HIV/AIDS Precautions - Correctional

Institutions
|What precautions should I take when employed in
correctional services?
Correctional service workers are at risk of infectious diseases including AIDS.

Identify high risk areas and procedures. Eliminate "blind" searches where you cannot see
what your hands are touching. Use mirrors and other devices.

What personal protection should I use?

Wear gloves:

 if hands have open sores

 when in contact with non-intact skin of inmates
 when in direct contact with blood, blood specimens, semen, tissue, body fluids, blood
soiled items
 when in contact with any surface or object visibly soiled with blood or body fluids
 when disposing of contaminated items

When an inmate becomes combative or threatening, gloves should be put on as soon as

possible.

Wash hands:

 after contacting blood or body fluids

 after cleaning up spills
 after handling contaminated items
 immediately after removing gloves and gown

What precautions should I take when performing

cardiopulmonary resuscitation?
 Use disposable mouthpieces or other resuscitation devices for CPR.

NOTE: Correctional service workers do not routinely wear masks and protective eye
wear. This equipment should be available when needed.

HIV/AIDS Precautions - Dental

 |What precautions should I take when employed in the
dental field?
Consider blood, saliva and gingival fluid from all dental patients as infective. Refer to
"Routine Practices" for preventing transmission of bloodborne infectious diseases.

 Use rubber dams in restorative dentistry whenever possible.

 Report immediately suspect fluid exposure, or a needlestick or sharp injury to a
designated person because if post-exposure chemoprophylaxis is to be
implemented, it should begin preferably within 1 to 2 hours after exposure.

What personal protection should I use?

Wear gloves:

 If you have open or healing wounds, or skin infections.

 When in contact with saliva, mucous membranes or blood.
 When in contact with blood-soiled items, body fluids or surfaces contaminated by
them.
 When examining all oral lesions.

Replace torn or punctured gloves immediately.

Use new gloves for every patient.

Wear gowns:

 When blood or body fluids are likely to soil clothing.

Change gowns daily or when visibly soiled with blood or body fluids.

Wear masks, face/eye protection or chin-length plastic face shields (with safety glasses or
goggles):

 To protect oral and nasal mucosa from the splatter of blood, saliva or gingival fluid.

Wash hands:

 Between patients.
 After completing procedure and before leaving work area.
 With germicidal soap before and immediately after removing gloves.

When should I decontaminate and sterilize instruments

and equipment?
  Use disposable materials. Dispose in plastic bags. Place needles and sharp instruments
in puncture-resistant containers before disposal. Check with local municipality for
disposal of contaminated waste.
 Routinely sterilize instruments used in all dental procedures. Store in sterile packs or
pouches.
 Sterilize after each use other dental instruments that come in contact with oral tissues
such as amalgam condensers, plastic instruments of handpieces and burs. High-level
disinfect if this is not possible.
 Cover with impervious-backed paper, tin foil or clear plastic wrap equipment and
surfaces that may become contaminated and are not easy to clean. Remove and
replace for each patient.
 Thoroughly clean blood and saliva from supplies used in mouth (impression material,
bite registration). Clean and disinfect.

How should I decontaminate of environmental surfaces?

 Use absorbent paper towelling to remove blood or saliva.
 Use a medical grade disinfectant to disinfect all potentially contaminated objects and
surfaces.
 Follow safe work procedures as stated in the material safety data sheets (MSDS) for
handling and disposal.

HIV/AIDS Precautions - Embalming and

Morgues
What precautions should I know when required to do
|
embalming?
Funeral directors and mortuary attendants or any person assisting in post mortem procedures
must wear gloves, masks, protective eyewear, gowns and waterproof aprons.

Consider all body fluids and tissues as potentially contaminated.

How should the deceased be transferred?

 Wear disposable pants and gowns and double gloves. Wear eye protection, mask and
cap if there is the possibility of splashing blood or body fluids.
 Identify body "Blood and Body Fluid Precautions". Keep identification with body.
  Check body for intravenous lines, catheters or colostomy bags. Take extreme care to
avoid accidental cuts or splashes before shrouding the body.
 Place body in shroud and impervious body bag for transport. Do not open bag in
transit.
 Remove protective clothing. Double plastic bag for incineration.

What precautions should I take when embalming?

 Use disposable materials.
 Remove all personal jewellery. Wear disposable pants and gowns or disposable
jumpsuit with hood, double gloves, eye protection, mask and cap, shoe covers and
plastic apron.
 Have instruments, puncture-resistant containers, and individual items, such as eye
caps and trocar buttons, readily available. Place needed amount of cosmetics on a
paper towel or wax paper sheet.
 Line garbage can with double plastic bags and place in work area.
 Usa a medical grade disinfectant to disinfect all potentially contaminated objects and
surfaces both during and after preparation. Discard left-over solution according to
material safety data sheet (MSDS) directions.
 Add a gallon of disinfectant solution to an enamel, porcelain or stainless steel bucket
before embalming begins. Place bucket underneath drainage hose from embalming
table.
 Ventilate preparation room to control exposure to formaldehyde and other volatile
airborne contaminants; the room should have a dedicated ventilation exhaust and
fresh air supply.
 Place body in casket immediately after restoration. Have head, arm and feet rests
tightly encased in plastic.
 Assign specific tasks with one person to do suturing.
 Make arrangements for a person not involved in procedures to take telephone calls
and answer door.

