Debra Hardy Havens, BS, RN, FNP Washington Representative for NAPNAP Capitol Associates, Inc. Washington, D.C.
Hepatitis B: The Challenge for Nurses
n
Karen
Bodenhorn
v
accinations are perhaps the most potent preventive health tool available. They are also one of the most costeffective medical interventions-for every $1 spent on immunization, $14 in medical treatment costs are saved. Despite this, the hepatitis-B virus (HBV) affects 300,000 Americans annually, and cases have increased by 50% in the last decade. The estimate is that HBV costs $750 million annually, in terms of medical expenses and lost productivity, not including costs associated with liver transplantations. Although the rates of infection and death from HBV are higher than for the acquired immunodeficiency syndrome (AIDS) virus, many public policy experts and health professionals agree that this disease has been overshadowed by AIDS. n
TEST YOUR KNOWLEDGE OF HBV True or False-HBV affects an estimated 12,000 healthcare workers every year. True or False-Of the 12,000 HBV casesin health-care workers each year, nearly 300 of those casesresult in death. True or False-Only 40% of the at-risk health-care population has been vaccinated against this virus. True or False-The risk of hepatitis-B infection for health care workers is five to ten times greater than that of the general population. True or False-The Occupational Health and Safety Administration
(OSHA)
of the federal government
is ex-
pected to issuenew regulations this year that will mandate that employers provide hepatitis-B vaccine to employees who are regularly exposed to blood and body fluids. n
RATING YOUR RESPONSES
is Vice President,
Health
Policy, for Capitol
25/B/34246
JOURNAL
OF PEDIATRIC
HEALTH
CARE
to protect yourself from this disease and become an active educator of your colleagues and patients? n
Associates,
Inc.
WHAT IS HEPATITIS?
HBV can cause a debilitating liver infection that lasts for weeks or months and has no known cure or effective treatment. It is the primary cause of liver cancer in the United States and a leading cause of cirrhosis. In addition, one half of the people who are infected with the virus develop no symptoms, yet a significant number remain contagious for life. n
HOW IS HBV TRANSMITTED?
HBV is transmitted by sexual contact, by needle sharing, through HBV-contained blood contacting skin wounds or other breaks in the skin, and by mucous-membrane contact with contaminated blood or blood products. Thus, the occupational risk of HBV infection directly relates to the extent of worker contact with infected blood or blood products. Also, certain body fluids and tissues are regarded as potentially infectious. n
TODAY’S VACCINATION
STATUS
Although the rates of infection and death from HBV are vastly higher than for the human immunodeficiency virus, the impetus to eradicate the disease is slight. Of the population considered to be at risk of developing the disease, fewer than 1% have been vaccinated. As indicated, even among health-care workers who are likely to be exposed to the HBV by the patients they treat, only about one half have been protected. n
The answers to all of the questions are true. How do your answers compare? Are you willing to take actions
Karen Bodenhorn
n
THE VACCINE
The original hepatitis vaccine was prepared from blood plasma and, because of this, concerns were raised about a possible risk of contracting HIV from the vaccine. This possibility has been eliminated with the newer vaccines. Three doses of vaccine are needed for a protection level of better than 95%. 41
42
Legislative
Volume 6, Number 1 January-February 1992
News
n FEDERAL GOVERNMENT TO HEPATITIS
RESPONSE
Like AIDS, hepatitis-B infections have been reported from every state. The seriousness of the problem has prompted OSHA, at the U.S. Department of Labor, to develop a mandatory occupational health standard to reduce workers’ exposure to HBV to help protect them from contracting blood-borne diseases in the workplace. A proposed standard was published in the Feahd Register on May 30, 1989. The final rule is expected to be published by the end of the year. Subsequently in February 1990, OSHA published an instruction regarding compliance procedures for occupational exposure to HBV and HIV. Concurrent with these OSHA activities, the Centers for Disease Control (CDC) are developing HIV guidelines to limit the right of an infected health-care worker to perform invasive procedures. Throughout these guidelines, HBV stands side by side with the recommendations to prevent and minimize exposure to bloodborne diseases. RECOMMENDED PRACTICES FOR PROTECTION AGAINST OCCUPATIONAL EXPOSURE TO HBV
n
most likely to be at high risk for the disease because of multiple sex partners, only 20% know of the HBV vaccine. This is compounded by the lack of information that health professionals have regarding the risk of HBV to heterosexuals. A 1985 CDC survey of physicians found that only 10% were aware that heterosexual activity with more than one partner was a risk factor for HBV. For the HBV prevention strategy to affect disease incidence, the role of heterosexual activity in the transmission of HBV must be recognized by both those at risk and their health-care providers. Policy makers at the CDC are giving consideration, as well, to the feasibility of universal immunization of infants, adolescents, or both. This strategy would provide immunity from infection before persons engage in risk-taking behavior and could preclude infections in persons who have no known risk factors. Nurse practitioners are encouraged to follow this debate and to be in the forefront in educating patients if and when a change to universal immunization is recommended. n
