Course Book : #119 - Blood Borne Pathogens Update

Blood borne Pathogens Update

Course 119

2 contact hours

 

Upon completion of this course the reader will be able to achieve the following objectives:

  1. Identify what are blood borne pathogens

  2. Understand universal precautions

  3. Understand Hepatitis and the various types

  4. How to protect yourself from blood borne pathogens

  5. Learn about the Hepatitis B vaccine

 

What are Blood Borne Pathogens?

 

Blood borne pathogens are viruses or bacteria that get into the bloodstream and cause disease. If a person comes in contact with blood infected with a blood borne pathogen, he or she may become infected as well. For more on infection control in the workplace, refer to course #113. To learn more about OSHA Regulations and how the laws apply in the workplace setting, refer to course #112.

 

Other body fluids can contain pathogens that may also spread blood borne diseases. These fluids include:

  • Blood products (such as plasma)

  • Semen

  • Vaginal secretions

  • Fluid in the uterus of a pregnant woman

  • Fluids surrounding the brain, spine, heart and joints

  • Fluids in the chest and abdomen

  • Any other fluid that contains visible blood, such as saliva and dental procedures.

 

Many bloodborne diseases are deadly. The risk of blood borne pathogens in the work place is serious. Yet, you can protect yourself by learning effective ways of minimizing your risk. A good place to start is with your employer’s exposure control plan. A copy should be available for you to consult at your workplace during work at all times.

 

 

Always keep in mind that you cannot tell who has a disease just by looking at them. It is impossible to tell who is carrying a blood borne pathogen through medical history or by examination, without the follow up of lab tests.

 

Bloodborne diseases affect all populations, all ages, all socioeconomic classes, from every state and around the world. Many people carry blood borne diseases without any symptoms. Many people have no idea that they are infected since they are asymptomatic.

 

We will explore some blood borne pathogens such as HIV, HBV, and HCV. These are the most prevent in a healthcare setting, and put healthcare workers at the greatest risk for exposure.

 

HIV: the virus that causes AIDS

HBV: Hepatitis B virus, causes serious liver damage

HCV: Hepatitis C causes serious liver disease

 

There are other blood borne pathogens we should be aware of:

These include

  • Hepatitis D

  • Diphtheria

  • Syphilis

  • Herpes

  • Ebola (viral hemorrhagic fever)

  • Malaria

Blood borne pathogens may be found in OPIM’s.

--- Other Potentially Infected Materials

 

These include the body fluids listed above, and also blood on any surface of contamination. In a situation where it is hard to tell body fluid from another, all body fluids should be considered infectious.

 

Universal Precautions

One should know that universal precautions is being replaced with the term, “standard precautions” because standard precautions is implemented through OSHA regulations which covers a BROADER scope of protection for the healthcare worker, and goes a step FARTHER to offer safeguarding measures.

Universal Precautions are the basis of OSHA’s Occupational exposure to blood borne pathogens final rule. For many healthcare workers, following universal precautions and body substance isolation (BSI).

 

What’s the guiding idea behind Universal Precautions?

 

Universal precautions require healthcare workers to treat blood and body fluids as if they are infected with a blood borne pathogen. Universal precautions help protect everyone from exposure of blood borne pathogens through guidelines on:

  • Proper hand washing

  • Use of personal protective equipment

  • Dealing with contaminated laundry and regulated waste

 

 

BODY SUBSTANCE ISOLATION

 

Is another infection control strategy that applies to any moist body matter. This means ALL body fluids and substances are treated as infectious. Body Substance Isolation may be used IN PLACE of Universal Precautions , PROVIDED guidelines for OSHA blood borne pathogens standards are met as well.

 

 

 

Universal precautions came about in 1984 in light of the raising concern of the HIV epidemic. The Center For Disease Control (CDC) recognized there was an urgent need to protect healthcare workers from blood and blood borne pathogens. In 1985 the CDC officially introduced Universal Precautions, as we know it today. It took OSHA and CDC another 6 years to put the FINAL PLAN into action to improve working environments and promote safety in healthcare facilities and for healthcare workers. So, in 1991 the rules became final for OSHA laws and regulations regarding Universal Precautions.

 

Universal Precautions have since been replaced with STANDARD PRECAUTIONS, which goes a step beyond in offering protection to patients and healthcare workers.

 

 

 

What’s the difference between Universal Precautions and Standard Precautions?

 

Universal precautions has stated that blood and body fluids are to be handled as “potentially infectious”, but also states that certain body fluids are NOT covered by Universal Precautions, and DO NOT REQUIRE UNIVERAL PRECAUTIONS such as:

  • Urine

  • Feces

  • Sweat

  • Vomit

  • Saliva

  • Nasal Drainage

  • Tears

 

WOW!!! We know that all of the above are BODY FLUIDS! So why would we NOT want to include them in UNIVERSAL PRECAUTIONS??

 

Well, CDC says, that UNLESS THEY CONTAIN VISIBLE BLOOD THEY DO NOT REQUIRE UNIVERSAL PRECAUTONS.

 

But, Think about this….. If while at work, what do you think would be the types of fluids one would come across in the course of a work day?

 

ALL OF THE ABOVE ARE VERY LIKELY!! Therefore, why should we be less cautious, because they may not contain VISIBLE BLOOD?

 

Standard Precautions are CDC recommendations. Standard Precautions are STRONGLY recommended to keep people safe, because they:

COMBINE the main idea from Universal Precautions and Body Substance Isolation.

 

Standard Precautions apply to blood and body fluid, secretions, excretions, and discharge, WHETHER OR NOT they contain visible blood.

 

So you see, that by using standard precautions we are protecting ourselves to a much higher degree of safety against coming in contact with blood or body fluids.

 

Standard Precautions come into play during ANY procedure where there is a chance of exposure to blood, body fluids, secretions and excretions. Standard Precautions apply to the care of ALL patients whether or not they have a confirmed or suspected infection.

 

Hand Washing

 

Hand washing is the most important link in the prevention of infections.

It is extremely important to wash you hands:

  • Between different patients

  • Anytime you remove a pair of gloves

  • Whenever you have touched blood or OPIM’s

  • Anytime you touch contaminated equipment

  • Between performing different procedures on the same patient

  • Before and after meals

  • And after using the restroom

 

 

There are different LEVELS of hand washing…..

The level of hand washing depends upon what job and procedure you are doing.

  • Routine or simple hand washing is used to remove dirt and transient (passing) germs from the skin using soap and water.

  • Hand antiseptics are used to kill transient germs with antimicrobial soaps or alcohol based hand gels. Remember that hand gels are a temporary solution, until proper hand washing can be done. Hand Gels do not take the place of proper hand washing.

  • Surgical scrubs help kill transient germs as well as those that may live on the skin. This may be done with antimicrobial agents and detergents that require a scrub of 5 or more minutes.

 

Spread of Infection

 

In order for a blood borne pathogen to gain entry into the body, all four of the following MUST be present:

  1. A pathogen must be present

  2. There needs to be a sufficient quantity of the pathogen to cause infection

  3. The person has to be susceptible to the pathogen

  4. There has to be a way for the pathogen to get into the body.

Lets look at these…..

It would make good sense that there must be an infectious pathogen present in order to transmit an infectious disease.

 

It would make sense that a person’s immune system has to be susceptible in order to become infected.

 

It would make sense that there needs to be a way for the infection to get into the body.

 

Now, lets look at “sufficient quantity”… How does one determine how much of a pathogen is needed to cause an infection?

 

Depending on a person’s immunity, what might take only a very small quality to infect one individual, may take a significant amount more for someone else in relatively good health.

So, the bottom line is never take risks, never take chances… when we are told that blood and body fluids are not considered infectious, UNLESS THEY CONTAIN VISIBLE BLOOD, think about the fact that microscopic blood can be present, and since it is unknown how much is a SUFFICIENT QUANITY to cause illness, it definitely makes GOOD SENSE to utilize STANDARD PRECAUTIONS, and treat ALL blood and body fluid as if it IS INFECTIOUS.

 

Hepatitis Update

There is so much to know and learn about the various types of Hepatitis. We will discuss the most common and give an overview of each.