What precautions should I use during clean up and

disposal?
 Consider all instruments and embalming table contaminated and potentially
infectious.
 Disinfect all working surfaces and restorative and embalming instruments. Wash
embalming table, floors, walls and embalming machine with hot soapy water.
Autoclave instruments if possible.
 Place all disposable material in a tightly secured double plastic bag. Tag for
incineration. Do not dispose with regular garbage. Wash hands with appropriate
germicide.
HIV/AIDS Precautions - Embalming and
Morgues - Procedures
|What are some safe practices to follow when
embalming?
 Take extreme care to prevent cuts, lacerations and splashing of contaminated blood or
body fluids.
 Work in the smallest area possible. Avoid unnecessary movements around the room.
 Wear two pairs of intact disposable gloves. Remove punctured, torn or leaking gloves.
Wash hands thoroughly. Put on two new pairs of gloves.
 Wear safety glasses or goggles, or a face shield (with safety glasses or goggles) when
there is a chance of fluids splashing.
 Carefully transfer body to table. Avoid putting undue pressure on abdomen and
thorax. Slowly unwrap body. Carefully put body bag in disposal bin.
 Disinfect body with medical grade disinfectant. Wash with a germicidal soap and
rinse thoroughly. Keep water pressure low to avoid splashing.
 Pack and cover open sores or lesions. Pack orifices with cotton soaked in sodium
hypochlorite solution.
 Use disposable shaving equipment.
 Cover face with towel soaked in disinfectant if using injector gun.
 Cover rib ends with towel if the body was autopsied. Remove viscera bag and put into
second plastic bag for disposal.
 Use electric aspirator to aspirate body fluids. Cover draining port to avoid flashback.
 Treat blood, body fluids and aspirated contents with a medical grade disinfectant for
30 minutes before flushing directly into sewer.
 Saturate immediately any spills of blood or body fluid with medical grade
disinfectant. Wipe clean with disposable absorbent material such as paper towels.
 Wash body in medical grade disinfectant, rinse and towel dry. Use disposable
absorbent material to dry body.
 Wrap body in plastic or plastic coveralls before dressing.
 Discard rubber or wooden-handled instruments used to apply cosmetics. Discard
unused cosmetics.
 Leave embalming area immediately should you receive a cut or needle puncture.
Encourage wound to bleed freely. Wash with soap and water. Treat with fresh
disinfectant. Bandage. Get medical help immediately.
 Wash eyes and skin immediately with running water should they be splashed with
blood or body fluids. Seek medical advice.
 Spit out immediately blood or body fluids splashed in the mouth. Rinse mouth with
water. Seek medical advice.
 Wash hands with a germicide after completing restoration procedures, after removing
protective clothing and gloves, and before leaving prep room.
 Report immediately suspect fluid exposure, or a needlestick or sharp injury to a
designated person because if post-exposure chemoprophylaxis is to be
implemented, it should begin preferably within 1 to 2 hours after exposure.

What are some good qualities of disinfectants?

  It is active, not outdated.
 Will not corrode or stain instruments.
 It needs to be broad spectrum which means it is able to kill bacteria, fungi, viruses and
microbes.
 It does not bleach or stain the skin.
 It is not irritating to the embalmer's skin or respiratory tract.
 It is not inactivated by the presence of biological debris.
 Check the Material Safety Data Sheet (MSDS) before using any chemical in the
workplace to ensure compatibility with other chemicals and instructions for safe use,
storage and handling.

How do I safely dispose of used materials?

 Check all local by-laws to ensure proper disposal of biomedical waste, hazardous
waste, contaminated personal protective equipment, and potentially contaminated
laundry.
 Make sure all waste containers are clearly labelled.
 Check the qualifications of the disposal company and keep all disposal records.
Manifests must be maintained.

HIV/AIDS Precautions - Emergency

Personnel
|What should I know when employed as emergency
personnel?
Emergency personnel are in contact with infectious diseases in a variety of circumstances.
They have contact with individuals for whom no medical information is available.

 Consider blood and body fluids from all patients as potentially infective.
 Take proper precautions to prevent exposure to blood and body fluids.

Report immediately suspect fluid exposure, or a needlestick or sharp injury to a

designated person because if post-exposure chemoprophylaxis is to be implemented, it
should begin preferably within 1 to 2 hours after exposure.

What personal protection should I wear?

Wear gloves:

 when you have open or healing wounds, or skin infections

 when in direct contact with blood or body fluids, secretions or excretions and surfaces
and objects exposed to them
NOTE: Emergency personnel do not routinely require gowns, masks and protective eye wear.
This equipment should, however, be available for certain medical emergencies such as
controlling bleeding with spurting blood.

