Viral Hepatitis is caused by many viruses (A to G), but Hepatitis B (previously serum hepatitis/ Australian antigen) is a serious disease and an ongoing concern in health care facilities.

Transmission

Although the Hepatitis B antigen (HBV) can be present in virtually all body fluids of an infected individual, blood/ blood products and semen are considered the most infectious. The virus can survive in dried blood on a surface for up to seven days under optimal conditions. Before a vaccine was available in 1981, in the United States, there were 15-18,000 HBV infections diagnosed each year in health care workers (HCW) through sharps injuries and blood splashes on mucous membranes (eye/mouth/nose). Transmission in the community occurs through the use of, or sharing of non-sterile needles (IV drugs/tattooing/acupuncture) and by unprotected sex. Transmission to a newborn can also occur during pregnancy and delivery if the mother has HBV. It is endemic in some areas of the world such as Africa, the Middle East and Asia, with 8-15% of the population infected with the HBV virus.

Symptoms:

Acute Hepatitis B can present with a variety of symptoms such as jaundice, dark urine, pale stools, nausea, malaise, anorexia, right upper quadrant discomfort, rash or hives with itching, fever, headache or joint pain. However, 50-60% of infected people may have an unrecognized, subclinical illness ("indigestion" or "the flu"). If the infection lasts beyond 6 months, it is considered to be chronic hepatitis.

Outcomes after acute Hepatitis B infection:

85% completely recover

10% have chronic persistent hepatitis with a delayed recovery

4% develop chronic active hepatitis leading to cirrhosis and/or liver cancer

1% have an acute, fulminant disease leading to death due to liver failure

Incubation period:

The development of symptoms after exposure to the HBV can be from 45-180 days, and rarely up to 9 months. Since 1969, all blood donated in Canada has been tested for HBV, however, if donated after the time of infection, but before antibodies have developed, the virus may not be detected. The questionnaire and nursing interview at clinics is used to identify these donors.

Recommendations to prevent the transmission of HBV:

1. Staff with significant contact to blood /body fluids should be vaccinated. Protective antibodies develop in 90-95% of healthy individuals after 3 doses of HBV vaccine.. Booster doses are no longer recommended.

2. Body substance precautions must be used with all patients, regardless of the diagnosis.

3. When appropriate, personal protective equipment (goggles, masks, shields, gloves ) must be worn.

4. Spills/splashes of body fluids must be contained, cleaned and disinfected immediately using a 1:100 dilution of sodium hypochlorite (bleach), a phenolic (DOC).

5. Items grossly soiled with large amounts of blood, such as surgical drapes/dressings or clotted circuits are biohazardous and are placed in yellow bags for disposal.

6. Care must be taken to maintain the sterility of multi-dose vials, such as Heparin or Xylocaine.

7. Shared equipment (vacutainer holders, accuchecks) should be disinfected between patients.

Management after an exposure:

TTH "rapid response workplace exposure hot line" phone number: 340-4800 ext. "STUK" (7885)

sharps injury: allow wound to bleed, wash with soap and water and apply an antiseptic solution

non intact skin exposure: wash with soap and water apply an antiseptic solution

mucous membrane exposure: flush copiously with large volume of water

All incidents must be reported to Occupational Health & Safety or to the Emergency department if after hours. A hepatitis antigen and/or antibody test will be drawn. If there is no record of HBV antibodies, HBIG (immune globulin) and the first dose of HBV vaccine will be given. Identify the name of contact patient if it is known.

References:

1. Surgical clinics of North America: Prevention of transmission of bloodborne pathogens.1995;75

2. Infection Control Guidelines. Preventing the transmission of bloodborne pathogens in health care and public service settings. CCDR 1997;30-35

3. The Toronto Hospital Infection Control Manual. Policy # 20.14, 50.01, 50.02, 60.08

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