands may be in contact with sharp instruments, needle tips or sharp tissues (e.g. fragments of bone or teeth) inside a patient’s open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times.

Procedures where the hands and fingertips of the worker are visible and outside the patient’s body at all times, as well as internal examinations or procedures that do not involve possible injury to the hands are not considered to be exposure-prone provided routine infection control procedures are adhered to.

It is the responsibility of HIV-positive healthcare workers to seek occupational health advice. However, all healthcare workers who are new to the NHS are offered a voluntary HIV test and, in the case of new workers who will perform exposure-prone procedures, this test is compulsory.²

Not all countries have such restrictive policies. For example, in relation to dentistry, in the United States, Australia and around half the European countries, HIV-positive dentists are permitted to practise. Moreover in 2009, representatives from a number of countries (excluding the UK) signed up to the ‘Beijing Declaration’ which states that there is no risk to patients as long as an HIV-positive dentist acts appropriately and follows standard infection control procedures.³