HIV, Hepatitis-B, Hepatitis-C: Blood-borne Diseases

http://www.needlestick.org/dlwa/osh/wp2.htm

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 hepatitis-C (HCV).

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.

Risks

HIV. . .

The Centers for Disease Control has:

·         Documented 32 cases of occupationally transmitted HIV in health care workers, including 12 nurses.

·         Investigated another 69 cases, including 14 nurses.

These are reported cases. Many exposures go unreported for fear of discrimination or loss of confidentiality.

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 available.

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.

Rights

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 hepatitis-B vaccine
• Gloves, gowns, goggles, face masks, and other necessary protective equipment
• Special protective equipment, if needed, such as hypoallergenic gloves or smaller sizes
• Immediate medical evaluation and followup if exposed
• Confidential 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
• Provide 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

Health care workers who are positive for HIV or HBV infection also are protected by federal legislation. You should know that:

• Mandatory testing for HIV/HBV is inappropriate
• Performing "non-invasive procedures" poses no risk of transmission to patients

What about patient's rights?

• You as a nurse have an ethical responsibility to know your HIV/HBV status and to protect your patient from possible harm
• Remember, patients who may be the source of an exposure should give their consent to be tested

Responsibilities

Always use universal precautions

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.

Respect sharps

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 hepatitis-B

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 exposures

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 benefits.

Comply with post-exposure follow-up

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 treatment.

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 problem

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.