 

Most commonly, we deal with Hepatitis A, B, C. (We also see D and E.. not as common) as well as f and g.

 

What is viral hepatitis?

 

Viral hepatitis is inflammation of the liver caused by a virus. It is common worldwide. It has since become a world wide epidemic affecting all parts of the globe. Until recently, only two types were known… Hepatitis A and Hepatitis B.. Other types were known as Non A, and Non B. New types such as Hepatitis B and E, and the delta agent ( Hepatitis D) have now been discovered and as research continues more viruses which can cause hepatitis infection are being identified. Viruses such as Epstein-Barr virus, cytomegalovirus ( CMV) and yellow fever virus can also infect the liver and produce hepatitis like symptoms.

 

How do you catch viral hepatitis?

 

It can be caught in different ways depending on the type of virus causing the infection. Hepatitis A and E are spread by the consumption of contaminated food or water. Most commonly by fecal-oral route. Hepatitis A is the one we hear about in restaurants where workers use the bathroom, and do not wash hands, therefore, contaminating food products that are ingested. Hepatitis B, C, and D are spread by contact with blood or other body fluids from an infected person. They are all blood borne pathogens.

 

How is a diagnosis of hepatitis made?

 

The diagnosis is confirmed by a blood test. The blood levels of liver enzymes are elevated, particularly when the patient has jaundice. These usually return to normal several weeks after the jaundice and other symptoms subside. Additional blood testing is done to identify the virus causing the acute illness. This is important in Hepatitis B and C, as they can persist and cause chronic infection, and even progresses to death if untreated.

 

What is the treatment for hepatitis?

 

Most patients do fairly well by being at home and on bed rest. Ample bed rest, together with a light diet and avoiding all alcoholic beverages are recommended. Occasionally the patient is hospitalized due to nausea, vomiting and liver failure. There are no specific anti-viral mediations that are used to treat viral hepatitis. Depending on the cause, certain forms of chronic hepatitis may be treated with steroid therapy, interferon, or other anti-viral agents. A liver transplant may be the only hope in cases of severe chronic hepatitis if the liver becomes so diseased, liver failure develops.

 

 

COMPARISON OF THE TYPES OF HEPATITIS ARE SPECIFICALLY OUTLINED IN THE CHART THAT FOLLOWS:

 

HEPATITIS A

Is an inflammation of the liver. This can be caused by alcohol and some drugs, but is most commonly caused by a viral infection.

How it spreads

Hepatitis A virus is a common infection in many parts of the world. It is most commonly transmitted through eating and drinking contaminated food/water.

Hepatitis A is transmitted in feces. It can be passed on even if tiny amounts of feces from a person with Hep A comes in contact with another person’s mouth. The mode is use of the restroom, and not washing hands prior to food preparation. The virus can also be transmitted through anal intercourse.

Signs and symptoms

Persons may have no signs and symptoms at all, but they can still pass on the hepatitis virus to others. Symptoms include:

  • A short, mild flu like illness

  • Nausea and vomiting

  • Diarrhea

  • Loss of appetite

  • Weight loss

  • Jaundice

  • Itchy skin

 

 

Tests available

Hepatitis A can be detected with a blood sample test.

A positive blood test may indicate:

1) that the person has come in contact in the past with Hep A, and the body has cleared it. The person now has a natural immunity against future infection with the Hepatitis A virus.

Current infection:

By the time most people have developed symptoms of Hepatitis A they are less infectious to others, but in the weeks prior to developing symptoms, the person will have been a risk for potentially infecting others. Those who have come in contact can be given an injection to reduce the risk of developing symptoms.

Diagnosis and Treatment

A person with Hepatitis A sometimes require hospitaliz-ation, and can be fatal if untreated. The vaccine is (IG) (Immuno-globulin)

Persons exposed can receive IG within 2 weeks after exposure. Those who may be traveling to foreign countries should be immunized prior to travel. Two doses are given, 6 months apart, for lasting protection. For hepatitis A, a single injection can give immunity for up to a year. A second booster at 6-12 months after the first, can give protection up to 10 years.

 

 

 

Hepatitis B

Hepatitis B is inflammation of the liver. Those with Hep B need to limit alcohol consumption.

This can be caused by alcohol and drugs, but is usually the result of viral infection.

ACTIVE HEP B: a flu like illness that can last for several months. A Chronic carrier is one that may have no symptoms, but is able to infect others. There IS NO CURE for Hep B. But, with proper care, rest, and diet persons infected can recover completely. Some people develop CHRONIC HBV infection, which means they are infected for life. CDC suggests that over 300 million people are chronic Hep B carriers.

How it spreads

Hep B is very common worldwide. It is very infectious. Hep B can be spread by:

  • Unprotect-ed sex

  • Sharing contam-inated needles

  • Non sterile tattoo supplies

  • Infected mother to baby

  • Through blood transfusion

  • Using a razor or toothbrush that is infected by another person

Thousands of healthcare workers get Hep B every year. CDC suggests about 250,000 persons per year become infected!

Hep B is NOT transmitted through casual contact.

Signs and symptoms

Many persons may have no signs and symptoms, but they can still pass the virus to others. Symptoms include:

  • Flu like illness

  • Nausea and vomiting

  • Loss of appetite

  • Weight loss

  • Jaundice

  • Itchy skin

 

Symptoms can take 6 weeks to 6 months to develop. Some people never get symptoms, but can still transmit the virus.

Tests available

Most adults infected with Hepatitis B fully recover and develop life long immunity. Between 2%-10% of infected persons will become chronic carriers, which means they will be infectious to others and can develop chronic liver disease. These include chronic hepatitis, liver cirrhosis and liver cancer.

Diagnosis and treatment

There is a vaccine available to prevent against Hepatitis B. It is highly suggested that all healthcare workers be immunized due to the risk of exposure on the job to blood and body fluids. The series consists of three injections, and the person is not protected unless all three are received. Once exposed, the person will show positive on a blood test, and has natural immunity against Hep B. Sometimes a liver biopsy needs to be done to find the extent of liver damage.

 

 

 

 

HEPATITIS C

Hep C is caused by a virus. Hep C causes liver damage. CDC states that about 33% of those who have HIV also have Hep C.

CDC suggests that about 30,000 persons a year become infected with HCV.

CDC states there are approx. 3.9 million infected HCV persons in the U.S. of which 2.7 million are chronically infected.

Hep C is the leading cause of liver cirrhosis, and liver cancer, and is the leading cause for needed liver transplant

How it spreads

Hepatitis C is transmitted through blood and body fluids, unsafe sex acts, and contaminated blood transfusions. It was not until 1992, that blood was tested when donated for Hep C. The major risk factors include IV drug use, sexual activity, and blood transfusions prior to 1992. Other risk factors include

Hemophilia, hemodialysis,

Organ transplant, and tattoos.

 

Signs and symptoms

many times a person infected with Hepatitis C have no symptoms, yet are very infectious to others. If there are symptoms, they may be flu like, nausea and vomiting, loss of appetite, weight loss, jaundice and itchy skin. CDC says that about 20% of those infected clear the virus from the body, while 80% remain infectious, and if symptoms persist over a number of years they will most likely develop liver cancer, cirrhosis, and be considered “chronically infected”

CDC states that 80% of those with Hep C have NO signs and symptoms.

Tests available

Testing for Hepatitis C has only been available since 1989.The blood test done is a test to detect antibodies to the Hep C virus. Liver function tests are also done to detect the degree of liver damage. Those who clear the infection does NOT mean that they are immune from getting the infection again.

Diagnosis and Treatment

There are no vaccines to prevent against HCV. Prevention is the main key to not getting HCV. HCV persons cannot donate blood, organs, or tissue.

Medication management can include the use of interferon. Hepatitis infected people should NOT drink alcohol, as it can make liver disease worse.

 

 

HEPATITIS D

Is a defective hepatitis that cannot exist unless the person is infected with Hepatitis B. Hepatitis D is referred to as DELTA HEPATITIS. (HDV) is found in the blood as is all other types of hepatitis.

HOW IT SPREADS

Hepatitis D is blood borne, and cannot exist with out a co-infection of Hep B.

Hepatitis D is spread the same way as Hepatitis B.

