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					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.

				
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