Hepatitis-C: Blood-borne Diseases
Why Be Concerned?
Nurses constantly balance occupational
risks with their primary goal of providing quality health care to all
persons. Because threats to personal well-being may affect practice,
nurses must promote a safe and healthy work environment to protect
themselves, their loved ones, patients, and coworkers.
As front-line providers of health care,
nurses have long been exposed to blood-borne pathogens on the job. The
AIDS epidemic has heightened awareness of this and has broadened our
knowledge of other bloodborne diseases, notably hepatitis-B (HBV) and
All three diseases are caused by
viruses that are transmitted through exchange of body fluids (blood,
semen, and vaginal secretions), AIDS, caused by the human
immunodeficiency virus (HIV), remains the most feared, although
hepatitis-B is more easily transmitted.
Most transmission of bloodborne viruses
continues to occur through sexual intercourse, from sharing needles to
inject drugs, and from pregnant mother to child before or during birth.
Transmission in the workplace is
possible if skin is punctured by a contaminated sharp, or broken skin or
mucous membrane is splashed with blood or body fluid.
HIV. . .
The Centers for Disease Control has:
Documented 32 cases of
occupationally transmitted HIV in health care workers, including 12
Investigated another 69
cases, including 14 nurses.
These are reported cases. Many
exposures go unreported for fear of discrimination or loss of
HBV. . .
is more readily transmitted:
8,700 health care workers
each year contract hepatitis-B on the job; more than 200 die.
A safe and effective
vaccine is now available; many employers must provide it for free
If you are not yet vaccinated, don't
wait. Begin the series of three shots now, so you can begin building
immunity to this deadly disease.
HCV. . .
is a growing threat to nurses:
Infection with HCV
appears to carry a great potential for chronic liver disease.
Antibody tests have been
developed to detect the virus, but the number of health care workers
infected is not known.
No vaccine is currently
Needlestick injury is the most common
cause for occupationally-related HIV infection. Many factors affect
whether an exposed nurse seroconverts, that is, develops the antibodies
that indicate infection has occurred. These include the amount of blood
or fluid involved; the severity/depth of the injury; and the disease
stage of the source.
The Occupational Safety and Health
Administration (OSHA) is the federal agency that guarantees your rights
to a safe and healthful workplace. Nurses and other employees who have
contact with blood or other infectious materials have specific rights
under OSHA's blood-borne pathogens standard, issued in 1991.
Employers must provide you:
- A free
- Gloves, gowns,
goggles, face masks, and other necessary protective equipment
protective equipment, if needed, such as hypoallergenic gloves or
medical evaluation and followup if exposed
treatment and protection of your medical records
Additionally, employers must:
- Make sure that
universal precautions are practiced institution-wide, and that
employees know which materials are potentially infectious
puncture- and leak-proof containers for sharps disposal
- Remove hazards
whenever possible by changing the design of the workplace
- Train employees
during orientation and annually about hazards and prevention
care workers who are positive
for HIV or HBV infection also are protected by federal legislation. You
should know that:
testing for HIV/HBV is inappropriate
"non-invasive procedures" poses no risk of transmission to patients
- You as a nurse
have an ethical responsibility to know your HIV/HBV status and to
protect your patient from possible harm
patients who may be the source of an exposure should give their
consent to be tested
Research shows that even with a
needlestick injury, the use of gloves may reduce the volume of blood
transferred. Proper face coverings will prevent splashes in the eyes,
nose, and mouth.
Recap needles only if absolutely
necessary, and then, use a resheathing device or one-handed "scoop"
method. Properly dispose of all sharp items immediately after use.
Get immunized against
OSHA can only assure that the vaccine
is free and available. You must make the choice to be vaccinated and
complete the 3-injection series.
Immediately report all
Don't wait. After disinfecting the
area, promptly report your exposure. You may have to make a quick
decision about starting an antiretroviral agent like AZT as prophylaxis.
The time frame for beginning this treatment is critical. Reporting is
also essential for establishing a claim for workers' compensation
Comply with post-exposure
The difficult period following exposure
requires frequent blood testing, safer sex practices, and carrying the
burden of uncertainty about your health. But following your health care
provider's recommendations is crucial in order to benefit from
Support your peers
As peers, we must offer support to
nurses who are potentially exposed. The uncertainty of being exposed to
HIV or hepatitis can have a devastating effect on personal lives. No
amount of risk counseling can fully allay those fears. Understanding of
these dynamics by co-workers is essential. In addition, HIV-infected
nurses who continue working face numerous challenges and deserve support
and confidentiality, and have the right to accommodations in their job.
Help to "design out" the
Become a member of your safety
committee. Actively participate in getting safer devices evaluated and
purchased for your worksite. As the largest group at risk for
needlestick injury in hospitals, we must know what devices are causing
the problems, and which new products exist to prevent these injuries.
Be a change agent
Be open to new products or practices
which could prevent exposure while still assuring patient comfort. If
there are obstacles to reporting or concerns about confidentiality,
follow the proper channels to change this. You may also wish to contact
your state nurses association and, if necessary, your local OSHA office.
The impact of possible exposure
to HIV or hepatitis can be devastating for the nurse, family and
friends, co-workers and the patient. To protect your health and
well-being while continuing to provide quality care, you need both
information and action.
- Use this
brochure to educate other nurses about risks, rights, and
responsibilities of workplace exposure to bloodborne disease.
- Work with
your facility's infection control or workplace safety and health
committee to make your concerns known.
- Make your
voice heard through joining your state nurses association.