SIGNS AND SYMPTOMS

It is stated that if a Hepatitis B infected person develops Hepatitis D, they are called “super infections” Chronic liver disease is common with those who have both HBV and HDV.

TESTS AVAILABLE

The test that is done is the test that detects for HBV through a blood sample.

DIAGNOSIS AND TREATMENT

Being Vaccinated against Hepatitis B will prevent the contracting of Hepatitis D.

 

 

 

 

HEPATITIS E

Hepatitis E is not very common and is rarely found in the USA. It is prevalent in India, Asia, Middle East, and Africa, as well as Mexico.

HOW IT SPREADS

Hep. E, (HEV) is transmitted by contaminated water, or contaminated foods. Hep E is transmitted by Fecal-oral route, and is very similar to the data we know about Hep. A.

SIGNS AND SYMPTOMS

Signs and symptoms for Hepatitis E are as those for Hepatitis A.

TESTS AVAILABLE

There is no vaccine for Hep E. Blood tests for the virus of Hep E are not widely available and so the diagnosis is currently made by excluding other causes of viral hepatitis for which blood tests are available.

DIAGNOSING AND TREATMENT

Women should not become pregnant if they have Hep. E, because up to 30% of those pregnant with Hep E have been known to die.

Diagnosis is dependent upon if the person has HBV or not, and treatment is same as HBV .

 

 

As you can see, there are many types of Hepatitis… There are also Hepatitis F and G and H and I !!! Incredible!!

 

Hepatitis F: In 1994 a scientist reported finding viral particles in the stool of post transfusion, non-A, non-B, non-C, non-E, hepatitis cases. Therefore it was labeled as “Hepatitis F” Injection of these particles were given to rhesus monkeys who developed hepatitis. This hepatitis became known as Hepatitis F. There is very little research to support Hepatitis F, and very little is actually known for its existence and modes of transmission, though it is believed to be similar to Hepatitis A in mode of transmission being Fecal-Oral route. In 1993, Japan scientists reported a study that the Hepatitis F virus might actually be a mutant of HBV.

 

Hepatitis G is also a scientific mystery as well. With little research and little known about Hepatitis G, It is considered the NEWEST form of known Hepatitis. Transmission is believed to be through blood exposure and is seen in IV drug users, individuals with clotting disorders such as hemophilia, and individuals who require hemodialysis for renal failure.

 

LEARN ABOUT THE HEPATITIS B VACCINE

 

The HBV vaccine is your best protection against HBV. The vaccine is given in a series of doses. Unless you receive all three doses you will not be protected from the HBV virus. Many people require a booster shot later on.

In order to know if you need a booster shot, you will have to have a blood test, known as a titer drawn to see if you still have antibodies in the blood to ward off HBV pathogens. It is not known how long the series may offer protection, as some studies suggest 5-10 years, when others say “indefinite”. If you have had the Hepatitis series, a booster is recommended every five years. A blood titer should be done to see if there are still immune antibodies present.

 

Those allergic to yeast cannot take the vaccinations. Those who are pregnant should not be vaccinated.

 

Keep in mind that there are no vaccines for Hepatitis C or HIV. You must continue to use standard precautions even if you have had the Hepatitis B series of vaccinations, to prevent other types of exposure to other blood borne pathogens.

 

Ways to protect yourself

 

We have learned a great deal about Universal and Standard Precautions. The only way to protect yourself is to take all necessary precautions- NOT CHANCES! Learn all you can about Blood Borne Pathogens.

READ- read your employers exposure control plan, and be familiar with policy and procedure in your place of employment.

 

RESEARCH- stay up to date and current by staying in contact with the CDC website. www.cdc.org

 

CONSULT- consult your supervisor, medical director, or infection control department to learn more and stay up to date on diseases and blood borne pathogens.

 

CONTACT- contact your state’s local health department to obtain valuable materials.

 

CALL- call the CDC for more information at 1-800-342-2437.

 

Remember to follow standard precautions, wash your hands, cover wounds, cuts and scrapes or any open sores.

 

Also important to practice good housekeeping by cleaning up spills and contaminated areas properly and promptly. Dispose of sharps in proper sharps boxes, and dispose of infectious waste and laundry per your facilities protocol.

A final thought.. Keep in mind that “wet” blood on any surface can contain both HIV and HBV, as well as any other blood borne pathogen it may be harboring. Once the blood has dried, it will no longer be able to contain HIV, as HIV requires a wet surface to survive. But, if there is hepatitis present in the blood, it can remain infectious for a period of 30 days regardless if the blood is wet or dry.

 

 

Summary

 

Although the body’s natural defense system defends well against disease, pathogens can still enter the body and cause infections. These pathogens can enter by direct contact, indirect contact, inhaling air exhaled by an infectious person, and through a bite of an infected animal or insect.

 

OSHA has issued regulations for on-the-job exposure to blood borne pathogens. OSHA has determined that employees face a significant risk to exposure on- the- job. OSHA concludes that your risk can be minimized or even removed using a combination of engineering controls and safe work practices, as well as the use of PPE. ( Personal Protective Equipment)

 

If you suspect or have come in contact with an exposure, always document the incident fully, notify your supervisor immediately, and seek medical attention without delay to participate in follow up care and procedures.

 

References:

 

Occupational Safety Health Administration

www.osha.gov

Preventing Disease Transmission

American Red Cross, 1993 edition

Staywell publications

 

www.muschealth.com

 

www.olddoc.idv.tw.com

 

www.aegis.com

 

www.avert.org

 

Blood borne Pathogens Update

Course 119

2 contact hours

 

Upon completion of this course the reader will be able to achieve the following objectives:

  1. Identify what are blood borne pathogens

  2. Understand universal precautions

  3. Understand Hepatitis and the various types

  4. How to protect yourself from blood borne pathogens

  5. Learn about the Hepatitis B vaccine

 

What are Blood Borne Pathogens?

 

Blood borne pathogens are viruses or bacteria that get into the bloodstream and cause disease. If a person comes in contact with blood infected with a blood borne pathogen, he or she may become infected as well. For more on infection control in the workplace, refer to course #113. To learn more about OSHA Regulations and how the laws apply in the workplace setting, refer to course #112.

 

Other body fluids can contain pathogens that may also spread blood borne diseases. These fluids include:

  • Blood products (such as plasma)

  • Semen

  • Vaginal secretions

  • Fluid in the uterus of a pregnant woman

  • Fluids surrounding the brain, spine, heart and joints

  • Fluids in the chest and abdomen

  • Any other fluid that contains visible blood, such as saliva and dental procedures.

 

Many bloodborne diseases are deadly. The risk of blood borne pathogens in the work place is serious. Yet, you can protect yourself by learning effective ways of minimizing your risk. A good place to start is with your employer’s exposure control plan. A copy should be available for you to consult at your workplace during work at all times.

 

 

Always keep in mind that you cannot tell who has a disease just by looking at them. It is impossible to tell who is carrying a blood borne pathogen through medical history or by examination, without the follow up of lab tests.

 

Bloodborne diseases affect all populations, all ages, all socioeconomic classes, from every state and around the world. Many people carry blood borne diseases without any symptoms. Many people have no idea that they are infected since they are asymptomatic.

 

We will explore some blood borne pathogens such as HIV, HBV, and HCV. These are the most prevent in a healthcare setting, and put healthcare workers at the greatest risk for exposure.

 

HIV: the virus that causes AIDS

HBV: Hepatitis B virus, causes serious liver damage

HCV: Hepatitis C causes serious liver disease

 

There are other blood borne pathogens we should be aware of:

These include

  • Hepatitis D

  • Diphtheria

  • Syphilis

  • Herpes

  • Ebola (viral hemorrhagic fever)

  • Malaria

Blood borne pathogens may be found in OPIM’s.

--- Other Potentially Infected Materials

 

These include the body fluids listed above, and also blood on any surface of contamination. In a situation where it is hard to tell body fluid from another, all body fluids should be considered infectious.

 

Universal Precautions

One should know that universal precautions is being replaced with the term, “standard precautions” because standard precautions is implemented through OSHA regulations which covers a BROADER scope of protection for the healthcare worker, and goes a step FARTHER to offer safeguarding measures.

