Transcript viral hepatitis - Philadelphia University

VIRAL HEPATITIS
WHAT IS VIRAL HEPATITIS ?
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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.
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.
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(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
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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.
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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.
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:
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.
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HEPATITIS SEROLOGY:
PRACTICE!!!!!!!!!!!!!!!
HBsAg
w HBcAB (TOTAL)
w HBsAB
w HAV-IGM
w HCV
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N.
N.
N.
N.
N.
NO evidence of viral hepatitis viruses.
HBsAG
w HBcAB (TOTAL)
w HBsAB
w HAV-IGM
w HCV
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PAST INFECTION.
N.
P.
P.
N.
N.
HBsAg
w HBcAB (total)
w HBsAB
w HAV-IGM
w HCV
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IMMUNIZATION.
N.
N.
P.
N.
N.
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.
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HBsAg
w HBcAB (TOTAL)
w HBsAB
w HAV-IGM
w HCV
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P.
P.
N.
P.
P.
Co infection with HBV, HAV, and HCV
HBsAG
P.
w HBcAB (total)
P.
w HBsAB
P.
w HAV-IGM
N.
w HCV
N.
w Past infection with recovery, and then reinfection that has become chronic, this is
very rare but does happen.
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What are the clinical symptoms
of Hepatitis B??
How will I keep from becoming
infected with HBV at work??
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.
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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??
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 , workplacespecific document that outlines in detail all
measures that will be taken to eliminate or
minimize employee exposure.
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What are the fundamental
components of an ECP??
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The 5 fundamental
components of an ECP are :
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1.Exposure Determination.
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2.Methods of Compliance.
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3. Hepatitis Vaccination.
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4. Communication of
Hazards.
w 5. Post Exposure Evaluation
and Follow Up.
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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 .
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.
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Specific Practices To Be Utilized
in workplace!!!!!!!!!!!!
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How to dispose of small amount of
regulated waste and remove gloves:
How to dispose a larger amounts of regulated
waste:
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.
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Place all sharps
(Needles, Syringes,
Broken Glass, Etc.)
into a sharps container.
How to wash hand properly??
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.
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Wet both hands and wrists.
Lather with soap and worm
water.
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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.
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Rinse hands and wrists well
to remove the soap.
How to clean spills or contaminated
surfaces:
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.
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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.
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What the third fundamental
components of an ECP??
(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.
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What is hepatitis B vaccine?
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
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Who should be vaccinated?
Everyone 18 years of age and younger
w over 18 years of age who are at risk for HBV
infection, which include :
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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
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
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5.Post exposure evaluation and
follow-up
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
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FACTS:
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
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FACTS:
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
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FACTS:
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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