Hepatitis C

General information

Hepatitis C is a serious disease of the liver caused by a virus. Hepatitis means inflammation of the liver. Sometimes, it can be brought on by alcohol or drugs, but usually it is caused by a virus. There are several different types of virus known to cause hepatitis. One virus causing increasing concern amongst Health Professionals is Hepatitis C, which is a blood borne virus. The incubation period, from exposure to the virus until the onset of the disease is one to six months. Symptoms of Hepatitis C vary considerably from flu like symptoms to an acute illness with abdominal pain and jaundice. Many will be unaware that they have sustained the infection. The consequences of hepatitis infection vary from one individual to another, these can include, chronic liver disease, cancer of the liver, and, in severe cases, death. Twenty percent of people will clear the virus at the acute stage, the remaining eighty percent will remain infected. This carrier state can persist for many years.

Hepatitis C is transmitted via blood and other body fluids. The most common cause of transmission in Health Care Workers is via needle stick injury or blood splashes to mucous membrane. Cuts and skin lesions can also provide a portal of entry. Hepatitis C is spread in the general population through sharing contaminated equipment for drug injection. Sexual transmission is possible but unusual. Infection may also have been acquired from receipt of unscreened blood or untreated plasma products (in the UK prior to September 1991 for blood, and 1985 for plasma).

The spread of Hepatitis C can be prevented amongst Health Care Workers by good practice and adoption of ‘Universal Precautions’, a system of good practice regardless of whether the situation is considered high risk or not.

The Department of Health issued new guidance in August 2002 ‘ Hepatitis C Infected Healthcare Workers’ http://www.doh.gov.uk/hepatitisc. The aim of the guidance is to prevent the transmission of Hepatitis C from Health Care Workers to patients. The guidance only applies to Health Care Workers involved in ‘exposure prone procedures’.

EXPOSURE PRONE PROCEDURES (EPPs) are defined as:-

Invasive procedures where there is a risk that injury to the health care worker may result in the exposure of the patient’s open tissue to the blood of the worker. They include procedures where the worker’s gloved hand may be in contact with sharp instruments, needle tips or sharp tissue (e.g. spicules of bone or teeth) inside a patient’s open body cavity, wound or confined anatomical space, where the hands or fingertips may not be completely visible at all times. (DOH Dec. 2002)

Health Care Workers who are intending to undertake professional training for a career that relies upon the performance of exposure prone procedures will be tested for antibodies to the Hepatitis C Virus on entry to HYMS and, if positive, for Hepatitis C virus RNA.

Anyone found to be Hepatitis C antibody positive will be recalled to the Occupational Health Unit for advice and further testing. A positive test would indicate a history of Hepatitis C infection.

A positive result would prevent commencement of areas of training involving EPPs until further tests and treatment had been implemented. Refusal to undergo testing would be treated as a positive result.

DOH guidelines are still under review, you will be informed of any changes.