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By Dottie Conroy, RN, BS, ACSP, CSPDM
MY MOTHER, AT THE AGE OF 35, delivered me by Cesearean sectiondue to eight internal and external uterine fibroid tumors. Two were larger thanI was at birth. Needless to say, she had a hysterectomy and was given four unitsof blood; one of them was tainted with hepatitis. In 1947, they did not know thevarious types of hepatitis. She died of liver cancer at the age of 72. This iswhy I teach my staff to wear personal protective equipment (PPE) and to useforceps to transfer instruments from one area to another in the decontaminationarea of a sterile processing department.
Hepatitis C is the new endangerment for central service andother healthcare personnel. It is a bloodborne virus previously known asnon-A/non-B, which has six major genotypes: 1a;1b; 2a;2b; 3;4;5; and 6. The genotype most commonly foundin the United States is 1a and 1b. The problem with creating a vaccine is thatit replicates faster than HIV or other types of viruses. This makes vaccinesharder to develop, so at this time, there is no vaccine available. In variousstudies, researchers are trying to determine if individuals receiving the HBCvaccine experience a greater decrease of symptoms and residual problems than theperson 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 virusvaccine to prevent a secondary viral infection. The only true prevention isprotection.
Hepatitis attacks the liver by causing inflammation andkilling liver cells. The incubation period is two to 26 weeks, and within thattime frame there is a two-week to 12-week period of flulike symptoms. Two thingscan happen: the first is after the initial infection, the body clears the virusand treats it like any cold virus. This occurs in about 20 percent of thepatient population. The second and more likely occurrence is the development ofthe infection into chronic hepatitis C virus.
In chronic hepatitis C virus cases, about 80 percent do notclear the virus, and of those, 10 percent to 15 percent have liver problems,including liver damage, fibrosis, steatosis, cirrhosis, and livercancer-hepatocellular carcinoma, which can cause major body systems to decreaseor shut down.
Hepatitis C is transmitted via blood, so those at risk includeintravenous drug users, anyone having a blood transfusion before 1992, those whoengage 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 inthe hospitals decontamination department. A puncture from an infected sharpcan transmit HCV infection. Testing for HCV is similar to testing for HIV, butnot the same tests are used. HCV testing uses the HCV ELISA test, which detectsantibodies for the virus. If this test is positive, the next step is to performthe RIBA HCV test, which confirms the infection. Just as in HIV testing, theELISA test can report false positives. The RIBA HCV test is expensive, and thatis why it is only used when the ELISA test is positive. Other tests which can bedone 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 millionAmericans are infected with hepatitis and may not know they are or how theybecame infected. About 8,000 to 10,000 individuals die from complications, andthis mortality rate will triple in the next 10 to 20 years. HVC is the leadingcause of liver transplants. People infected with HCV are prohibited from the intake ofalcohol and recreational drugs. Again, they are vaccinated against HAV and HBVto prevent other viral infections causing even more stress on the liver.
Use of PPE is required by OSHA; other preventive practicesmust be in place to prevent transmission of hepatitis C as well as the otherforms of hepatitis. One such practice is to avoid punctures caused bycontaminated sharps. Using forceps to transfer instruments rather that puttinghands into a container in which they could be potentially punctured, is one verysmart maneuver. The wearing of gloves protects against the invasion of HCVthrough small openings in the skin. Full-face shields or goggles are used toprotect 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 openareas on the body. The most important thing to remember, however, is that thesestrategies only work if you use them and protect yourself.
DottieConroy, RN, BS, ACSP, CSPDM, is central service manager of Methodist Hospital inHenderson, Ky.