Universal Precautions are the basis of OSHA’s Occupational exposure to blood borne pathogens final rule. For many healthcare workers, following universal precautions and body substance isolation (BSI).

 

What’s the guiding idea behind Universal Precautions?

 

Universal precautions require healthcare workers to treat blood and body fluids as if they are infected with a blood borne pathogen. Universal precautions help protect everyone from exposure of blood borne pathogens through guidelines on:

  • Proper hand washing

  • Use of personal protective equipment

  • Dealing with contaminated laundry and regulated waste

 

 

BODY SUBSTANCE ISOLATION

 

Is another infection control strategy that applies to any moist body matter. This means ALL body fluids and substances are treated as infectious. Body Substance Isolation may be used IN PLACE of Universal Precautions , PROVIDED guidelines for OSHA blood borne pathogens standards are met as well.

 

 

 

Universal precautions came about in 1984 in light of the raising concern of the HIV epidemic. The Center For Disease Control (CDC) recognized there was an urgent need to protect healthcare workers from blood and blood borne pathogens. In 1985 the CDC officially introduced Universal Precautions, as we know it today. It took OSHA and CDC another 6 years to put the FINAL PLAN into action to improve working environments and promote safety in healthcare facilities and for healthcare workers. So, in 1991 the rules became final for OSHA laws and regulations regarding Universal Precautions.

 

Universal Precautions have since been replaced with STANDARD PRECAUTIONS, which goes a step beyond in offering protection to patients and healthcare workers.

 

 

 

What’s the difference between Universal Precautions and Standard Precautions?

 

Universal precautions has stated that blood and body fluids are to be handled as “potentially infectious”, but also states that certain body fluids are NOT covered by Universal Precautions, and DO NOT REQUIRE UNIVERAL PRECAUTIONS such as:

  • Urine

  • Feces

  • Sweat

  • Vomit

  • Saliva

  • Nasal Drainage

  • Tears

 

WOW!!! We know that all of the above are BODY FLUIDS! So why would we NOT want to include them in UNIVERSAL PRECAUTIONS??

 

Well, CDC says, that UNLESS THEY CONTAIN VISIBLE BLOOD THEY DO NOT REQUIRE UNIVERSAL PRECAUTONS.

 

But, Think about this….. If while at work, what do you think would be the types of fluids one would come across in the course of a work day?

 

ALL OF THE ABOVE ARE VERY LIKELY!! Therefore, why should we be less cautious, because they may not contain VISIBLE BLOOD?

 

Standard Precautions are CDC recommendations. Standard Precautions are STRONGLY recommended to keep people safe, because they:

COMBINE the main idea from Universal Precautions and Body Substance Isolation.

 

Standard Precautions apply to blood and body fluid, secretions, excretions, and discharge, WHETHER OR NOT they contain visible blood.

 

So you see, that by using standard precautions we are protecting ourselves to a much higher degree of safety against coming in contact with blood or body fluids.

 

Standard Precautions come into play during ANY procedure where there is a chance of exposure to blood, body fluids, secretions and excretions. Standard Precautions apply to the care of ALL patients whether or not they have a confirmed or suspected infection.

 

Hand Washing

 

Hand washing is the most important link in the prevention of infections.

It is extremely important to wash you hands:

  • Between different patients

  • Anytime you remove a pair of gloves

  • Whenever you have touched blood or OPIM’s

  • Anytime you touch contaminated equipment

  • Between performing different procedures on the same patient

  • Before and after meals

  • And after using the restroom

 

 

There are different LEVELS of hand washing…..

The level of hand washing depends upon what job and procedure you are doing.

  • Routine or simple hand washing is used to remove dirt and transient (passing) germs from the skin using soap and water.

  • Hand antiseptics are used to kill transient germs with antimicrobial soaps or alcohol based hand gels. Remember that hand gels are a temporary solution, until proper hand washing can be done. Hand Gels do not take the place of proper hand washing.

  • Surgical scrubs help kill transient germs as well as those that may live on the skin. This may be done with antimicrobial agents and detergents that require a scrub of 5 or more minutes.

 

Spread of Infection

 

In order for a blood borne pathogen to gain entry into the body, all four of the following MUST be present:

  1. A pathogen must be present

  2. There needs to be a sufficient quantity of the pathogen to cause infection

  3. The person has to be susceptible to the pathogen

  4. There has to be a way for the pathogen to get into the body.

Lets look at these…..

It would make good sense that there must be an infectious pathogen present in order to transmit an infectious disease.

 

It would make sense that a person’s immune system has to be susceptible in order to become infected.

 

It would make sense that there needs to be a way for the infection to get into the body.

 

Now, lets look at “sufficient quantity”… How does one determine how much of a pathogen is needed to cause an infection?

 

Depending on a person’s immunity, what might take only a very small quality to infect one individual, may take a significant amount more for someone else in relatively good health.

So, the bottom line is never take risks, never take chances… when we are told that blood and body fluids are not considered infectious, UNLESS THEY CONTAIN VISIBLE BLOOD, think about the fact that microscopic blood can be present, and since it is unknown how much is a SUFFICIENT QUANITY to cause illness, it definitely makes GOOD SENSE to utilize STANDARD PRECAUTIONS, and treat ALL blood and body fluid as if it IS INFECTIOUS.

 

Hepatitis Update

There is so much to know and learn about the various types of Hepatitis. We will discuss the most common and give an overview of each.

 

Most commonly, we deal with Hepatitis A, B, C. (We also see D and E.. not as common) as well as f and g.

 

What is viral hepatitis?

 

Viral hepatitis is inflammation of the liver caused by a virus. It is common worldwide. It has since become a world wide epidemic affecting all parts of the globe. Until recently, only two types were known… Hepatitis A and Hepatitis B.. Other types were known as Non A, and Non B. New types such as Hepatitis B and E, and the delta agent ( Hepatitis D) have now been discovered and as research continues more viruses which can cause hepatitis infection are being identified. Viruses such as Epstein-Barr virus, cytomegalovirus ( CMV) and yellow fever virus can also infect the liver and produce hepatitis like symptoms.

 

How do you catch viral hepatitis?

 

It can be caught in different ways depending on the type of virus causing the infection. Hepatitis A and E are spread by the consumption of contaminated food or water. Most commonly by fecal-oral route. Hepatitis A is the one we hear about in restaurants where workers use the bathroom, and do not wash hands, therefore, contaminating food products that are ingested. Hepatitis B, C, and D are spread by contact with blood or other body fluids from an infected person. They are all blood borne pathogens.

 

How is a diagnosis of hepatitis made?

 

The diagnosis is confirmed by a blood test. The blood levels of liver enzymes are elevated, particularly when the patient has jaundice. These usually return to normal several weeks after the jaundice and other symptoms subside. Additional blood testing is done to identify the virus causing the acute illness. This is important in Hepatitis B and C, as they can persist and cause chronic infection, and even progresses to death if untreated.

 

What is the treatment for hepatitis?

 

Most patients do fairly well by being at home and on bed rest. Ample bed rest, together with a light diet and avoiding all alcoholic beverages are recommended. Occasionally the patient is hospitalized due to nausea, vomiting and liver failure. There are no specific anti-viral mediations that are used to treat viral hepatitis. Depending on the cause, certain forms of chronic hepatitis may be treated with steroid therapy, interferon, or other anti-viral agents. A liver transplant may be the only hope in cases of severe chronic hepatitis if the liver becomes so diseased, liver failure develops.

 

 

COMPARISON OF THE TYPES OF HEPATITIS ARE SPECIFICALLY OUTLINED IN THE CHART THAT FOLLOWS:

 

HEPATITIS A

Is an inflammation of the liver. This can be caused by alcohol and some drugs, but is most commonly caused by a viral infection.

How it spreads

Hepatitis A virus is a common infection in many parts of the world. It is most commonly transmitted through eating and drinking contaminated food/water.

Hepatitis A is transmitted in feces. It can be passed on even if tiny amounts of feces from a person with Hep A comes in contact with another person’s mouth. The mode is use of the restroom, and not washing hands prior to food preparation. The virus can also be transmitted through anal intercourse.

