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HEPATITS C  (HCV)

Overview:

Hepatitis C is the most common blood borne virus in the United States. More than 3 million Americans are living with chronic infection. Hepatitis C is responsible for an estimated 8,000 to 10,000 deaths each year in the US due to chronic liver disease (cirrhosis) and liver cancer. Hepatitis C is a concern for healthcare providers. Blood infected with the HCV is more infectious than HIV infected blood but not as infectious as HBV. Additionally, HCV is more common in the US than HIV.

Mode of Transmission: Hepatitis C is transmitted through contact with the blood or bodily fluids of a person infected with HCV.

 

Examples of Transmission: 

You can get HCV by:

  • A needle stick from a bloody needle

  • A cut from a bloody sharp object

  • Infectious fluids entering through an open wound, scrape, broken cuticle, or chapped skin

  • Through mucous membranes, such as in the eye, nose, or mouth

 

Several groups are noted to have a high risk of hepatitis HCV the following populations are at increased risk of becoming infected with HBV:

  • Infants born to infected mothers

  • Sex partners of infected persons

  • Sexually active persons who are not in a long-term, mutually monogamous relationship 

  • Men who have sex with men

  • Injection drug users

  • Household contacts of persons with chronic HBV infection

  • Health care and public safety workers at risk for occupational exposure to blood or blood-contaminated body fluids

  • Hemodialysis patients

  • Residents and staff of facilities for developmentally disabled person

  • Travelers to countries with intermediate or high prevalence of HBV infection

 

Prevention:

Currently there is not a vaccine for Hepatitis C. The best ways for fire fighters and other first responders to prevent HCV transmission are to become educated and consistently use safe sharp practices,

 

Precautions:

Universal

 

Signs and Symptoms of an Acute HCV infection include:

  • Mild fever

  • Muscle or joint aches

  • Vague abdominal pain

  • Loss of appetite

  • Jaundice (yellow skin color)

  • Tea-colored urine and light clay-colored bowel movements

 

Many of these symptoms go undetected because they are so mild and can disappear completely. The majority of people infected with Hepatitis C do not notice symptoms until after the virus causes liver damage, which can take as long as 10 or more years after initial infection.

A small number of people infected with HCV are able to clear the virus from their bodies. Hepatitis C becomes a chronic (life-long) infection in the majority (75-85%) of patients.

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Signs and Symptoms of Chronic HCV (liver damage has occurred) may include:

  • Jaundice, dark urine, light colored bowel movements

  • Fatigue

  • Abdominal pain, loss of appetite, nausea, vomiting

  • Easy bruising or excessive bleeding

  • Swollen abdomen and/or ankles

  • Joint pain

Complications: Persons with the chronic hepatitis C run the risk of developing severe health complications, including cirrhosis, liver cancer, liver failure, and death.

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Exposure Determination:

If yes is the answer to 1 or more of the following questions 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 any sharps injury or body fluid 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 preferably at the same Emergency Department as the source patient

    • Source patient baseline testing

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Medical evaluation for a HCV exposure:

  • You will be evaluated for blood borne pathogen exposure

  • If you are exposed to Hepatitis C, you should have blood drawn as soon as possible (within 7 days) for baseline testing for antibodies to HCV and liver function

  • Since false positive results can occur, all positive anti-HCV antibody results should be confirmed by a second, different test.

 

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

    1. OC Public Health Communicable Disease Exposure Form

  2. The City “Report of Employee Injury” form

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

  4. Sharps Injury Log

General Post Exposure Treatment: Post exposure prophylaxis (PEP) of hepatitis C is not recommended. Test the source for HCV RNA. If the source is HCV RNA positive, or if HCV infection status unknown, follow this Hep C Exposure Algorithms.

Post Exposure Follow-up

  • The CDC recommends follow-up HCV and liver enzyme levels (alanine aminotransferase or ALT) testing, options include

    • Anti-HCV antibody testing at 4-6 months after exposure, or

    • HCV RNA testing 4-6 weeks post-exposure

What Is The Risk Of Infection After An Occupational Exposure: Based on limited studies, the risk for infection after a needle stick or cut exposure to HCV-infected blood is approximately 1.8%. The risk following a blood splash is unknown, but is believed to be extremely small; however, HCV-infection from such  exposures have been reported.

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