July 11th, 2012
By Jennifer Olin, BSN, RN
For the first time in over 20 years the US Centers for Disease Control and Prevention (CDC) has updated its recommendations for the management of hepatitis B virus (HBV) for infected healthcare providers and students to prevent HBV transmission. They were published on July 6 in the CDC's Morbidity and Mortality Weekly Report.
"The primary goal of this report is to promote patient safety while providing risk management and practice guidance to HBV-infected health-care providers and students, particularly those performing exposure-prone procedures such as certain types of surgery," writes Scott D. Holmberg, MD and colleagues.
What is Hepatitis
HBV is just one strain of hepatitis, which is an inflammation of the liver, most commonly caused by a viral infection. HBV is one of the five main hepatitis viruses, referred to as types A, B, C, D and E. These five types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread.
Hepatitis types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.
Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C, and D usually occur as a result of parenteral contact with infected body fluids.
The most common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.
Acute infections may occur with limited or no symptoms, or may include symptoms such as jaundice, dark urine, extreme fatigue, nausea, vomiting, and abdominal pain.
For a closer look:
Hepatitis B and Healthcare Workers
Back in the 1980s, 17,000 healthcare workers a year would contract HBV and up to 300 each year would die from the infection. In fact, the nickname for Hepatitis B during this era was the "healthcare workers" disease.
In 1991 the Occupational Safety and Health Administration’s Bloodborne Pathogen Standard (BBP) was passed requiring employers to provide the vaccine free of charge to all workers with the possibility of exposure during the course of their work. The incidence of occupational hepatitis B infections declined dramatically, from more than 17,000 cases in 1983, before the availability of the vaccine, to 400 in 1995 — a 95% decline and an amazing example of an OSHA success.
As of 2007, an estimated 75% of healthcare workers in the US have been vaccinated against hepatitis B. The vaccination process includes a course of three injections given with the second injection at least one month after the first dose and the third injection given six months after the first dose.
However, those guidelines have not eliminated the disease, only made us safer in caring for patients and ourselves when it comes to exposure to the virus.
According to the authors of the new CDC recommendations, as with the previous 1991 guidelines, HBV infection should not disqualify individuals from practicing in healthcare fields.
"Because percutaneous injuries sustained by health-care personnel during certain surgical, obstetrical, and dental procedures provide a potential route of HBV transmission to patients as well as providers, this report emphasizes prevention of operator injuries and blood exposures…” they added.
Changes to the previous recommendations include:
As nurses we are taught to use Universal Precautions with every patient. This doesn’t mean being standoffish or not touching our patients with our bare hands it just means being careful and using common sense. That combined with the right vaccines will keep you working in healthcare for as long as you choose.