WASH hands as soon as possible:

 with waterless antiseptic hand cleaner when hand washing facilities are not available.
Follow manufacturer's recommendations
 after direct contact with a potentially infected person
 after removing gloves
 if hands become contaminated with blood or body fluids

Be careful in situations such as body searches and removing people from automobile wrecks
where the chance for broken glass, needles, or sharp edges is possible.

What precautions should I take when performing

cardiopulmonary resuscitation?
 Have available disposable mouthpieces or other ventilation devices for emergency
mouth-to-mouth resuscitation.
 Wrap fingers in gauze, a clean handkerchief or other clean material to remove saliva,
blood or other secretions from mouth and lips of victim before beginning mouth-to-
mouth resuscitation. Remove further secretions as they appear.
 Clean and rinse surface of devices. Clean with medical grade disinfectant if using
reusable equipment.

What precautions should I take when handling

contaminated clothing?
 Remove as much of the contaminant as possible by scraping off dry, crusted matter
with a disposable item.
 Wash off wet contaminant with a rag or disposable paper towel.
 Launder or dry clean contaminated clothing. No special precautions are needed.

HIV/AIDS Precautions - Emergency

Personnel
| Whatshould I know when employed as emergency
personnel?
Emergency personnel are in contact with infectious diseases in a variety of circumstances.
They have contact with individuals for whom no medical information is available.

 Consider blood and body fluids from all patients as potentially infective.
 Take proper precautions to prevent exposure to blood and body fluids.

Report immediately suspect fluid exposure, or a needlestick or sharp injury to a

designated person because if post-exposure chemoprophylaxis is to be implemented, it
should begin preferably within 1 to 2 hours after exposure.

What personal protection should I wear?

Wear gloves:

 when you have open or healing wounds, or skin infections

 when in direct contact with blood or body fluids, secretions or excretions and surfaces
and objects exposed to them

NOTE: Emergency personnel do not routinely require gowns, masks and protective eye wear.
This equipment should, however, be available for certain medical emergencies such as
controlling bleeding with spurting blood.

WASH hands as soon as possible:

 with waterless antiseptic hand cleaner when hand washing facilities are not available.
Follow manufacturer's recommendations
 after direct contact with a potentially infected person
 after removing gloves
 if hands become contaminated with blood or body fluids

Be careful in situations such as body searches and removing people from automobile wrecks
where the chance for broken glass, needles, or sharp edges is possible.

What precautions should I take when performing

cardiopulmonary resuscitation?
 Have available disposable mouthpieces or other ventilation devices for emergency
mouth-to-mouth resuscitation.
 Wrap fingers in gauze, a clean handkerchief or other clean material to remove saliva,
blood or other secretions from mouth and lips of victim before beginning mouth-to-
mouth resuscitation. Remove further secretions as they appear.
 Clean and rinse surface of devices. Clean with medical grade disinfectant if using
reusable equipment.

What precautions should I take when handling

contaminated clothing?
  Remove as much of the contaminant as possible by scraping off dry, crusted matter
with a disposable item.
 Wash off wet contaminant with a rag or disposable paper towel.
 Launder or dry clean contaminated clothing. No special precautions are needed.

HIV/AIDS Precautions - Health Care

What should I know when employed as a health care
worker?
Consider blood and body fluids from all patients as potentially infective. Refer to Routine
Practices for preventing transmission of bloodborne infectious diseases.

Report immediately suspect fluid exposure, or a needlestick or sharp injury to a

designated person because if post-exposure chemoprophylaxis is to be implemented, it
should begin preferably within 1 to 2 hours after exposure.

What personal protection should I wear?

Wear gloves:

 When you have open or healing wounds, or skin infections.

 When in contact with blood or body fluids, secretions, excretions or non-intact skin.
 When in contact with surfaces or articles contaminated with blood or body fluids.
 When performing venipuncture or other vascular access procedures.
 When carrying out cleaning or decontamination procedures.

Replace torn or punctured gloves immediately.

Use new gloves for every patient.

Wear protective eye wear, masks or face shields (with safety glasses or goggles):

 During procedures likely to generate droplets of blood or body fluids.

Protective eye wear, masks and clothing are not needed for routine care of AIDS virus-
infected persons.

Wear gowns:

 When the splashing of blood or body fluids may occur.

Wash hands:
  Before and after direct patient contact.
 Immediately and thoroughly when contaminated by blood or body fluids.
 After removing gloves.
 After a glove tear or suspected glove leak.
 Before leaving a work area.

The use of gloves does not eliminate the need for hand washing. Hand washing is one of the
most important procedures for the prevention of transmission.

What precautions should I follow when working with

linen?
 Handle soiled linen as little as possible.
 Bag soiled linen at location.
 Transport linen in impervious bag if outside of linen bag is soiled. Process according
to hospital policy.
 Do not sort or rinse soiled linen in patient care area.

What precautions should I follow when performing

cardiopulmonary resuscitation?
1. Use mouthpieces or other ventilation devices for CPR. Avoid direct contact with
patients.
2. Clean and gas-sterilize equipment before reusing.

HIV/AIDS Precautions - Laboratories

| What should I know when employed in a laboratory?
Consider blood and body fluids from all patients as infective. Refer to Routine Practices for
preventing transmission of bloodborne infectious diseases.

