Which healthcare worker with an active viral illness should be excluded from patient care?

• A. Hepatitis C virus (HCV)
• B. Cytomegalovirus
• C. Hepatitis A virus (HAV)
• D. Genital herpes simplex virus

Answer: (C)

The key concept here is determining when a healthcare worker with an active viral illness poses a transmission risk to patients and should be excluded from direct care. The most concerning factor is how easily the virus spreads through common routes in a healthcare setting.

Hepatitis A is transmitted primarily via the fecal-oral route and is shed in stool during the illness. This makes even routine patient contact and environmental contamination a plausible route for spreading the infection to patients, especially those who are more vulnerable. Because of this high potential for transmission, active Hepatitis A infection is a clear reason to exclude a worker from patient care until they’re no longer contagious, following local policies on return to work.

Hepatitis C, on the other hand, is mainly transmitted through blood. With standard precautions and no active bleeding or other symptoms increasing exposure risk, an employee with Hepatitis C can often continue providing patient care. Cytomegalovirus is commonly present and can be shed in bodily fluids, but outbreaks in typical healthcare settings are not driven by routine patient contact in the same way as fecal-oral pathogens, so exclusion isn’t routinely required solely for CMV. Genital herpes simplex virus is contagious during active lesions or viral shedding in the affected area; if a worker has active lesions, patient-contact activities involving those areas should be avoided, but when lesions are not present, return to care can be considered with appropriate precautions.

So, the best answer is the worker with active Hepatitis A, due to its high transmissibility via the fecal-oral route and the resulting justification to exclude from patient care during the contagious period.