Signs and symptoms

Persons may have no signs and symptoms at all, but they can still pass on the hepatitis virus to others. Symptoms include:

  • A short, mild flu like illness

  • Nausea and vomiting

  • Diarrhea

  • Loss of appetite

  • Weight loss

  • Jaundice

  • Itchy skin

 

 

Tests available

Hepatitis A can be detected with a blood sample test.

A positive blood test may indicate:

1) that the person has come in contact in the past with Hep A, and the body has cleared it. The person now has a natural immunity against future infection with the Hepatitis A virus.

Current infection:

By the time most people have developed symptoms of Hepatitis A they are less infectious to others, but in the weeks prior to developing symptoms, the person will have been a risk for potentially infecting others. Those who have come in contact can be given an injection to reduce the risk of developing symptoms.

Diagnosis and Treatment

A person with Hepatitis A sometimes require hospitaliz-ation, and can be fatal if untreated. The vaccine is (IG) (Immuno-globulin)

Persons exposed can receive IG within 2 weeks after exposure. Those who may be traveling to foreign countries should be immunized prior to travel. Two doses are given, 6 months apart, for lasting protection. For hepatitis A, a single injection can give immunity for up to a year. A second booster at 6-12 months after the first, can give protection up to 10 years.

 

 

 

Hepatitis B

Hepatitis B is inflammation of the liver. Those with Hep B need to limit alcohol consumption.

This can be caused by alcohol and drugs, but is usually the result of viral infection.

ACTIVE HEP B: a flu like illness that can last for several months. A Chronic carrier is one that may have no symptoms, but is able to infect others. There IS NO CURE for Hep B. But, with proper care, rest, and diet persons infected can recover completely. Some people develop CHRONIC HBV infection, which means they are infected for life. CDC suggests that over 300 million people are chronic Hep B carriers.

How it spreads

Hep B is very common worldwide. It is very infectious. Hep B can be spread by:

  • Unprotect-ed sex

  • Sharing contam-inated needles

  • Non sterile tattoo supplies

  • Infected mother to baby

  • Through blood transfusion

  • Using a razor or toothbrush that is infected by another person

Thousands of healthcare workers get Hep B every year. CDC suggests about 250,000 persons per year become infected!

Hep B is NOT transmitted through casual contact.

Signs and symptoms

Many persons may have no signs and symptoms, but they can still pass the virus to others. Symptoms include:

  • Flu like illness

  • Nausea and vomiting

  • Loss of appetite

  • Weight loss

  • Jaundice

  • Itchy skin

 

Symptoms can take 6 weeks to 6 months to develop. Some people never get symptoms, but can still transmit the virus.

Tests available

Most adults infected with Hepatitis B fully recover and develop life long immunity. Between 2%-10% of infected persons will become chronic carriers, which means they will be infectious to others and can develop chronic liver disease. These include chronic hepatitis, liver cirrhosis and liver cancer.

Diagnosis and treatment

There is a vaccine available to prevent against Hepatitis B. It is highly suggested that all healthcare workers be immunized due to the risk of exposure on the job to blood and body fluids. The series consists of three injections, and the person is not protected unless all three are received. Once exposed, the person will show positive on a blood test, and has natural immunity against Hep B. Sometimes a liver biopsy needs to be done to find the extent of liver damage.

 

 

 

 

HEPATITIS C

Hep C is caused by a virus. Hep C causes liver damage. CDC states that about 33% of those who have HIV also have Hep C.

CDC suggests that about 30,000 persons a year become infected with HCV.

CDC states there are approx. 3.9 million infected HCV persons in the U.S. of which 2.7 million are chronically infected.

Hep C is the leading cause of liver cirrhosis, and liver cancer, and is the leading cause for needed liver transplant

How it spreads

Hepatitis C is transmitted through blood and body fluids, unsafe sex acts, and contaminated blood transfusions. It was not until 1992, that blood was tested when donated for Hep C. The major risk factors include IV drug use, sexual activity, and blood transfusions prior to 1992. Other risk factors include

Hemophilia, hemodialysis,

Organ transplant, and tattoos.

 

Signs and symptoms

many times a person infected with Hepatitis C have no symptoms, yet are very infectious to others. If there are symptoms, they may be flu like, nausea and vomiting, loss of appetite, weight loss, jaundice and itchy skin. CDC says that about 20% of those infected clear the virus from the body, while 80% remain infectious, and if symptoms persist over a number of years they will most likely develop liver cancer, cirrhosis, and be considered “chronically infected”

CDC states that 80% of those with Hep C have NO signs and symptoms.

Tests available

Testing for Hepatitis C has only been available since 1989.The blood test done is a test to detect antibodies to the Hep C virus. Liver function tests are also done to detect the degree of liver damage. Those who clear the infection does NOT mean that they are immune from getting the infection again.

Diagnosis and Treatment

There are no vaccines to prevent against HCV. Prevention is the main key to not getting HCV. HCV persons cannot donate blood, organs, or tissue.

Medication management can include the use of interferon. Hepatitis infected people should NOT drink alcohol, as it can make liver disease worse.

 

 

HEPATITIS D

Is a defective hepatitis that cannot exist unless the person is infected with Hepatitis B. Hepatitis D is referred to as DELTA HEPATITIS. (HDV) is found in the blood as is all other types of hepatitis.

HOW IT SPREADS

Hepatitis D is blood borne, and cannot exist with out a co-infection of Hep B.

Hepatitis D is spread the same way as Hepatitis B.

SIGNS AND SYMPTOMS

It is stated that if a Hepatitis B infected person develops Hepatitis D, they are called “super infections” Chronic liver disease is common with those who have both HBV and HDV.

TESTS AVAILABLE

The test that is done is the test that detects for HBV through a blood sample.

DIAGNOSIS AND TREATMENT

Being Vaccinated against Hepatitis B will prevent the contracting of Hepatitis D.

 

 

 

 

HEPATITIS E

Hepatitis E is not very common and is rarely found in the USA. It is prevalent in India, Asia, Middle East, and Africa, as well as Mexico.

HOW IT SPREADS

Hep. E, (HEV) is transmitted by contaminated water, or contaminated foods. Hep E is transmitted by Fecal-oral route, and is very similar to the data we know about Hep. A.

SIGNS AND SYMPTOMS

Signs and symptoms for Hepatitis E are as those for Hepatitis A.

TESTS AVAILABLE

There is no vaccine for Hep E. Blood tests for the virus of Hep E are not widely available and so the diagnosis is currently made by excluding other causes of viral hepatitis for which blood tests are available.

DIAGNOSING AND TREATMENT

Women should not become pregnant if they have Hep. E, because up to 30% of those pregnant with Hep E have been known to die.

Diagnosis is dependent upon if the person has HBV or not, and treatment is same as HBV .

 

 

As you can see, there are many types of Hepatitis… There are also Hepatitis F and G and H and I !!! Incredible!!

 

Hepatitis F: In 1994 a scientist reported finding viral particles in the stool of post transfusion, non-A, non-B, non-C, non-E, hepatitis cases. Therefore it was labeled as “Hepatitis F” Injection of these particles were given to rhesus monkeys who developed hepatitis. This hepatitis became known as Hepatitis F. There is very little research to support Hepatitis F, and very little is actually known for its existence and modes of transmission, though it is believed to be similar to Hepatitis A in mode of transmission being Fecal-Oral route. In 1993, Japan scientists reported a study that the Hepatitis F virus might actually be a mutant of HBV.

 

Hepatitis G is also a scientific mystery as well. With little research and little known about Hepatitis G, It is considered the NEWEST form of known Hepatitis. Transmission is believed to be through blood exposure and is seen in IV drug users, individuals with clotting disorders such as hemophilia, and individuals who require hemodialysis for renal failure.

 

LEARN ABOUT THE HEPATITIS B VACCINE

 

The HBV vaccine is your best protection against HBV. The vaccine is given in a series of doses. Unless you receive all three doses you will not be protected from the HBV virus. Many people require a booster shot later on.