Report immediately suspect fluid exposure, or a needlestick or sharp injury to a

designated person because if post-exposure chemoprophylaxis is to be implemented, it
should begin preferably within 1 to 2 hours after exposure.

What personal protection should I wear?

Wear gloves:

 when processing blood or body fluid specimens

 when handling contaminated articles
 during cleaning and decontamination procedures

Change gloves after processing specimen.

Wear gowns:

 while working with potentially infectious material

Wear masks and protective eye wear:

 if mucous membrane contact is likely

Remove protective clothing before leaving laboratory.

Wash hands:

 after processing specimens

 after completing laboratory activities
 after removing protective clothing
 after a glove tear or suspected glove leak
 before leaving laboratory

Do not pipette by mouth.

What precautions should I follow when working with

needles and sharps?
 Use needles only when there is no alternative. Consider needles and sharp instruments
as potentially infective.
 Use puncture-resistant containers. Label containers.
 Clean and sterilize reusable syringes before reusing.
 Do not recap, bend, break or remove needles by hand from disposable syringes or
otherwise handle after use.

When should I decontaminate lab materials and surfaces?

Laboratory surfaces should be decontaminated:

 After a spill of blood or body fluid. Disinfect with a medical grade disinfectant.
 Before reprocessing contaminated material used in lab tests.
 When work activities have been completed.

How should I dispose and transport contaminated lab test

material?
 Place contaminated lab test material in bags and dispose according to policy for
infectious waste.
 Put specimen into a sturdy container with secure lid to prevent leaking.
 Avoid contaminating outside of container and accompanying lab form.
  Place container in a clear, impervious plastic bag.

HIV/AIDS Precautions - Needles and

Sharps
|What precautions should be used when working with
needles and sharps?
Consider all sharps as potentially infective. The user of the sharp should plan for it's safe use
and disposal.

 Use puncture-resistant containers.

 Label containers.
 Clean and sterilize reusable syringes before reusing.
 Place large bore reusable needles in puncture-proof containers.
 Use clamps to remove lancet and scalpel blades from holders, not your fingers.
 Do not recap, bend, break or remove needles by hand from disposable syringes or
otherwise handle after use.

How should decontamination and waste disposal be

handled?
 Disinfect or sterilize medical devices or apparatus according to manufacturer's
instructions.
 Clean instruments thoroughly before disinfecting with a germicide or medical grade
disinfectant.
 Incinerate or autoclave infectious waste before disposal. Carefully pour bulk blood,
suctioned fluids, excretions or secretions into a drain connected to a sanitary sewer.
Check with local, regional or provincial authorities regarding by-laws.

How should blood/body fluid spills be cleaned?

 Remove visible material from patient care areas and decontaminate.
 Remove blood or body fluids with absorbent paper towels. Dispose according to
hospital policy.
 Clean area and use disinfectant.

How should I handle laboratory specimens?

 Place collected blood and body fluid specimens in sterile containers. Securely close
lid.
 Clean the outside of the container with disinfectant if visibly contaminated.
 Place container in a clear impervious plastic bag.
  Label container "Blood and Body Fluid Precautions." Label requisition and attach to
outside of bag.
 Do not transport in a vacuum/pneumatic system.

How should patient care articles be handled?

 Use disposable patient care articles whenever possible.
 Incinerate or dispose of disposable articles according to hospital policy.
 Place articles soiled with blood in impervious bag. Label "Blood and Body Fluid
Precautions."
 Reprocess reusable items according to hospital policy.

HIV/AIDS Precautions - Workplace

Concerns
|What are some basic facts about HIV?
The Human Immunodeficiency Virus (HIV) is a virus that infects the immune system.
Acquired Immune Deficiency Syndrome (AIDS) is the most advanced stage of the
HIV infection. HIV causes the immune system to become vulnerable to other infections.
There is presently no cure or vaccine for HIV. It takes, on average, 10 years for the initial
HIV infection to progress to AIDS.

How is HIV transmitted?

The human immunodeficiency virus (HIV) can pass from one person to another in the
following ways:

 by unprotected sexual intercourse with infected persons

 by using contaminated needles
 via transfusion of infected blood or blood products
 from an infected mother to her infant before or during birth
 via organ transplant from an infected donor

HIV is not found in vomit, feces, nasal secretions, tears or urine unless these fluids are visibly
contaminated with blood.
HIV is not spread by casual contact. There is no risk of becoming infected with HIV by
working on the same assembly line, using the same equipment, sharing locker rooms or toilet
facilities or being in the same office as someone with HIV infection or AIDS.

Who are the workers at risk?

All workers who are in contact with contaminated blood or other body fluids are at risk.
Exposure to HIV in the workplace occurs through:

 skin and mucous membrane contact with blood and other body fluids of an infected
person
 accidents with needles or other sharp instruments contaminated with the blood of an
infected person

How is transmission in the workplace prevented?

