Testing healthcare staff for infection with HIV and hepatitis: logistic and ethical considerations.

Introduction The issue ofwhether to test healthcare workers for the presence of blood borne viruses arouses much controversy and indignation. Unfortunately, the heat of this debate has often been fuelled by media sensationalisAn or medical examples of shroud waving, which have served to obfuscate the real issues which lie at the heart ofthis proposal. This review will focus on three virus infections, HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). To examine the ethical considerations involved in this question properly, it is necessary to understand the natural history, potential for vaccination and available treatment of each of these conditions, as well as review the evidence that an infected healthcare worker poses any risk to the health of their patients. Only on this basis can one judge whether or not mandatory testing of healthcare workers will benefit the individual healthcare worker and/or their employees and/or their patients and/or society at large. By examining the pros and cons of such proposed testing regimes for each of these groups, a balanced decision on the ethical issues can be reached. Once the ethical balances have been set, it will be possible to assess the logistics and costs in obtaining this supposed benefit which would accrue from the testing of healthcare workers. In the real life debate, this decision and who makes it seems most likely to determine the future course of policy and practice.