Guidelines for Health Care Workers with Herpes Lesions
This Operational Circular is designed to advise Department of Health staff on Departmental policies and procedures and may contain advice that is not appropriate in other circumstances.
Worldwide, 50 to 90% of adults carry Herpes Simplex Virus-1(HSV-1). The initial infection most commonly occurs in the first five years of life.1 Primary infection may be mild and inapparent but overt disease may appear as an illness of varying severity. Herpes simplex virus-2 (HSV-2) is usually acquired sexually in early adulthood, often in people with pre-existing HSV-1 infection, and most transmission occurs via asymptomatic viral shedding in skin or genital secretions.
Herpes simplex virus (HSV) infects the skin and sensory neurons of the dorsal root ganglia, where it causes lifelong latent infection. The virus is often reactivated, resulting in spread of the virus down neuronal axons in spinal or trigeminal nerves, either to be shed asymptomatically in saliva (HSV1) or genital secretions (HSV-2), or to cause overt disease of the skin, mucosa and, occasionally, major organs.2,3
Facial Herpes is most often caused by HSV-1; HSV-2 may cause primary infection of the oral cavity, typically in association with oro-genital sex, but recurrent disease in this location due to HSV-2 is very rare.5
To provide Health Care Workers (HCWs) who have Herpes lesions with the recommended guidelines for preventing the transmission of the virus in the workplace.
||HCWs with HSV lesions of the hand (herpetic whitlow), the face, or other exposed areas, and who has direct patient contact should be advised that there is a potential cross infection risk. However, transmission of herpes in the health care setting is uncommon as it requires direct transfer of the virus from an active lesion to broken skin or a mucosal surface. Patient to staff infection is more common that vice versa. The risk of secondary spread is greater to patients who are immunocompromised.|
||A HSV lesion should be considered infectious until the lesion has become crusted and dry (weeping from under the crust is potentially infectious).|
||Any HCW with direct patient contact and who has a suspected HSV lesion of the hands should report to the designated Staff Health Officer of their institution, e.g. Infection Control Professional or Staff Occupational Health Medical Officer or Nurse.|
||HSV infections involving mucosal sites, i.e genital or oro-facial are not readily transmissible to a patient during routine care. Standard precautions are adequate protection.|
||Infection Control Precautions in Newborn Nurseries|
||HSV in the newborn varies in prevalence around the world, from 1 in 2,500 live births in the United States to 1 in 13,000 births in Australia.2 Transmission of HSV in newborn nurseries from infected staff to newborns has been documented. The risk of transmission to infants by personnel who have oro-labial HSV infection (e.g. cold sores) or who shed virus asymptomatically from the mouth, is low. Compromising patient care by excluding personnel with cold sores who are essential for the operation of the nursery must be weighed against the potential risk of infecting newborns.|
||Hands (herpetic whitlow)|
The risk of transmission from an active herpetic whitlow to a patient, especially a newborn is higher. There should be no direct patient contact until the lesions have healed.
||Avoid hand contact with the oro-facial lesions. Personnel with cold sores who have contact with infants should cover the lesions with an appropriate dressing (e.g. impermeable dressing) and ensure that they do not touch their lesions. They should comply strictly with Standard Precautions, especially hand hygiene policies.|
||To assist in the prevention of the transmission of HSV, non-sterile gloves should be worn by HCWs for procedures where contamination with saliva is likely, e.g. suctioning and saliva.|
||Consideration should be given to the exclusion of HCWs with active oro-facial or hand lesions from direct care for patients with the following conditions:4
- Women during delivery.
- Neonates requiring special care or intensive care.
- Immunosuppressed patients (e.g. oncology, patients requiring intensive care, post-organ transplant, HIV/AIDS).
- Patients with dermatologic conditions (e.g. dermatitis).
- Burns patients.
- Patients having ophthalmic procedures.
||HCWs are reminded that asymptomatic shedding from all forms of HSV is still the most common form of transmission. Therefore close contact, e.g. kissing may spread infection to an immunosuppressed person.|
||Currently, there is no evidence that personnel with genital infections pose a risk to patients provided that they wash their hands before attending each patient.|
Dr Shirley Bowen
COMMUNICABLE DISEASE CONTROL DIRECTORATE
BIBLIOGRAPHY / REFERENCES:
||Chin J, (ed) 2000, Control of communicable diseases manual, 17th ed. American Public Health Association; Washington, DC: 257-261.
||Dwyer, D E and Cunningham, A L. 2002, Herpes simplex and varicella-zoster virus, Practise Essentials-infectious Diseases. MJA, Vol 177, No (5) pp 267-273.
||Picking L K, (ed) 2003, Red Book: Report of the Committee on Infectious Diseases. 26th ed American Academy of Paediatrics. Herpes Simplex. American Academy of Paediatrics; 2003:344-353.
||Communicable Disease Network Australia 2002. Draft: Infection control guidelines for the prevention of transmission of infectious diseases in the health care setting Australian Government Publishing Services, Canberra.http://www.health.gov.au/pubhlth/strateg/communic/review/
||Lafferty, W E, Coombs, R W, Benedetti J, Critchlow C and Corey L. (1987) Recurrences after oral and genital herpes simplex virus infection. Influence of site infection and viral type. New England Journal of Medicine 316;1444-9.