Understanding Hepatitis
and the Appropriate Barrier Protection

Hepatitis C DEFINITION Hepatitis C is a disease of the liver caused by the Hepatitis C Virus (HCV).42 CLINICAL MANIFESTATIONS The clinical manifestations that might be present include: Jaundice Fatigue Dark urine Abdominal pain Anorexia Nausea Approximately 80% of infected persons exhibit no signs or symptoms.43,44 INCUBATION PERIOD The incubation period is anywhere from 2 weeks-6 months. The average incubation period is 6-9 weeks.45 CAUSE The cause is the Hepatitis C Virus (HCV), an ssRNA, enveloped, flavivirus. DIAGNOSIS Serological (antibody) test: Antibodies develop within several weeks in individuals that have become infected with the hepatitis C virus. These antibodies are produced in the immune system. Unfortunately, the body is not always effective in eliminating the virus, so the virus remains in the blood. Occasionally, a false-positive reading can occur. Less than 10% of Hepatitis C Antibody tests EIA-3 (enzyme immunoassay) give a false positive reading.46 POST-EXPOSURE PROPHYLAXIS No post-exposure prophylactic is available at this time. LONG-TERM EFFECTS Chronic infection occurs in: Chronic infection: 75-85% of infected persons. Chronic liver disease: 70% of chronically infected persons. Deaths from chronic liver disease: <3%. HCV is a leading indication for liver transplant.47 TRANSMISSION HCV is spread primarily by direct contact with human blood. Before anti-HCV screening was available, the majority of HCV infections were due to blood transfusions. Other ways a person could become infected with the disease are as follows: Dialysis patients may unknowingly share supplies/equipment that have the infected blood of another person on them. Healthcare workers that have frequent contact with blood on the job, especially if they suffer an accidental needlestick. Pregnant women who have HCV can pass the virus to their unborn child. Sharing needles used for drugs, body piercing, or tattooing. Having sex with a person infected with HCV. Sharing personal items with an infected person you live with, such as toothbrushes and razors, or items that might have blood on them.48 WHO IS AT RISK? Listed in order of high to low risk: Persons injecting illegal drugs, even if they experimented a few times many years ago. Recipients of clotting factors made before 1987. Hemodialysis patients (long-term kidney dialysis). Recipients of blood transfusion and/or solid organs before July 1992. People with undiagnosed liver problems. Infants born to infected mothers. Healthcare/public safety workers. People having sex with multiple partners.49 TREATMENT The most current treatment for HCV is combination drug therapy using pegylated interferon and ribavirin. The primary goal of caring for a patient with hepatitis C is to help optimize quality of life. The patient must be closely monitored for clinical symptoms. Laboratory results should also be closely observed to monitor liver function. A liver transplant may be necessary depending on the level of liver damage. It is equally important to teach the patient to conserve energy, eat a balanced diet, drink plenty of fluids, and include mild exercise in their daily routine. Adequate hydration is essential. Mild exercise can reduce side effects. Patients may experience depression, and therefore patient education regarding it is extremely important and plays a key role in managing the disease.50 INFECTION CONTROL AND PREVENTION Infection Control Do not share personal care items that might have blood on them, such as razors or toothbrushes. Due to the risk involved, reconsider tattooing or body piercing. There is a possibility of becoming infected with the hepatitis virus if the tools have not been adequately cleaned/disinfected between uses. If you are having sex with multiple partners, make sure you are properly using a condom every time you have sex. This may reduce the risk of transmission. Always follow routine Standard Precautions that include the following: Hand Washing Wash hands immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. Gloves Wear gloves manufactured from proper barrier protection materials when touching blood, bodily fluids, secretions, excretions, and contaminated items. Put on clean gloves just before touching mucous membranes and non-intact skin. Change gloves between tasks and procedures on the same patient after contact with material that may contain a high concentration of microorganisms. Remove gloves promptly after use, before touching non-contaminated items and environmental surfaces, and before going to another patient. Wash hands immediately to avoid transfer of microorganisms to other patients or environments. Masks, Eye Protection, Face Shields Wear a standard surgical mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and activities that are likely to generate splashes or sprays. Prevention In 2001, the Federal Needlestick Safety and Prevention Act strengthened the requirements related to the use of safety-engineered sharp devices. To reduce employees’ occupational exposure to HIV, hepatitis C, and other bloodborne diseases, the Act requires the use of safety-engineered sharp devices and needle-less systems in hospitals and other healthcare settings.51 Healthcare institutions require reporting of all exposures to blood and bodily fluids. Immediate first aid and follow-up care is extremely important for all healthcare workers. The source patient as well as the healthcare worker will need to be tested for HIV, HBV, and HCV. In the case of injury, there is currently no recommendation for the use of antiviral agents for HCV. Prevention of HCV is the goal for all healthcare professionals. If you are HCV positive, do not donate blood, organs, or tissue. VACCINE RECOMMENDATIONS There is no vaccine available at this time for hepatitis C. FACTS, STATISTICS, AND TRENDS The number of new infections per year has declined from an average of 240,000 in the 1980s to about 25,000 in 2001. Most infections are due to illegal injection drug use. Transfusion-associated cases occurred prior to blood donor screening; transmission now occurs in less than one per million transfused unit of blood. An estimated 3.9 million (1.8%) Americans have been infected with HCV, of which 2.7 million are chronically infected.52

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