SPD Personnel Should be Aware of the Dangers of Hepatitis
By Dottie Conroy, RN, BS, ACSP, CSPDM
MY MOTHER, AT THE AGE OF 35, delivered me by Cesearean section due to eight internal and external uterine fibroid tumors. Two were larger than I was at birth. Needless to say, she had a hysterectomy and was given four units of blood; one of them was tainted with hepatitis. In 1947, they did not know the various types of hepatitis. She died of liver cancer at the age of 72. This is why I teach my staff to wear personal protective equipment (PPE) and to use forceps to transfer instruments from one area to another in the decontamination area of a sterile processing department.
Hepatitis C is the new endangerment for central service and other healthcare personnel. It is a bloodborne virus previously known as non-A/non-B, which has six major genotypes: 1a;1b; 2a;2b; 3;4;5; and 6. The genotype most commonly found in the United States is 1a and 1b. The problem with creating a vaccine is that it replicates faster than HIV or other types of viruses. This makes vaccines harder to develop, so at this time, there is no vaccine available. In various studies, researchers are trying to determine if individuals receiving the HBC vaccine experience a greater decrease of symptoms and residual problems than the person without it. But the data is not as conclusive as first thought. However, the patient infected with hepatitis C virus (HCV) is given a hepatitis B virus vaccine to prevent a secondary viral infection. The only true prevention is protection.
Hepatitis attacks the liver by causing inflammation and killing liver cells. The incubation period is two to 26 weeks, and within that time frame there is a two-week to 12-week period of flulike symptoms. Two things can happen: the first is after the initial infection, the body clears the virus and treats it like any cold virus. This occurs in about 20 percent of the patient population. The second and more likely occurrence is the development of the infection into chronic hepatitis C virus.
In chronic hepatitis C virus cases, about 80 percent do not clear the virus, and of those, 10 percent to 15 percent have liver problems, including liver damage, fibrosis, steatosis, cirrhosis, and liver cancer-hepatocellular carcinoma, which can cause major body systems to decrease or shut down.
Hepatitis C is transmitted via blood, so those at risk include intravenous drug users, anyone having a blood transfusion before 1992, those who engage in unprotected sexual activity, and individuals who work in healthcare. It does not matter whether you are a direct patient-care provider or a worker in the hospitals decontamination department. A puncture from an infected sharp can transmit HCV infection. Testing for HCV is similar to testing for HIV, but not the same tests are used. HCV testing uses the HCV ELISA test, which detects antibodies for the virus. If this test is positive, the next step is to perform the RIBA HCV test, which confirms the infection. Just as in HIV testing, the ELISA test can report false positives. The RIBA HCV test is expensive, and that is why it is only used when the ELISA test is positive. Other tests which can be done for definition and staging of the disease process are viral load, genotype, liver chemistry and liver function tests, and liver biopsies.
The National Institutes of Health states that 4 million Americans are infected with hepatitis and may not know they are or how they became infected. About 8,000 to 10,000 individuals die from complications, and this mortality rate will triple in the next 10 to 20 years. HVC is the leading cause of liver transplants. People infected with HCV are prohibited from the intake of alcohol and recreational drugs. Again, they are vaccinated against HAV and HBV to prevent other viral infections causing even more stress on the liver.
Use of PPE is required by OSHA; other preventive practices must be in place to prevent transmission of hepatitis C as well as the other forms of hepatitis. One such practice is to avoid punctures caused by contaminated sharps. Using forceps to transfer instruments rather that putting hands into a container in which they could be potentially punctured, is one very smart maneuver. The wearing of gloves protects against the invasion of HCV through small openings in the skin. Full-face shields or goggles are used to protect the entry of the virus through the mucosa and tear ducts of the eyes. The wearing of non-penetrable cover gowns prevents the worker against any open areas on the body. The most important thing to remember, however, is that these strategies only work if you use them and protect yourself.
Dottie Conroy, RN, BS, ACSP, CSPDM, is central service manager of Methodist Hospital in Henderson, Ky.