Infection Control · patient case question
What infection control precautions are required for this patient?
Patient case: Viral hepatitis and a history of opioid misuse
Patient: Male, 41 years old
Chief complaint: “I need this tooth out, it's been aching for a week.”
History: HIV on antiretroviral therapy. Chronic hepatitis B and hepatitis C co-infection with documented hepatic impairment. History of opioid use disorder, currently in recovery for 18 months.
Findings: Non-restorable tooth #31 with a chronic apical abscess. Moderate pain. INR mildly prolonged at 1.4.
Show answer and explanation
Correct answer: B. Standard precautions
- A. Airborne precautions are for AIRBORNE pathogens — active pulmonary tuberculosis, measles, varicella. Blood-borne viruses are not transmitted by the airborne route.
- B. CORRECT. STANDARD PRECAUTIONS are applied to EVERY patient regardless of known infection status, precisely because a patient's status is often unknown. They fully cover blood-borne viruses — HIV, hepatitis B and hepatitis C — through gloves, mask, eye protection, gown, safe sharps handling, and appropriate instrument reprocessing. No additional precautions are required for blood-borne pathogens.
- C. Hospital treatment is not indicated by blood-borne viral status. It might be considered for severe hepatic coagulopathy, but an INR of 1.4 does not require it.
- D. Deferring care until viral loads fall is discriminatory and clinically unjustified, and it would be an ethical and legal violation. The patient has an active infection needing treatment.
Note: Hepatitis B is the most transmissible of the three by percutaneous exposure, which is why HBV vaccination for dental personnel is mandatory. Post-exposure risk after a needlestick runs roughly: HBV 6–30 percent unvaccinated, HCV about 1.8 percent, HIV about 0.3 percent.
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