In order to know if you need a booster shot, you will have to have a blood test, known as a titer drawn to see if you still have antibodies in the blood to ward off HBV pathogens. It is not known how long the series may offer protection, as some studies suggest 5-10 years, when others say “indefinite”. If you have had the Hepatitis series, a booster is recommended every five years. A blood titer should be done to see if there are still immune antibodies present.

 

Those allergic to yeast cannot take the vaccinations. Those who are pregnant should not be vaccinated.

 

Keep in mind that there are no vaccines for Hepatitis C or HIV. You must continue to use standard precautions even if you have had the Hepatitis B series of vaccinations, to prevent other types of exposure to other blood borne pathogens.

 

Ways to protect yourself

 

We have learned a great deal about Universal and Standard Precautions. The only way to protect yourself is to take all necessary precautions- NOT CHANCES! Learn all you can about Blood Borne Pathogens.

READ- read your employers exposure control plan, and be familiar with policy and procedure in your place of employment.

 

RESEARCH- stay up to date and current by staying in contact with the CDC website. www.cdc.org

 

CONSULT- consult your supervisor, medical director, or infection control department to learn more and stay up to date on diseases and blood borne pathogens.

 

CONTACT- contact your state’s local health department to obtain valuable materials.

 

CALL- call the CDC for more information at 1-800-342-2437.

 

Remember to follow standard precautions, wash your hands, cover wounds, cuts and scrapes or any open sores.

 

Also important to practice good housekeeping by cleaning up spills and contaminated areas properly and promptly. Dispose of sharps in proper sharps boxes, and dispose of infectious waste and laundry per your facilities protocol.

A final thought.. Keep in mind that “wet” blood on any surface can contain both HIV and HBV, as well as any other blood borne pathogen it may be harboring. Once the blood has dried, it will no longer be able to contain HIV, as HIV requires a wet surface to survive. But, if there is hepatitis present in the blood, it can remain infectious for a period of 30 days regardless if the blood is wet or dry.

 

 

Summary

 

Although the body’s natural defense system defends well against disease, pathogens can still enter the body and cause infections. These pathogens can enter by direct contact, indirect contact, inhaling air exhaled by an infectious person, and through a bite of an infected animal or insect.

 

OSHA has issued regulations for on-the-job exposure to blood borne pathogens. OSHA has determined that employees face a significant risk to exposure on- the- job. OSHA concludes that your risk can be minimized or even removed using a combination of engineering controls and safe work practices, as well as the use of PPE. ( Personal Protective Equipment)

 

If you suspect or have come in contact with an exposure, always document the incident fully, notify your supervisor immediately, and seek medical attention without delay to participate in follow up care and procedures.

 

References:

 

Occupational Safety Health Administration

www.osha.gov

Preventing Disease Transmission

American Red Cross, 1993 edition

Staywell publications

 

www.muschealth.com

 

www.olddoc.idv.tw.com

 

www.aegis.com

 

www.avert.org

 

Blood borne Pathogens Update

Course 119

2 contact hours

 

Upon completion of this course the reader will be able to achieve the following objectives:

  1. Identify what are blood borne pathogens

  2. Understand universal precautions

  3. Understand Hepatitis and the various types

  4. How to protect yourself from blood borne pathogens

  5. Learn about the Hepatitis B vaccine

 

What are Blood Borne Pathogens?

 

Blood borne pathogens are viruses or bacteria that get into the bloodstream and cause disease. If a person comes in contact with blood infected with a blood borne pathogen, he or she may become infected as well. For more on infection control in the workplace, refer to course #113. To learn more about OSHA Regulations and how the laws apply in the workplace setting, refer to course #112.

 

Other body fluids can contain pathogens that may also spread blood borne diseases. These fluids include:

  • Blood products (such as plasma)

  • Semen

  • Vaginal secretions

  • Fluid in the uterus of a pregnant woman

  • Fluids surrounding the brain, spine, heart and joints

  • Fluids in the chest and abdomen

  • Any other fluid that contains visible blood, such as saliva and dental procedures.

 

Many bloodborne diseases are deadly. The risk of blood borne pathogens in the work place is serious. Yet, you can protect yourself by learning effective ways of minimizing your risk. A good place to start is with your employer’s exposure control plan. A copy should be available for you to consult at your workplace during work at all times.

 

 

Always keep in mind that you cannot tell who has a disease just by looking at them. It is impossible to tell who is carrying a blood borne pathogen through medical history or by examination, without the follow up of lab tests.

 

Bloodborne diseases affect all populations, all ages, all socioeconomic classes, from every state and around the world. Many people carry blood borne diseases without any symptoms. Many people have no idea that they are infected since they are asymptomatic.

 

We will explore some blood borne pathogens such as HIV, HBV, and HCV. These are the most prevent in a healthcare setting, and put healthcare workers at the greatest risk for exposure.

 

HIV: the virus that causes AIDS

HBV: Hepatitis B virus, causes serious liver damage

HCV: Hepatitis C causes serious liver disease

 

There are other blood borne pathogens we should be aware of:

These include

  • Hepatitis D

  • Diphtheria

  • Syphilis

  • Herpes

  • Ebola (viral hemorrhagic fever)

  • Malaria

Blood borne pathogens may be found in OPIM’s.

--- Other Potentially Infected Materials

 

These include the body fluids listed above, and also blood on any surface of contamination. In a situation where it is hard to tell body fluid from another, all body fluids should be considered infectious.

 

Universal Precautions

One should know that universal precautions is being replaced with the term, “standard precautions” because standard precautions is implemented through OSHA regulations which covers a BROADER scope of protection for the healthcare worker, and goes a step FARTHER to offer safeguarding measures.

Universal Precautions are the basis of OSHA’s Occupational exposure to blood borne pathogens final rule. For many healthcare workers, following universal precautions and body substance isolation (BSI).

 

What’s the guiding idea behind Universal Precautions?

 

Universal precautions require healthcare workers to treat blood and body fluids as if they are infected with a blood borne pathogen. Universal precautions help protect everyone from exposure of blood borne pathogens through guidelines on:

  • Proper hand washing

  • Use of personal protective equipment

  • Dealing with contaminated laundry and regulated waste

 

 

BODY SUBSTANCE ISOLATION

 

Is another infection control strategy that applies to any moist body matter. This means ALL body fluids and substances are treated as infectious. Body Substance Isolation may be used IN PLACE of Universal Precautions , PROVIDED guidelines for OSHA blood borne pathogens standards are met as well.

 

 

 

Universal precautions came about in 1984 in light of the raising concern of the HIV epidemic. The Center For Disease Control (CDC) recognized there was an urgent need to protect healthcare workers from blood and blood borne pathogens. In 1985 the CDC officially introduced Universal Precautions, as we know it today. It took OSHA and CDC another 6 years to put the FINAL PLAN into action to improve working environments and promote safety in healthcare facilities and for healthcare workers. So, in 1991 the rules became final for OSHA laws and regulations regarding Universal Precautions.

 

Universal Precautions have since been replaced with STANDARD PRECAUTIONS, which goes a step beyond in offering protection to patients and healthcare workers.

 

 

 

What’s the difference between Universal Precautions and Standard Precautions?

 

Universal precautions has stated that blood and body fluids are to be handled as “potentially infectious”, but also states that certain body fluids are NOT covered by Universal Precautions, and DO NOT REQUIRE UNIVERAL PRECAUTIONS such as:

  • Urine

  • Feces

  • Sweat

  • Vomit

  • Saliva

  • Nasal Drainage

  • Tears

 

WOW!!! We know that all of the above are BODY FLUIDS! So why would we NOT want to include them in UNIVERSAL PRECAUTIONS??

 

Well, CDC says, that UNLESS THEY CONTAIN VISIBLE BLOOD THEY DO NOT REQUIRE UNIVERSAL PRECAUTONS.

 

But, Think about this….. If while at work, what do you think would be the types of fluids one would come across in the course of a work day?

 

ALL OF THE ABOVE ARE VERY LIKELY!! Therefore, why should we be less cautious, because they may not contain VISIBLE BLOOD?

 

Standard Precautions are CDC recommendations. Standard Precautions are STRONGLY recommended to keep people safe, because they:

COMBINE the main idea from Universal Precautions and Body Substance Isolation.

