VIRAL HEPATITIS WHAT IS VIRAL HEPATITIS ? w HEPATITIS is a serious disease caused by virus that attacks the liver . There are various strains of viral hepatitis which can cause lifelong infection, cirrhosis ( scarring) of the liver , liver cancer , liver failure, and death. w Which strain of hepatitis virus is of greatest concern in the occupational setting, and what is my risk of becoming infected at work ? w HBV is of greatest concern in the occupational setting for several reasons: w (1)there is a relatively high risk of becoming infected following an exposure . In fact , exposure to known contaminated source results in 37-62%likelihood of infection. w (2) the chance of developing clinical hepatitis following exposure is 22-31%. w (3) HBV not only transmitted through percutaneous exposure , but also can be transmitted through surface contact with dried blood or other potentially infectious materials. w (4) HBV infections that occur in workers with no history of nonoccupational exposure or occupational percutaneous injury might have resulted from direct or indirect blood or body fluid exposures that inoculated HBV into cutaneous scratches, abrasions, burns, or other lesions, or on mucosal surfaces HEPATITIS B VIRUS: HOW THE VIRUS REPRODUCES ?? First the virus attached to a liver cell membrane. The virus is then transported into the liver cell The core particle then releases it’s contents of DNA and DNA polymerase into the liver cell nucleus. w Once within the cell nucleus the hepatitis B DNA causes the liver cell to produce, via messenger RNA ; HBs protein , HBc protein , DNA polymerase, the HBe protein , and other undetected protein and enzymes. w DNA polymerase causes the liver cell to make copies of hepatitis B DNA from messenger RNA. The cell then assembles ’live’ copies of virus. However because of the excess numbers of surface proteins produced many of these stick together to form small spheres and chains. These can give a characteristic “ ground glass” appearance to blood samples seen under a microscope. The copies of the virus and excess surface antigen are released from the liver cell membrane into blood stream and from there can infect other liver cells . HEPATITIS B MARKERS: w HBsAg:Present in acute or chronic infection. w HBsAb:Present in recovery or immunization. w Anti -HB Core: May be “Total” (IgG&IgM) or IgM. Lifelong marker of past and active infection in either acute or chronic. w HBeAg:Acute infection, and extremely infectious. w Anti-Hbe: Usually prognostic for resolution. w HAV-Total and HAV-IgM:Anti -HAV. HEPATITIS SEROLOGY: PRACTICE!!!!!!!!!!!!!!! w HBsAg N. w HBcAB (TOTAL) N. w HBsAB N. w HAV-IGM N. w HCV N. w NO evidence of viral hepatitis viruses. w HBsAG N. w HBcAB (TOTAL) P. w HBsAB P. w HAV-IGM N. w HCV N. w PAST INFECTION. w HBsAg N. w HBcAB (total) N. w HBsAB P. w HAV-IGM N. w HCV N. w IMMUNIZATION. w HBsAg P. w HBcAB (Total) P. w HBsAB N. w HAV-IGM N. w HCV N. w MAY BE ACUTE OR CHRONIC. w Order Hep. B Core IgM to clarify. w The IgM will be positive , If Acute. w HBsAg P. w HBcAB (TOTAL) P. w HBsAB N. w HAV-IGM P. w HCV P. w Co infection with HBV, HAV, and HCV w HBsAG P. w HBcAB (total) P. w HBsAB P. w HAV-IGM N. w HCV N. w Past infection with recovery, and then re- infection that has become chronic, this is very rare but does happen. What are the clinical symptoms of Hepatitis B?? How will I keep from becoming infected with HBV at work?? w The primary measure for prevention of hepatitis B is immunization. w Hepatitis B can be prevented using either preexposure prophylaxis with hepatitis vaccine or postexposure prophylaxis with hepatitis B immune globulin and hepatitis vaccine. Are there any other strains of bloodborne hepatitis that are significant in the occupational setting ?? What do I need to know about OSHA’s bloodborne pathogens standard?? w You must understand and follow all workplace rules and policies to prevent exposure to BBP. w Each workplace must have a written exposure control plane (ECP). w An ECP is a comprehensive , workplace- specific document that outlines in detail all measures that will be taken to eliminate or minimize employee exposure. What are the fundamental components of an ECP?? w The 5 fundamental components of an ECP are : w 1.Exposure Determination. w 2.Methods of Compliance. w 3. Hepatitis Vaccination. w 4. Communication of Hazards. w 5. Post Exposure Evaluation and Follow Up. w 1.Exposure Determination: an exposure determination is simply a listing of all employee with occupational exposure (those who may become exposed to blood or OPIM ) , and the tasks and procedures in which exposure may occur . w Methods of Compliance: