After hearing and incorporating feedback from midwives, stakeholders, and the general public, the College has approved an updated Blood Borne Virus Standard.
The College held a public consultation in October and November 2021 on proposed revisions to the Blood Borne Pathogens standard. During the consultation, we received responses from 23 midwives, one member of the public, and two midwifery stakeholders.
In general, respondents were not supportive of the standard and questioned the relevance of some of its components. Their feedback, and the College’s responses, are listed here:
- The revised standard should not require a disclosure of personal health information. The revised standard does not require the disclosure of personal health information. While the previous version of this standard (in place since 2014) did require midwives to report their seropositive status, the revised standard only requires an annual declaration of compliance.
- A midwife’s blood borne virus status should not be tied to registration status. A midwife’s blood borne virus status is not tied to registration. Midwives will be required to submit an annual declaration that they are complying with the Blood Borne Virus standard. If a midwife chooses not to submit this declaration, it will not affect their registration and they will still be eligible to renew.
- The revised standard is not in line with public health measures of other colleges. No other health care providers require this level of testing. Most other regulated health professions in Ontario are not authorized to perform exposure prone procedures (EPPs), which means their standards do not have to consider the transmission of blood borne viruses. The revisions to the new standard are in line with the other regulators who have memberships with scopes of practice that overlap with the midwifery scope of practice. The revisions are also in line with recommendations from the Public Health Agency of Canada.
- Annual testing for HBV should not be required. Testing should only be done if exposure occurs. The the risk of transmitting the hepatitis B virus (HBV) from an infected midwife to a client is much higher than the other blood borne viruses. Using the evidence around transmissibility, HBV testing is more frequent (every year) and HCV and HIV testing is less frequent (every three years). However, annual testing of HBV is only required for midwives who do not have evidence of HBV immunity. The reason for requiring testing in the absence of a known exposure is that a midwife could be unknowingly exposed to a blood borne virus in situations outside of their midwifery practise.
Based on the feedback we received, we have made the following revisions to the standard:
- Added that there is no need for testing for those with demonstrated immunity to HBV.
- The term “treating physician” was replaced with “treating primary care provider” to reflect that nurse practitioners may also manage the care of a midwife diagnosed with a blood borne virus.
Our next steps in proceeding with the policy:
The approved Blood Borne Viruses standard will be posted to the College’s website, replacing the current version, on June 1, 2022.