 

Standard Precautions apply to blood and body fluid, secretions, excretions, and discharge, WHETHER OR NOT they contain visible blood.

 

So you see, that by using standard precautions we are protecting ourselves to a much higher degree of safety against coming in contact with blood or body fluids.

 

Standard Precautions come into play during ANY procedure where there is a chance of exposure to blood, body fluids, secretions and excretions. Standard Precautions apply to the care of ALL patients whether or not they have a confirmed or suspected infection.

 

Hand Washing

 

Hand washing is the most important link in the prevention of infections.

It is extremely important to wash you hands:

  • Between different patients

  • Anytime you remove a pair of gloves

  • Whenever you have touched blood or OPIM’s

  • Anytime you touch contaminated equipment

  • Between performing different procedures on the same patient

  • Before and after meals

  • And after using the restroom

 

 

There are different LEVELS of hand washing…..

The level of hand washing depends upon what job and procedure you are doing.

  • Routine or simple hand washing is used to remove dirt and transient (passing) germs from the skin using soap and water.

  • Hand antiseptics are used to kill transient germs with antimicrobial soaps or alcohol based hand gels. Remember that hand gels are a temporary solution, until proper hand washing can be done. Hand Gels do not take the place of proper hand washing.

  • Surgical scrubs help kill transient germs as well as those that may live on the skin. This may be done with antimicrobial agents and detergents that require a scrub of 5 or more minutes.

 

Spread of Infection

 

In order for a blood borne pathogen to gain entry into the body, all four of the following MUST be present:

  1. A pathogen must be present

  2. There needs to be a sufficient quantity of the pathogen to cause infection

  3. The person has to be susceptible to the pathogen

  4. There has to be a way for the pathogen to get into the body.

Lets look at these…..

It would make good sense that there must be an infectious pathogen present in order to transmit an infectious disease.

 

It would make sense that a person’s immune system has to be susceptible in order to become infected.

 

It would make sense that there needs to be a way for the infection to get into the body.

 

Now, lets look at “sufficient quantity”… How does one determine how much of a pathogen is needed to cause an infection?

 

Depending on a person’s immunity, what might take only a very small quality to infect one individual, may take a significant amount more for someone else in relatively good health.

So, the bottom line is never take risks, never take chances… when we are told that blood and body fluids are not considered infectious, UNLESS THEY CONTAIN VISIBLE BLOOD, think about the fact that microscopic blood can be present, and since it is unknown how much is a SUFFICIENT QUANITY to cause illness, it definitely makes GOOD SENSE to utilize STANDARD PRECAUTIONS, and treat ALL blood and body fluid as if it IS INFECTIOUS.

 

Hepatitis Update

There is so much to know and learn about the various types of Hepatitis. We will discuss the most common and give an overview of each.

 

Most commonly, we deal with Hepatitis A, B, C. (We also see D and E.. not as common) as well as f and g.

 

What is viral hepatitis?

 

Viral hepatitis is inflammation of the liver caused by a virus. It is common worldwide. It has since become a world wide epidemic affecting all parts of the globe. Until recently, only two types were known… Hepatitis A and Hepatitis B.. Other types were known as Non A, and Non B. New types such as Hepatitis B and E, and the delta agent ( Hepatitis D) have now been discovered and as research continues more viruses which can cause hepatitis infection are being identified. Viruses such as Epstein-Barr virus, cytomegalovirus ( CMV) and yellow fever virus can also infect the liver and produce hepatitis like symptoms.

 

How do you catch viral hepatitis?

 

It can be caught in different ways depending on the type of virus causing the infection. Hepatitis A and E are spread by the consumption of contaminated food or water. Most commonly by fecal-oral route. Hepatitis A is the one we hear about in restaurants where workers use the bathroom, and do not wash hands, therefore, contaminating food products that are ingested. Hepatitis B, C, and D are spread by contact with blood or other body fluids from an infected person. They are all blood borne pathogens.

 

How is a diagnosis of hepatitis made?

 

The diagnosis is confirmed by a blood test. The blood levels of liver enzymes are elevated, particularly when the patient has jaundice. These usually return to normal several weeks after the jaundice and other symptoms subside. Additional blood testing is done to identify the virus causing the acute illness. This is important in Hepatitis B and C, as they can persist and cause chronic infection, and even progresses to death if untreated.

 

What is the treatment for hepatitis?

 

Most patients do fairly well by being at home and on bed rest. Ample bed rest, together with a light diet and avoiding all alcoholic beverages are recommended. Occasionally the patient is hospitalized due to nausea, vomiting and liver failure. There are no specific anti-viral mediations that are used to treat viral hepatitis. Depending on the cause, certain forms of chronic hepatitis may be treated with steroid therapy, interferon, or other anti-viral agents. A liver transplant may be the only hope in cases of severe chronic hepatitis if the liver becomes so diseased, liver failure develops.

 

 

COMPARISON OF THE TYPES OF HEPATITIS ARE SPECIFICALLY OUTLINED IN THE CHART THAT FOLLOWS:

 

HEPATITIS A

Is an inflammation of the liver. This can be caused by alcohol and some drugs, but is most commonly caused by a viral infection.

How it spreads

Hepatitis A virus is a common infection in many parts of the world. It is most commonly transmitted through eating and drinking contaminated food/water.

Hepatitis A is transmitted in feces. It can be passed on even if tiny amounts of feces from a person with Hep A comes in contact with another person’s mouth. The mode is use of the restroom, and not washing hands prior to food preparation. The virus can also be transmitted through anal intercourse.

Signs and symptoms

Persons may have no signs and symptoms at all, but they can still pass on the hepatitis virus to others. Symptoms include:

  • A short, mild flu like illness

  • Nausea and vomiting

  • Diarrhea

  • Loss of appetite

  • Weight loss

  • Jaundice

  • Itchy skin

 

 

Tests available

Hepatitis A can be detected with a blood sample test.

A positive blood test may indicate:

1) that the person has come in contact in the past with Hep A, and the body has cleared it. The person now has a natural immunity against future infection with the Hepatitis A virus.

Current infection:

By the time most people have developed symptoms of Hepatitis A they are less infectious to others, but in the weeks prior to developing symptoms, the person will have been a risk for potentially infecting others. Those who have come in contact can be given an injection to reduce the risk of developing symptoms.

Diagnosis and Treatment

A person with Hepatitis A sometimes require hospitaliz-ation, and can be fatal if untreated. The vaccine is (IG) (Immuno-globulin)

Persons exposed can receive IG within 2 weeks after exposure. Those who may be traveling to foreign countries should be immunized prior to travel. Two doses are given, 6 months apart, for lasting protection. For hepatitis A, a single injection can give immunity for up to a year. A second booster at 6-12 months after the first, can give protection up to 10 years.

 

 

 

Hepatitis B

Hepatitis B is inflammation of the liver. Those with Hep B need to limit alcohol consumption.

This can be caused by alcohol and drugs, but is usually the result of viral infection.

ACTIVE HEP B: a flu like illness that can last for several months. A Chronic carrier is one that may have no symptoms, but is able to infect others. There IS NO CURE for Hep B. But, with proper care, rest, and diet persons infected can recover completely. Some people develop CHRONIC HBV infection, which means they are infected for life. CDC suggests that over 300 million people are chronic Hep B carriers.

How it spreads

Hep B is very common worldwide. It is very infectious. Hep B can be spread by:

  • Unprotect-ed sex

  • Sharing contam-inated needles

  • Non sterile tattoo supplies

  • Infected mother to baby

  • Through blood transfusion

  • Using a razor or toothbrush that is infected by another person

Thousands of healthcare workers get Hep B every year. CDC suggests about 250,000 persons per year become infected!

Hep B is NOT transmitted through casual contact.

Signs and symptoms

Many persons may have no signs and symptoms, but they can still pass the virus to others. Symptoms include:

  • Flu like illness

  • Nausea and vomiting

  • Loss of appetite

  • Weight loss

  • Jaundice

  • Itchy skin

 

Symptoms can take 6 weeks to 6 months to develop. Some people never get symptoms, but can still transmit the virus.