The Centers for Disease Control recommend using routine practices to protect workers at risk
from HIV exposure. This approach stresses that all situations involving contact with blood
and certain other body fluids present a risk. Universal precautions outline the use of barriers
to prevent workplace exposure to HIV and other viruses. These barriers include the use of:

 engineering controls such as retractable needles

 safe work practices and administrative controls
 protective equipment such as gloves, gowns or aprons, masks, and protective eye
wear.

HIV/AIDS in the Workplace

| What is HIV and AIDS?
The Human Immunodeficiency Virus (HIV) is a virus that infects the immune system.
Acquired Immune Deficiency Syndrome (AIDS). AIDS is the most advanced stage of the
HIV infection and causes the immune system to become vulnerable to other infections. HIV
can also be known as "the AIDS virus."

The full name for AIDS describes several of the characteristics of the disease.

Acquired indicates that it is not an inherited condition.

Immune Deficiency indicates that the body's immune system breaks down.

Syndrome indicates that the disease results in a variety of health problems.

It takes on average, 10 years for the initial HIV infection to progress to AIDS. There is
presently no cure or vaccine for HIV.

How does HIV affect the body?

The human immune system involves many types of cells which guard against germs
responsible for most diseases. The immune system's most important guard cells are B-cells
and T-cells, which are special white blood cells. B-cells and T-cells cooperate to fight any
germ that attacks the human body.

B-cells produce particular proteins, called antibodies, that try to neutralize the invading germ.
After a person recovers from an infection, these antibodies continue to circulate in the
bloodstream, acting as part of the immune system's "memory." Immune system memory
explains why a person rarely suffers a second attack from an infectious disease such as
measles. If the same germ is encountered again, the antibodies will recognize and neutralize
it. T-cells attack the germ directly and try to kill it.

Special white blood cells, called T-helper cells, activate B-cells and T-cells to fight infection.
When a virus gets into the blood stream, T-helper cells activate B-cells and T-cells. These
then start communicating with each other to develop the proper strategy to fight the virus. But
when the body is infected with HIV, this does not happen. HIV penetrates T-helper cells and,
over time, multiplies. This eventually kills T-helper cells. Without T-helper cells, activation
of B-cells and T-cells does not occur. Without activation of B-cells and T-cells, the body's
immune system cannot function properly. When T-cell counts reach a certain level and there
are HIV antibodies present in the bloodstream, a person is considered to have AIDS.

How is HIV transmitted?

HIV is transmitted from an infected person by body fluids such as blood, semen or other
blood-containing secretions. As a result, anyone who is occupationally (or otherwise)
exposed to these body fluids risks contracting the disease. Preventive measures include
wearing protective clothing, gowns, gloves, masks and goggles to control the spread of HIV
among workers who may be at risk.

Unprotected sexual intercourse with infected people poses the single most important risk of
infection. HIV can also be passed from one partner into the bloodstream of the other through
tiny cuts or scratches.

Intravenous drug abusers may contract HIV if they share needles with infected people.
Hemophiliacs requiring frequent transfusions or blood products (factor VIII) are at risk due to
the possibility of receiving contaminated blood. Since 1985, Canada's Red Cross has been
screening all blood donations for HIV antibodies.

HIV can be transmitted from an infected mother to her unborn child before or during birth, or
through breastfeeding. Studies indicate infection takes place across the placenta. Therefore, a
Cesarean section delivery does not prevent the transmission of HIV from an infected mother
to her infant.
Some reports indicate that HIV can be transmitted through heart, pancreas, kidney, liver and
bone transplants, and by artificial insemination. No recipients have developed AIDS but all
organs are screened for HIV antibodies.

The transmission of HIV occurs only when the virus enters the bloodstream. Casual contact
with a person who has HIV does not pose a risk. Several studies indicate that sharing
telephones, swimming pools, toilets or other household items and facilities with people
infected with HIV poses no risk. The virus is not transmitted during the preparation or
serving of food and beverages. The virus is also not known to travel through air or to be
transmitted by mosquitoes or other insects.

Some studies show HIV transmission did not occur after bites from patients infected with the
HIV. This suggests that transmission of HIV through contact with saliva alone is unlikely.

How long does it take to develop the disease?

There is no fixed period between the first contact with HIV and the development of the
disease. Signs and symptoms resulting from infection with HIV develop in stages. Many
infected individuals may have no symptoms for several years. But others may develop
symptoms within three years from the time of infection.

Symptoms of HIV infection are fever, swollen lymph glands in the neck and armpits,
sweating, aches, fatigue, unexplained weight loss and diarrhea.

Within eight years, about 50 percent of all infected people develop specific conditions
categorized as AIDS. These conditions include a lung disease called "pneumocystis carinii
pneumonia," skin tumours called "Kaposi's sarcoma," fungal and viral infections such as
candidiasis and herpes zoster, and severe diarrhea.

Some AIDS patients also suffer from dementia resulting in problems with memory and
thinking. AIDS patients are prone to various infections of the brain, just as they suffer from
an unusually high number of cancers, bacterial and viral infections of other parts of the body.

How is HIV recognized?

Doctors use laboratory tests to confirm HIV infection. The Elisa and Western Blot analyses
identify people who have been exposed to HIV. These tests determine if the blood contains
particular antibodies that result from contact with the virus. They do not identify who among
a group of infected individuals will develop the disease. The presence of antibodies or HIV
markers means the person has been infected with HIV but no one can predict when and if
they will get AIDS related symptoms.

