Paramedic Kardex

Overview:

Hepatitis B is an infectious disease that is responsible for an estimated 4,000 to 5,000 deaths each year in the United States due to chronic liver disease, cirrhosis and liver cancer. Hepatitis B is a serious threat to all healthcare providers. Blood infected with the HBV is much more infectious than HIV infected blood. Additionally, HBV is more common in the US than HIV with a greater proportion of the population infected with hepatitis B then with HIV. 

Several groups are noted to have a high risk of hepatitis B, including parenteral (IV) drug abusers, heterosexuals with multiple partners, homosexual men, clients and staff in institutions for the developmentally disabled, prisoners, and hemodialysis center patients.

Mode of Transmission: Blood Borne - Hepatitis B is transmitted via contact with the blood or body fluids of a person infected with HBV

 

Examples of Transmission:

The virus can survive as dried, visible blood for up to 1 week.

• Exposure to blood through a needle stick or cut from sharp instrument

• Direct contact with blood or open sores of an infected patient

• Sharing personal care items with an infected person (ex. razors, toothbrushes)

• Injection Drug Use, Sexual Activity, Mother-to-Child 

 

Prevention:

A 3 series vaccine

 

Precautions:

Universal

 

Signs and Symptoms:

The majority (>70%) of adults with acute HBV will have symptoms. Small children, under age 5, may have no symptoms at all. Signs and symptoms of acute HBV may include:

 

• Jaundice

• Dark urine, light colored bowel movements

• Fatigue, Fever

• Loss of appetite, nausea, vomiting

• Joint pain

• Abdominal pain

 

 

Complications:

Persons infected with the hepatitis B virus run the risk of developing severe health complications, including cirrhosis, liver cancer, liver failure, and death. They can also become a hepatitis B carrier and transmit infection to their partner and children.

 

Exposure Determination:

If you can answer yes to one or more of the following then an exposure has occurred:

1. Did a contaminated needle stick injury occur? (Was the needle ever in the patient’s body?)

2. Did blood/OPIM make contact with the surface of the eye, or inner surface of the nose or mouth?

3. Did blood /OPIM make contact with an open area of the skin?

4. Were there cuts caused by sharp objects covered with blood or OPIM?

A Significant blood or body Fluids exposure is  a combination of one or more of the types of body fluids and one or more of the injuries listed below and requires immediate medical evaluation.

• Body fluids: Blood, serum, plasma and all fluids visibly contaminated with blood. Pleural, amniotic, pericardial, peritoneal, synovial, and cerebrospinal fluids. Vaginal secretions, semen and saliva 

• Injuries: Percutaneous (needle stick, laceration, abrasion, bites, etc.). Mucous membrane (e.g. eyes, nose, and mouth). Skin (e.g. cut chapped or abraded skin.) The larger the area of skin and the time of contact, the more important it is to verify that all the relevant skin area is intact.

 

Immediately Following Exposure:

• Wash needle sticks and cuts with soap and water

• Flush splashes to the nose, mouth, or skin with water

• Irrigate eyes with clean water, saline, or sterile irrigates

• Immediately seek medical treatment same facility as source if possible.

  • Source baseline testing

• If you were exposed to hepatitis B, it is an OSHA requirement to have blood drawn as soon as possible to determine your baseline serologic status. This test determines if you have protective antibodies.

• If you do not have protective antibodies, your healthcare provider may decide to give you the vaccine and/or hepatitis B Immune Globulin (HBIG) for immediate protection.

 

General Post Exposure Treatment:

Post-exposure treatment should begin as soon as possible following the exposure, preferably within 24 hours, and no later than 7 days. If you have not been vaccinated, then hepatitis B vaccination is recommended for any exposure regardless of the source person’s hepatitis B status. HBIG and/or hepatitis B vaccine may be recommended depending on your immunity to hepatitis B and the source person’s infection status. While there is no cure for Hepatitis B, there are a number of medications that may be used to treat symptoms. Persons infected with hepatitis B should protect their liver from further damage, by getting immunized for hepatitis A, avoiding alcohol and having continuing medical care.

 

Paperwork Required

1. OC Public Health Communicable Disease Exposure Form (policy 330.96) with Fire incident number on top. Should be faxed while still in the hospital Fax: (714) 564-4050 per county policy must be received within 7 calendar days

OC Public Health Communicable Disease Exposure Form

1. The City “Report of Employee Injury” form

2. Medical Service Order- RM -67 (when medical care is required)

3. Sharps Injury Log

 

Post Exposure Follow-up: Because post exposure treatment is highly effective in preventing HBV infection, CDC does not recommend routine follow-up after treatment. However, any symptoms suggesting hepatitis (e.g., yellow eyes or skin, loss of appetite, nausea, vomiting, fever, stomach or joint pain, extreme tiredness) should be reported to your healthcare provider. If you receive the hepatitis B vaccine, you should be tested 1-2 months after completing the vaccine series to determine if you have responded to the vaccine and are protected against the HBV infection; check again at 6 months if no antibody is detected. 

 

What Is The Risk Of Infection After An Occupational Exposure: Pre-hospital workers who have received a Hepatitis B vaccine and have developed immunity to the virus are at virtually no risk for infection. For an unvaccinated person, the risk from a single needle stick or a cut exposure to HBV-infected blood ranges from 6%-30% and is corrected with the Hepatitis B e antigen (HBeAg) As you can see an exposure to HepB is much more transferable than HIV.