AD 2017 Q4

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the risks involved. I do not think
the remainder of the dive team
needs to be notified.
I might go further to recommend
that any divers with HCV and their
designated buddies be required
to carry independent secondary
air sources in case of emergency.
If the HCV-infected diver has
open wounds in the mouth or
nose, I believe he or she should
avoid diving, as this considerably
increases transmission risks.
Sadler: The legal implications are
best considered on a local basis, but
ethically speaking, I oppose putting
people at elevated risk without
their informed consent.
Gish: The risk is extremely low, and
a patient’s privacy is important. In
my opinion this does not need to
be discussed in a public setting, nor
does direct notification need to be
required. HCV is rarely transmitted
other than through direct blood
sharing with sharp instruments,
sexual contact and, rarely, maternal
fetal transmission. No informed
consent or specific alerts need to
take place; this is a private issue
protected by the Health Insurance
Portability and Accountability Act
of 1996 (HIPAA).
Sampath and Mangum: Yes, the
buddy, dive team and divemaster
should be made aware. The
hepatitis C virus can survive outside
the body at room temperature on
environmental surfaces for up to
three weeks. The buddy and dive
team should be made aware of the
potential to have exposure to HCV
so they can knowingly protect
themselves from exposure.
What measures or
accommodations are necessary if
an HCV-infected person is part
of a dive group or dive team?
Homa: Proper education about
transmission of any infectious
agent is critical for divemasters
and instructors. Education is also
important for the diving public
so potential buddies can make
informed decisions about their own
well-being. Besides restrictions
in the case of open wounds in
the mouth or nose, I do not see
any other accommodations that
would need to be made. It might be
reasonable to require divers with
a current HCV infection (and/or
their buddies) to carry their own
secondary air supplies. I would view
such a requirement as extreme, but
it could improve the peace of mind
of other members of the dive team.
Sadler: Accommodations could
include separate or isolated
equipment, baseline and/or routine
screening for the entire team and
enforcement of universal precautions
(antitransmission protocols such as
the use of nitrile gloves implemented
by most public safety agencies). Any
equipment that is shared by a team,
such as a full-face mask, should
be decontaminated with a bleach
solution.
Diving emergencies are random,
potentially deadly and often
occur without warning. There
is no room to hesitate in taking
remedial action. It is imperative
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