Murlidhar, V: Manual for health-care workers (HCW’s) on blood – borne viral occupational disease. Participatory research in Asia (PRIA), 42 Tughlakabad Institutional Area, New Delhi 110 062.

A manual detailing measures to prevent the transmission of blood borne viruses in the health-care setting benefits health workers, patients and the general public. In the absence of such protective measures, the health worker is at risk of infection while performing various procedures, and the infected worker poses a risk to patients. Inappropriately discarded hospital waste also exposes the public to infection.

Occupational health is a medical ethics issue. The health-care industry’s commitment to resources protecting its workers from occupational illness reflects the importance it gives to the people who provide care. In this country, many health-care institutions place a low priority on protective equipment for their staff. Shortages of basic protective equipment are routine in public health services. It is common to find laboratory workers handling blood specimens without gloves. Few hospitals offer their staff the Hepatitis B vaccine free of charge. A small minority of hospitals follow guidelines on infectious waste disposal. All this emphasises the powerlessness of health-care workers as a group.

In the case of blood-borne infections such as HIV, the absence of basic protective equipment also reinforces irrational and discriminatory testing practices on patients. Hospitals which routinely test their patients for HIV without their consent may give the impression that staff welfare is a concern (1), though this practice is both unethical and useless.

The manual presents a wealth of information on three subjects: the epidemiology of occupationally acquired, blood-borne infections (HIV, HBV and HCV), preventive practices, and specific measures for post exposure prophylaxis.

The epidemiological information presented in the manual, on the risks of transmission of blood-borne viral infections, comes from health-care settings in developed countries. The author notes that there is anecdotal evidence of occupationally-acquired HIV infection among health-care workers in Mumbai, Ahmedabad and Vellore, and that two cases of occupationally-acquired HIV infection have been reported in a major medical college hospital, but provides no further details. The author mentions that such incidents are hushed up in India.

What are the ground realities of such occupationally-acquired infections in India? It is very likely that many health-care workers are exposed to, and infected with, these and other pathogens in the course of their work. It is also more than likely that such infected workers receive little or no treatment from their employers. This subject deserves discussion in the manual.

The discussion on personal protective equipment, decontamination and sterilisation could benefit from comments relating ideal circumstances to ground realities. There is also a need to differentiate between the responsibilities of the health care institution and those of the health-care worker.

A great deal of information has been packed into less than 40 pages. The manual would benefit from editing and design inputs. Essential instructions on prevention and post-exposure prophylaxis should be presented in simple charts in order to be of benefit to the health-care worker.