SUMMARY
Hepatitis is on the rise. Nurse Practitioners-let’s on this challenge! I
Two basic practices guide nurses in protecting themselves from exposure to HBV. The first is to follow “universal precautions. ” The term refers to a method of infection control in which all human blood and other potentially infectious materials are treated as if they are known to be infectious for HIV and HBV. The second practice is to get a vaccination if you are at risk of acquiring HBV infection. Several educational booklets that also describe in further detail engineering controls to protect the worker, work-practice controls, and the role of personal protective equipment are available. (See listing of publications.) Finally, all nurses should know the modes of transmission and prevention of these infections. n
EDUCATING
YOUR PATIENTS ABOUT HBV
Although the primary focus of this article is occupational exposure of health workers and nurses, within the epidemiology of the disease, occupational exposure accounts for only 5% of the cases (Alter et al., 1990). Therefore, to prevent HBV, groups at high risk of infection must be immunized. Nurses have a pivotal role in educating patients and their families about this disease. The lack of information is great. For example, nearly 70% of adults 18 to 55 years of age do not know that a vaccine exists to prevent hepatitis. For pediatric and family nurse practitioners, especially those caring for adolescents, the challenge is even greater. Among those young people aged 18 to 24 years, the group
take
REFERENCES Alter, M. J., Hadler, S. C., Margolis, H. S., Alexander, W. J., Hu I’. Y., Judson, F. N., Mares, A., Miller, J. K., Moyer, L. A. (1990). The changing epidemiology of hepatitis B in the United States. JAMA, 263, 1218-1222. Centers for Disease Control. (1991). Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR, 40/No.RR-8. Center for Disease Control. (1987). Recommendations for prevention of HIV transmission in health-care settings. MMWR, 36/No.2S. Centers for Disease Control. (1988). Update: Universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodbome pathogens in health-care settings. MNWR, 37lNo.24. Garner, Julia S., & Favero, Martin S. (1985). Guidelines for Handwashing and Hospital Environmental Control. U. S. Department of Health and Human Services publication no. 99-1117. U.S. Department of Labor, Occupational Safety and Health Administration. (1990). Enforcement procedures for occupational exposure to hepatitis B virus and human irnmunodeficiency virus. Compliant Assistance Guideline fbr the Februavy 27, 1990, OSHA hstrwtion CPL 2-2.44B. U.S. Department of Labor, Occupational Safety and Health Administration. (1989). Occupational exposure to bloodborne pathogens; proposed rule and notice of hearing. Federal Register, 54, 23042-23139. U.S. Department of Labor, Occupational Safety and Health Adrninistration. (1990). Worker exposure to AIDS and hepatitis B. OSHA #3102.
Hepatitis B: The Challenge for Nurses
n
Karen
Bodenhorn
v
accinations are perhaps the most potent preventive health tool available. They are also one of the most costeffective medical interventions-for every $1 spent on immunization, $14 in medical treatment costs are saved. Despite this, the hepatitis-B virus (HBV) affects 300,000 Americans annually, and cases have increased by 50% in the last decade. The estimate is that HBV costs $750 million annually, in terms of medical expenses and lost productivity, not including costs associated with liver transplantations. Although the rates of infection and death from HBV are higher than for the acquired immunodeficiency syndrome (AIDS) virus, many public policy experts and health professionals agree that this disease has been overshadowed by AIDS. n
TEST YOUR KNOWLEDGE OF HBV True or False-HBV affects an estimated 12,000 healthcare workers every year. True or False-Of the 12,000 HBV casesin health-care workers each year, nearly 300 of those casesresult in death. True or False-Only 40% of the at-risk health-care population has been vaccinated against this virus. True or False-The risk of hepatitis-B infection for health care workers is five to ten times greater than that of the general population. True or False-The Occupational Health and Safety Administration
(OSHA)
of the federal government
is ex-
pected to issuenew regulations this year that will mandate that employers provide hepatitis-B vaccine to employees who are regularly exposed to blood and body fluids. n
RATING YOUR RESPONSES
is Vice President,
Health
Policy, for Capitol
25/B/34246
JOURNAL
OF PEDIATRIC
HEALTH
CARE
to protect yourself from this disease and become an active educator of your colleagues and patients? n
Associates,
Inc.
WHAT IS HEPATITIS?
HBV can cause a debilitating liver infection that lasts for weeks or months and has no known cure or effective treatment. It is the primary cause of liver cancer in the United States and a leading cause of cirrhosis. In addition, one half of the people who are infected with the virus develop no symptoms, yet a significant number remain contagious for life. n
HOW IS HBV TRANSMITTED?