Doctors diagnose AIDS by blood tests (tests showing less than 200 CD4+ T cells per cubic
millimeter of blood, compared with about 1,000 CD4+ T cells for healthy people, and CD4+
T cells accounting for less than 14 percent of all lymphocytes, a type of white blood cell.) and
the presence of specific illnesses such as pneumocystis carinii pneumonia or Kaposi's
sarcoma. These diseases overcome the weakened immune system and are responsible for the
high death rate among AIDS patients.

Can HIV or AIDS be treated?

As yet, there is no cure for HIV or AIDS. Individuals infected with HIV have been receiving
improved care and newer and more effective treatment including prophylaxis. There are
many antiretroviral drugs available. But so far, these treatments can only slow or suppress the
virus, not eliminate it.

Is HIV and AIDS an occupational concern?

In Canada, only a few cases of probable occupational HIV infection have been reported.
Nevertheless, where ever there is the possibility of contact with blood in the workplace,
workers should take precautions to prevent contact with the skin, eyes or mucous membranes
(e.g. mouth).

"Standard Precautions" are recommended to prevent the spread of HIV in the workplace.
Standard Precautions are based on the principle that all blood, body fluids, secretions, and
excretions except sweat, non-intact skin, and mucous membranes, unless they contain visible
blood, may contain transmissible infectious agents. Standard Precautions involve using
protective clothing such as gloves, gowns or aprons, masks and protective eye wear when
dealing with people's blood and other blood-contaminated body fluids such as semen and
vaginal secretions. They also do not apply to saliva except in dentistry where saliva is likely
to be contaminated with blood. Standard precautions are sometimes referred to as Routine
Practices.

Hand washing after contact with blood, blood-contaminated body fluids and soiled items is
also recommended to reduce the risk of infection.

The best approach to most diseases is to prevent their occurrence - occupationally-related

diseases are no exception. In the case of HIV, prevention is the only cure.

Occupational Groups Risking Exposure to the AIDS Virus

The occupational groups listed below risk exposure to HIV in the workplace. The table that
follows suggests preventive measures for these groups. For many situations, using all
protective barriers listed in the table is not necessary, but workplaces should always make
them available in case of emergency response scenarios.

Surgeons, Nurses and Nurses Aides

Only a few cases of virus transmission to health care workers have been reported. Surgeons,
nurses and nurses' aides, however, should take precautions to avoid needlestick injuries, cuts
with sharp instruments and exposure through skin lesions to potentially infectious blood and
body fluids.

Physicians and Laboratory Workers

These people continuously handle infectious samples. Doctors, in diagnosing HIV patients,
carry out physical examinations and collect blood samples. Laboratory technicians analyze
potentially infected samples. Although in Canada none of these professionals has been
reported to have developed AIDS, they should always implement safe laboratory practices.

Ambulance Workers

Ambulance workers are potentially at risk because they attend accidents and fatalities.
Ambulance workers perform first aid on individuals for whom no medical information is
available. Blood contact is a possibility for workers when removing injured people from the
scene of an accident.

Dental Workers

Dental workers are exposed daily to the blood and saliva of patients. Precautionary measures
should be adopted because of possible exposure to HIV, and because the mouth can be the
vehicle for the transmission of many infectious diseases.

Embalmers

Embalming the bodies of persons with a HIV infection presents a risk because HIV can live
for hours in a deceased body.

Police and Firefighters

These workers attend accident scenes where they might be exposed to HIV through blood
contact with skin cuts or scratches.

Mental Health Institution Workers and Correctional Service Workers

These workers risk exposure to HIV when cleaning blood spills or when giving first aid
where there is a possibility of blood contact.

A particular concern that correctional service workers share with police is dealing with
violent people. Workers bitten by prisoners or suspects require prompt medical attention.
Bites frequently result in infection with organisms other than HIV.

Cleaners

Cleaning staff risk exposure when cleaning up spills of blood or other body fluids. Cleaning
staff need to know how to use protective clothing and proper cleaning techniques. All
cleaning equipment used to clean spills of body fluids should be kept in a restricted area and
should not be used in any other area of the workplace.

Laundry Workers
Launderers are exposed to potentially contaminated linen. All laundry should be bagged and
labeled as possibly infectious if there was contact with any person with an infectious disease.

Incinerator Attendants

Incinerator attendants in health care facilities risk exposure to HIV while disposing of
infectious waste.

Post-mortem Attendants

These workers are at risk especially if an autopsy is necessary when a patient with a HIV
infection dies.

Preventive measures for reducing occupational exposure to HIV

Occupation Preventive Measures

Surgeons, nurses and nurses aids  Wash hands.

 Use gloves.
 Wear goggles, gowns and masks if splashing of
body fluids is expected.
 Use disposable needles, syringes and devices for
mouth-to-mouth resuscitation.
 Bag and label contaminated linen.

Physicians and laboratory workers  Wash hands.

