What precautions are necessary for a 1-year-old child with Hepatitis C Virus (HCV) positive status undergoing surgery?

Perioperative Precautions for HCV-Positive 1-Year-Old Child

Standard universal precautions for bloodborne pathogens are sufficient for a 1-year-old HCV-positive child undergoing surgery, as HCV is not transmitted by casual contact and poses minimal risk to healthcare workers when proper infection control measures are followed. 1

Key Surgical Precautions

Blood and Body Fluid Precautions

• All surgical staff must use standard universal precautions including gloves (preferably latex), goggles/masks when splashing is possible, and water-repellent gowns or plastic aprons during procedures involving blood or body fluid contact 1, 2
• Hand washing is mandatory before and after any contact with blood and body fluids, even when gloves are worn 2
• All specimens must be treated as biohazardous material 2
• Infectious waste protocols apply to all refuse and surgical linens 2

Sharps and Needlestick Prevention

• Meticulous attention to sharps handling is critical, as percutaneous exposure is the primary transmission route for HCV 2
• All surgical instruments and sharps must be handled with extreme care to prevent needlestick injuries 1, 2
• Establish clear institutional protocols for postexposure management should any healthcare worker sustain a needlestick or mucosal exposure 1

Important Clinical Context

HCV Does Not Contraindicate Surgery

• Surgery is NOT contraindicated in children with chronic HCV infection 1
• Solid organ transplantation and bone marrow transplantation are also not contraindicated in HCV-positive children 1

Preoperative Assessment Considerations

• Review liver biochemistries (albumin, aminotransferases, total bilirubin, INR, platelet count) to assess hepatic function and disease severity 1
• Children with HCV typically appear clinically well, with hepatomegaly occurring in ≤10% of patients 1
• Hepatotoxic drugs should be used with caution after assessing risks versus benefits, though corticosteroids, cytotoxic chemotherapy, and therapeutic doses of acetaminophen are not contraindicated 1

Anesthesia Considerations

• If the child has cirrhosis (uncommon at age 1), assess for varices and hepatocellular carcinoma per standard recommendations 1
• Coagulation parameters (INR, platelet count) should be optimized if abnormal 1

Common Pitfalls to Avoid

Do NOT Over-Isolate or Restrict

• HCV is NOT transmitted by casual contact - the child poses no transmission risk through routine perioperative care 1
• Negative pressure rooms are NOT required for HCV-positive patients (this is only necessary for airborne pathogens like COVID-19 or tuberculosis) 1
• Special isolation beyond standard universal precautions is unnecessary and inappropriate 1, 2

Do NOT Delay Necessary Surgery

• There is no medical indication to postpone necessary surgical procedures based solely on HCV-positive status 1
• The surgical urgency should be determined by the underlying surgical condition, not the HCV status 1

Postexposure Management Protocol

Should any healthcare worker experience needlestick or mucosal exposure during the procedure:

• Baseline anti-HCV and ALT testing for the exposed worker 1
• Follow-up anti-HCV testing at 4-6 months and ALT monitoring 1
• HCV RNA testing can be performed at 4-6 weeks if earlier diagnosis is desired 1
• No postexposure prophylaxis (immunoglobulin or antivirals) is recommended for HCV exposure 1

Family Education

• Reassure parents that their child can safely undergo surgery with standard precautions 1
• Educate about universal precautions for bloodborne pathogen transmission: covering open wounds, cleaning blood-contaminated surfaces with dilute bleach, and avoiding sharing personal hygiene items (toothbrushes, razors, nail clippers) 1