Tests available

Most adults infected with Hepatitis B fully recover and develop life long immunity. Between 2%-10% of infected persons will become chronic carriers, which means they will be infectious to others and can develop chronic liver disease. These include chronic hepatitis, liver cirrhosis and liver cancer.

Diagnosis and treatment

There is a vaccine available to prevent against Hepatitis B. It is highly suggested that all healthcare workers be immunized due to the risk of exposure on the job to blood and body fluids. The series consists of three injections, and the person is not protected unless all three are received. Once exposed, the person will show positive on a blood test, and has natural immunity against Hep B. Sometimes a liver biopsy needs to be done to find the extent of liver damage.

 

 

 

 

HEPATITIS C

Hep C is caused by a virus. Hep C causes liver damage. CDC states that about 33% of those who have HIV also have Hep C.

CDC suggests that about 30,000 persons a year become infected with HCV.

CDC states there are approx. 3.9 million infected HCV persons in the U.S. of which 2.7 million are chronically infected.

Hep C is the leading cause of liver cirrhosis, and liver cancer, and is the leading cause for needed liver transplant

How it spreads

Hepatitis C is transmitted through blood and body fluids, unsafe sex acts, and contaminated blood transfusions. It was not until 1992, that blood was tested when donated for Hep C. The major risk factors include IV drug use, sexual activity, and blood transfusions prior to 1992. Other risk factors include

Hemophilia, hemodialysis,

Organ transplant, and tattoos.

 

Signs and symptoms

many times a person infected with Hepatitis C have no symptoms, yet are very infectious to others. If there are symptoms, they may be flu like, nausea and vomiting, loss of appetite, weight loss, jaundice and itchy skin. CDC says that about 20% of those infected clear the virus from the body, while 80% remain infectious, and if symptoms persist over a number of years they will most likely develop liver cancer, cirrhosis, and be considered “chronically infected”

CDC states that 80% of those with Hep C have NO signs and symptoms.

Tests available

Testing for Hepatitis C has only been available since 1989.The blood test done is a test to detect antibodies to the Hep C virus. Liver function tests are also done to detect the degree of liver damage. Those who clear the infection does NOT mean that they are immune from getting the infection again.

Diagnosis and Treatment

There are no vaccines to prevent against HCV. Prevention is the main key to not getting HCV. HCV persons cannot donate blood, organs, or tissue.

Medication management can include the use of interferon. Hepatitis infected people should NOT drink alcohol, as it can make liver disease worse.

 

 

HEPATITIS D

Is a defective hepatitis that cannot exist unless the person is infected with Hepatitis B. Hepatitis D is referred to as DELTA HEPATITIS. (HDV) is found in the blood as is all other types of hepatitis.

HOW IT SPREADS

Hepatitis D is blood borne, and cannot exist with out a co-infection of Hep B.

Hepatitis D is spread the same way as Hepatitis B.

SIGNS AND SYMPTOMS

It is stated that if a Hepatitis B infected person develops Hepatitis D, they are called “super infections” Chronic liver disease is common with those who have both HBV and HDV.

TESTS AVAILABLE

The test that is done is the test that detects for HBV through a blood sample.

DIAGNOSIS AND TREATMENT

Being Vaccinated against Hepatitis B will prevent the contracting of Hepatitis D.

 

 

 

 

HEPATITIS E

Hepatitis E is not very common and is rarely found in the USA. It is prevalent in India, Asia, Middle East, and Africa, as well as Mexico.

HOW IT SPREADS

Hep. E, (HEV) is transmitted by contaminated water, or contaminated foods. Hep E is transmitted by Fecal-oral route, and is very similar to the data we know about Hep. A.

SIGNS AND SYMPTOMS

Signs and symptoms for Hepatitis E are as those for Hepatitis A.

TESTS AVAILABLE

There is no vaccine for Hep E. Blood tests for the virus of Hep E are not widely available and so the diagnosis is currently made by excluding other causes of viral hepatitis for which blood tests are available.

DIAGNOSING AND TREATMENT

Women should not become pregnant if they have Hep. E, because up to 30% of those pregnant with Hep E have been known to die.

Diagnosis is dependent upon if the person has HBV or not, and treatment is same as HBV .

 

 

As you can see, there are many types of Hepatitis… There are also Hepatitis F and G and H and I !!! Incredible!!

 

Hepatitis F: In 1994 a scientist reported finding viral particles in the stool of post transfusion, non-A, non-B, non-C, non-E, hepatitis cases. Therefore it was labeled as “Hepatitis F” Injection of these particles were given to rhesus monkeys who developed hepatitis. This hepatitis became known as Hepatitis F. There is very little research to support Hepatitis F, and very little is actually known for its existence and modes of transmission, though it is believed to be similar to Hepatitis A in mode of transmission being Fecal-Oral route. In 1993, Japan scientists reported a study that the Hepatitis F virus might actually be a mutant of HBV.

 

Hepatitis G is also a scientific mystery as well. With little research and little known about Hepatitis G, It is considered the NEWEST form of known Hepatitis. Transmission is believed to be through blood exposure and is seen in IV drug users, individuals with clotting disorders such as hemophilia, and individuals who require hemodialysis for renal failure.

 

LEARN ABOUT THE HEPATITIS B VACCINE

 

The HBV vaccine is your best protection against HBV. The vaccine is given in a series of doses. Unless you receive all three doses you will not be protected from the HBV virus. Many people require a booster shot later on.

In order to know if you need a booster shot, you will have to have a blood test, known as a titer drawn to see if you still have antibodies in the blood to ward off HBV pathogens. It is not known how long the series may offer protection, as some studies suggest 5-10 years, when others say “indefinite”. If you have had the Hepatitis series, a booster is recommended every five years. A blood titer should be done to see if there are still immune antibodies present.

 

Those allergic to yeast cannot take the vaccinations. Those who are pregnant should not be vaccinated.

 

Keep in mind that there are no vaccines for Hepatitis C or HIV. You must continue to use standard precautions even if you have had the Hepatitis B series of vaccinations, to prevent other types of exposure to other blood borne pathogens.

 

Ways to protect yourself

 

We have learned a great deal about Universal and Standard Precautions. The only way to protect yourself is to take all necessary precautions- NOT CHANCES! Learn all you can about Blood Borne Pathogens.

READ- read your employers exposure control plan, and be familiar with policy and procedure in your place of employment.

 

RESEARCH- stay up to date and current by staying in contact with the CDC website. www.cdc.org

 

CONSULT- consult your supervisor, medical director, or infection control department to learn more and stay up to date on diseases and blood borne pathogens.

 

CONTACT- contact your state’s local health department to obtain valuable materials.

 

CALL- call the CDC for more information at 1-800-342-2437.

 

Remember to follow standard precautions, wash your hands, cover wounds, cuts and scrapes or any open sores.

 

Also important to practice good housekeeping by cleaning up spills and contaminated areas properly and promptly. Dispose of sharps in proper sharps boxes, and dispose of infectious waste and laundry per your facilities protocol.

A final thought.. Keep in mind that “wet” blood on any surface can contain both HIV and HBV, as well as any other blood borne pathogen it may be harboring. Once the blood has dried, it will no longer be able to contain HIV, as HIV requires a wet surface to survive. But, if there is hepatitis present in the blood, it can remain infectious for a period of 30 days regardless if the blood is wet or dry.

 

 

Summary

 

Although the body’s natural defense system defends well against disease, pathogens can still enter the body and cause infections. These pathogens can enter by direct contact, indirect contact, inhaling air exhaled by an infectious person, and through a bite of an infected animal or insect.

 

OSHA has issued regulations for on-the-job exposure to blood borne pathogens. OSHA has determined that employees face a significant risk to exposure on- the- job. OSHA concludes that your risk can be minimized or even removed using a combination of engineering controls and safe work practices, as well as the use of PPE. ( Personal Protective Equipment)

 

If you suspect or have come in contact with an exposure, always document the incident fully, notify your supervisor immediately, and seek medical attention without delay to participate in follow up care and procedures.

 

References:

 

Occupational Safety Health Administration

www.osha.gov

Preventing Disease Transmission

American Red Cross, 1993 edition

Staywell publications

 

www.muschealth.com

 

www.olddoc.idv.tw.com

 

www.aegis.com

 

www.avert.org