HBV is transmitted by sexual contact, by needle sharing, through HBV-contained blood contacting skin wounds or other breaks in the skin, and by mucous-membrane contact with contaminated blood or blood products. Thus, the occupational risk of HBV infection directly relates to the extent of worker contact with infected blood or blood products. Also, certain body fluids and tissues are regarded as potentially infectious. n
TODAY’S VACCINATION
STATUS
Although the rates of infection and death from HBV are vastly higher than for the human immunodeficiency virus, the impetus to eradicate the disease is slight. Of the population considered to be at risk of developing the disease, fewer than 1% have been vaccinated. As indicated, even among health-care workers who are likely to be exposed to the HBV by the patients they treat, only about one half have been protected. n
The answers to all of the questions are true. How do your answers compare? Are you willing to take actions
Karen Bodenhorn
n
THE VACCINE
The original hepatitis vaccine was prepared from blood plasma and, because of this, concerns were raised about a possible risk of contracting HIV from the vaccine. This possibility has been eliminated with the newer vaccines. Three doses of vaccine are needed for a protection level of better than 95%. 41
42
Legislative
Volume 6, Number 1 January-February 1992
News
n FEDERAL GOVERNMENT TO HEPATITIS
RESPONSE
Like AIDS, hepatitis-B infections have been reported from every state. The seriousness of the problem has prompted OSHA, at the U.S. Department of Labor, to develop a mandatory occupational health standard to reduce workers’ exposure to HBV to help protect them from contracting blood-borne diseases in the workplace. A proposed standard was published in the Feahd Register on May 30, 1989. The final rule is expected to be published by the end of the year. Subsequently in February 1990, OSHA published an instruction regarding compliance procedures for occupational exposure to HBV and HIV. Concurrent with these OSHA activities, the Centers for Disease Control (CDC) are developing HIV guidelines to limit the right of an infected health-care worker to perform invasive procedures. Throughout these guidelines, HBV stands side by side with the recommendations to prevent and minimize exposure to bloodborne diseases. RECOMMENDED PRACTICES FOR PROTECTION AGAINST OCCUPATIONAL EXPOSURE TO HBV
n
most likely to be at high risk for the disease because of multiple sex partners, only 20% know of the HBV vaccine. This is compounded by the lack of information that health professionals have regarding the risk of HBV to heterosexuals. A 1985 CDC survey of physicians found that only 10% were aware that heterosexual activity with more than one partner was a risk factor for HBV. For the HBV prevention strategy to affect disease incidence, the role of heterosexual activity in the transmission of HBV must be recognized by both those at risk and their health-care providers. Policy makers at the CDC are giving consideration, as well, to the feasibility of universal immunization of infants, adolescents, or both. This strategy would provide immunity from infection before persons engage in risk-taking behavior and could preclude infections in persons who have no known risk factors. Nurse practitioners are encouraged to follow this debate and to be in the forefront in educating patients if and when a change to universal immunization is recommended. n
SUMMARY
Hepatitis is on the rise. Nurse Practitioners-let’s on this challenge! I
Two basic practices guide nurses in protecting themselves from exposure to HBV. The first is to follow “universal precautions. ” The term refers to a method of infection control in which all human blood and other potentially infectious materials are treated as if they are known to be infectious for HIV and HBV. The second practice is to get a vaccination if you are at risk of acquiring HBV infection. Several educational booklets that also describe in further detail engineering controls to protect the worker, work-practice controls, and the role of personal protective equipment are available. (See listing of publications.) Finally, all nurses should know the modes of transmission and prevention of these infections. n
EDUCATING
YOUR PATIENTS ABOUT HBV
Although the primary focus of this article is occupational exposure of health workers and nurses, within the epidemiology of the disease, occupational exposure accounts for only 5% of the cases (Alter et al., 1990). Therefore, to prevent HBV, groups at high risk of infection must be immunized. Nurses have a pivotal role in educating patients and their families about this disease. The lack of information is great. For example, nearly 70% of adults 18 to 55 years of age do not know that a vaccine exists to prevent hepatitis. For pediatric and family nurse practitioners, especially those caring for adolescents, the challenge is even greater. Among those young people aged 18 to 24 years, the group
take
REFERENCES Alter, M. J., Hadler, S. C., Margolis, H. S., Alexander, W. J., Hu I’. Y., Judson, F. N., Mares, A., Miller, J. K., Moyer, L. A. (1990). The changing epidemiology of hepatitis B in the United States. JAMA, 263, 1218-1222. Centers for Disease Control. (1991). Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR, 40/No.RR-8. Center for Disease Control. (1987). Recommendations for prevention of HIV transmission in health-care settings. MMWR, 36/No.2S. Centers for Disease Control. (1988). Update: Universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodbome pathogens in health-care settings. MNWR, 37lNo.24. Garner, Julia S., & Favero, Martin S. (1985). Guidelines for Handwashing and Hospital Environmental Control. U. S. Department of Health and Human Services publication no. 99-1117. U.S. Department of Labor, Occupational Safety and Health Administration. (1990). Enforcement procedures for occupational exposure to hepatitis B virus and human irnmunodeficiency virus. Compliant Assistance Guideline fbr the Februavy 27, 1990, OSHA hstrwtion CPL 2-2.44B. U.S. Department of Labor, Occupational Safety and Health Administration. (1989). Occupational exposure to bloodborne pathogens; proposed rule and notice of hearing. Federal Register, 54, 23042-23139. U.S. Department of Labor, Occupational Safety and Health Adrninistration. (1990). Worker exposure to AIDS and hepatitis B. OSHA #3102.