are all protective work practices, policies, rules, and controls, from the broadest to the most specific. w Broad policies include a statement within the ECP that all employee will follow universal precautions, or that eating , drinking, storing food, mouth pipetting, smoking, applying lip balm, cosmetics, or contact lenses in the work area is prohibited. Specific Practices To Be Utilized in workplace!!!!!!!!!!!! w How to dispose of small amount of regulated waste and remove gloves: How to dispose a larger amounts of regulated waste: w Before removing disposable gloves, gather all contaminated materials together and put them in a biohazard (red) bag. w Make sure the bag intact and that there is no danger of leaking. w Strip off disposable gloves, drop them into the red bag, close the bag by handling only the clean outside surfaces ,do not throw the biohazard bag into the regular trash. w Wash hands with soap and water. w Inform your supervisor so he/she can make arrangements to properly dispose of the biohazard bag. w Place all sharps (Needles, Syringes, Broken Glass, Etc.) into a sharps container. How to wash hand properly?? w Proper handwashing is one of the most important infection control Mesures for employees working with blood or OPIM. w Handwashing facilities must be available within the facility to all employees with occupational exposure. w Wet both hands and wrists. Lather with soap and worm water. w Spread the lather to the back of hands and wrists. Clean the finger tips and between the fingers . Washing time should be at least 15 seconds. w Rinse hands and wrists well to remove the soap. How to clean spills or contaminated surfaces: w The first step is to contain the spill . For small spill , gauze or paper towels should be placed over the blood or OPIM for containment and adsorption. w Next, apply a disinfectant. This can be a 0.5% solution of sodium hypochlorite in water. w Use paper towels or a dust pan and broom to remove the materials. w Dispose of the contaminated materials in a properly labeled waste container. w Once contaminated materials are removed from the surface, reapply the sterilant and allow ten minutes before wiping again. What the third fundamental components of an ECP?? w (3) Hepatitis B Vaccination: The vaccin is given in three stages. w (1) The initial injection. w (2) A second injection one month later. w (3) A third injection 6 months after the first injection. What is hepatitis B vaccine? w Hepatitis B vaccine has been available since 1982. w Made with recombinant DNA technology, and contain protein portions of HBV. w The vaccine administrated IM w usually given on schedule of 0,1,6 months Who should be vaccinated? w Everyone 18 years of age and younger w over 18 years of age who are at risk for HBV infection, which include : @ sexually active heterosexual adults with more than one sex partner in the prior 6 months, or have a history of sexually transmitted disease. @ Homosexual and bisexual men @ drug users @ person at occupational risk of infection @ hemodialysis patients @ household and sex contacts of persons with chronic HBV infection 4.Communication of Hazards w This part of the ECP describes labeling w The biohazard legend must be placed on all containers of blood or OPIM. w The container for storage , transport , or shipping shall bear this label 5.Post exposure evaluation and follow-up w An exposure incident is a specific eye, mouth, other mucous membrane, non intact skin, or parenteral (e.g. needle stick) w Immediately wash the affected body part with soap and water w Notify your supervisor w It is essential to ensure the proper medical evaluation and follow up FACTS: w Hepatitis B can be prevented with a safe and effective vaccine. w You cannot get hepatitis B from the hepatitis B vaccine. w Hepatitis B virus infects nearly 80,000 people in U.S each year w even if a person infected with Hepatitis B virus does not feel sick , he or she can still infect others FACTS: w Medicare will pay up to 80% of the cost for hepatitis B vaccination for qualifying individuals w Hepatitis B killed over 5,000 in the U.S in 1999 w HBV is found in blood and other body fluids such as semen and vaginal secretions, it is 100 times more infectious than HIV FACTS: w HBV can be transmitted by sexual contact , hepatitis B is the only sexually transmitted disease for which there is a vaccine that offers protection w Infant born to women with HBV infection have a very high chance of getting hepatitis B from their mothers w the hepatitis B vaccine is recognized as the first anti-cancer vaccine, because it can prevent primary liver cancer caused by hepatitis B infection.