 Use coats and gloves.
 Wear goggles, gowns and masks if splashing of
body fluids is expected.
 Use disposable needles and syringes, mechanical
pipetting devices and biological safety cabinets.
 Disinfect work surfaces and equipment with
sodium hypochlorite solution

Ambulance workers  Wash hands.

 Use gloves.
 Use disposable needles, syringes and devices for
mouth-to-mouth resuscitation.

Dentists and other dental workers  Wash hands.

 Use gloves.
 Use disposable needles and syringes
 Use goggles, gowns and masks if splashing of
blood is expected.

Embalmers  Wash hands.

  Use gloves, gowns, boot-covers, goggles and
masks.
 Use disposable surgical instruments.
 Sterilize reusable equipment. Disinfect work
surfaces with sodium hypochlorite solution.

Police and firefighters  Wash hands

 Use gloves.
 Use disposable devices for mouth-to-mouth
resuscitation.

Mental health institution workers  Wash hands.

and correctional service workers  Use gloves.
 Keep cleaning equipment in restricted areas.
 Use disposable devices for mouth-to-mouth
resuscitation.

Cleaners  Wash hands.

 Use gloves.
 Keep cleaning equipment in restricted areas.

Laundry workers  Wash hands.

 Use gloves.

Incinerator attendants  Wash hands.

 Use gloves.

Post-mortem attendants  Wash hands.

 Use gloves.
 Wear goggles, masks and boot-covers if
splashing of blood and body fluids is expected.
 Bag, label and incinerate wastes.
Hantavirus

What is Hantavirus?
Hantavirus is a virus that is found in the urine, saliva, or droppings of infected deer mice and
some other wild rodents (cotton rats, rice rats in the southeastern Unites States and the white-
footed mouse). It causes a rare but serious lung disease called Hantavirus pulmonary
syndrome (HPS). The virus does not remain active for long once outside of its host -- less
than 1 week outdoors and a few hours when exposed to direct sunlight.

How common is Hantavirus?

The virus was first reported in Canada in 1994 with 3 cases in British Columbia. Since then,
about 50 cases have been reported, mostly in western Canada (Manitoba, Saskatchewan,
Alberta and British Columbia).

How can Hantavirus enter my body?

People can contract the Hantavirus infection through inhalation of respirable droplets of
saliva or urine, or through the dust of feces from infected wild rodents, especially the deer
mouse. Transmission can also occur when contaminated material gets into broken skin, or
possibly, ingested in contaminated food or water. Person-to-person transmission in North
America has not been reported. A few situations of Hantavirus pulmonary syndrome in South
America suggests person-to-person transmission is possible. However, the viruses isolated in
South America are genetically distinct from those described in North America.

How does Hantavirus affect my health?

The disease caused by Hantavirus is called Hantavirus pulmonary syndrome. Symptoms
appear within 1 to 5 weeks after exposure. The average is 2 to 3.5 weeks. This disease is
extremely serious since 50-60% of the people who get the disease die. The disease begins as
a flu-like illness. In the early stage, a worker may experience fever, chills, muscle aches,
headaches, nausea, vomiting, and shortness of breath, rapid heartbeat and gastrointestinal
problems. However, the disease progresses rapidly and infected people experience an
abnormal fall in blood pressure and their lungs will fill with fluid. Severe respiratory failure,
resulting in death, can occur within a few days of the early stage symptoms.

What is the treatment for Hantavirus pulmonary

syndrome?
There is no specific vaccine, treatment or cure for Hantavirus infection but early recognition
and medical care in an intensive care unit can help with recovery. Infected people may be
given medication for fever and pain and oxygen therapy.

What occupations are at risk?

Cases of Hantavirus infection contracted in Canada and the United States have been
associated with these activities:

 Sweeping out a barn and other ranch buildings

 Trapping and studying mice
 Using compressed air and dry sweeping to clean up wood waste in a sawmill
 Handling grain contaminated with mouse droppings and urine
 Entering a barn infested with mice
 Planting or harvesting field crops
 Occupying previously vacant dwellings
 Disturbing rodent-infested areas while hiking or camping
 Living in dwellings with a sizable indoor rodent population

For workers that might be exposed to rodents as part of their normal job duties, employers are
required to comply with relevant occupational health and safety regulations in their
jurisdiction. Typically, employers are required to develop and implement an exposure control
plan to eliminate or reduce the risk and hazard of Hantavirus in their workplace.

How can we prevent exposure to Hantavirus?

There are no vaccines against Hantavirus. Since human infection occurs through inhalation of
contaminated material, clean-up procedures must be performed in a way that limits the
amount of airborne dust. Treat all mice and droppings as being potentially infected. People
involved in clean-up activities where there are not heavy accumulation of droppings should
wear disposable protective clothing and gloves (neoprene, nitrile or latex-free), rubber boots
and a disposable N95 respirator. For cleaning up rodent contaminated areas with heavy
accumulations of droppings it is necessary to use powered air-purifying (PARP) or air-
supplied respirators with P100 filters and eye or face protection to avoid contact with any
aerosols.
Dead mice, nests and droppings should be soaked thoroughly with a 1:10 solution of sodium
hypochlorite (household bleach). Bleach kills the virus and reduces the chance of further
transmission. The contaminated material should be placed in a plastic bag and sealed for
disposal. Disinfect by wet-wiping all reusable respirator surfaces, gloves, rubber boots and
goggles with bleach solution. All disposable protective clothing, gloves and respirators
should be placed in plastic bags and sealed for disposal. Please contact your local
environmental authorities concerning approved disposal methods.

