Hepatitis B and exposure prone procedures. (new guidelines implemented in Britain in July 1994) (Editorial)

By this month all of Britain's surgeons undertaking exposure prone procedures should be immune to hepatitis B--either through natural immunity or after a course of immunisation.(1)(2)(3) Government guidelines make exceptions for staff who fail to respond to the vaccine and those who are positive for hepatitis B surface antigen--provided that they are negative for hepatitis B e antigen. The guidelines' aim is to identify and exclude any health care worker who is positive for hepatitis B e antigen from performing procedures in which injury to the worker could result in blood contaminating the patient's open tissue.

Two short papers in this week's journal suggest that implementing these guidelines has not been without problems. Poole and colleagues report that four surgeons needed six or nine doses of vaccine (instead of the usual three) to develop adequate immunity; two consultant surgeons refused either to be vaccinated or to provide evidence of immunity (p 94).(4) In another report Hassan and Oldham describe one health care worker who …