Thoroughly wash hands with soap and water after removing the gloves.

Where can I get more information?

The U.S. Centers for Disease Control and the Workers' Compensation Board of British
Columbia have guidelines that cover a variety of workplace situations. For more details on
risk assessment and precautions for specific situations not clearly addressed by existing
guidelines contact specific agencies responsible for such detailed information, for example,
your local public health office.

Hantavirus. US Centers for Disease Control

A Hantavirus Exposure Control Program for Employers and Workers. Worksafe BC

Hepatitis A

What is hepatitis A?
Hepatitis A is an infectious liver disease caused by the hepatitis A virus (HAV). The disease
varies in clinical severity from a mild illness lasting 1-2 weeks to a severely disabling disease
lasting several months.

There are other kinds of viral hepatitis such as hepatitis B, hepatitis C, hepatitis D, and
hepatitis E. These diseases and the viruses that cause them are not related to hepatitis A
although they also affect the liver. They may have other, different symptoms and different
modes of transmission. This means that there are different ways of spreading the disease and
different means for preventing and controlling these diseases.

How long does it take for hepatitis A to develop?

The incubation period (the time between initial contact with the virus and the onset of the
disease) for hepatitis A ranges from 15 to 50 days. The length of the incubation period
depends on the amount of virus to which a person is exposed. Exposure to a large dose of
virus results in a short incubation period.
What are the symptoms of hepatitis A?
Three of every four persons infected with hepatitis A virus have symptoms. When symptoms
develop they include fever, tiredness, loss of appetite, nausea, abdominal pain, dark urine,
and yellowing of the skin and eyeballs (jaundice).

Infected individuals can spread the virus from 2 weeks before the symptoms begin to 2 weeks
after symptoms end. However, an infected person who has no symptoms can still spread the
virus. Unlike some other forms of viral hepatitis, hepatitis A does not cause long-term
(chronic) damage and is usually not fatal. Those with pre-existing liver disease have a higher
risk of complications. The severity of the illness tends to increase with age. After infection,
most people are immune to HAV for life.

What test is available for hepatitis A?

The common test for hepatitis A is the antibody test. When a person becomes infected, the
body creates antibodies to protect itself from the virus. There is a blood test available to
measure these antibodies. A doctor should also do a complete medical examination and get
information about your activities in order to make a clinical diagnosis of hepatitis A.

How is hepatitis A transmitted?

The hepatitis A virus is found in the feces of infected persons. The virus is usually spread
from person to person by putting something in the mouth that has been contaminated with the
feces of a person with hepatitis A. The virus is more easily spread under poor sanitary
conditions and when good personal hygiene is not practiced. The virus can also be
transmitted through oral and anal sexual activity.

People can get hepatitis A by drinking contaminated water or eating raw and undercooked
shellfish harvested from contaminated water. Fruits and vegetables or other foods can
become contaminated during handling. However, working with an infected person, for
example sharing an office, does not pose the risk for hepatitis A.

Should hepatitis A be an occupational concern?

There continues to be little evidence of risk for hepatitis A infection in the workplace. Health
care workers are not considered to be at increased risk when they follow standard infection
control procedures. Workers in the food handling sector may be at risk if exposed to
contaminated food or water. People who visit, live or work in countries where hepatitis A is
common may be at increased risk. As well, people who work with HAV infected animals or
in a hepatitis A research laboratory may be at risk.

A report from Quebec shows that sewage workers may be at increased risk during community
outbreaks.

In the US some reports state that staff of institutions for disabled children may be at increased
risk. However, due to insufficient data, the National Advisory Committee on Immunization
(NACI) in Canada has not recommended routine vaccination of such workers.

How common is it?

The reported incidence of HAV in Canada remained above 4 per 100,000 between 1980 and
1997 and has declined to 1.47 per 100,000 in 2004.

How can we prevent hepatitis A in the workplace?

The prevention of hepatitis A in the workplace is based on good hygiene and sanitation.

Education programs for workers about personal hygiene practices should emphasize that
careful hand washing is extremely important in the prevention of disease. Workers should be
informed about using appropriate protective clothing and about removing it at the end of the
shift. They should also be informed about the necessity of washing hands frequently, and
before eating, drinking, or smoking; they should also avoid nail biting.

A hepatitis A vaccine is available and highly effective in preventing infection. Consult your
health professional.

Hepatitis B

What is hepatitis B?
Hepatitis B is an infectious liver disease. It is caused by the hepatitis B virus (HBV).
Infections of hepatitis B occur only if the virus is able to enter the blood stream and reach the
liver. Once in the liver, the virus reproduces and releases large numbers of new viruses into
the bloodstream.

To combat the disease, the body has several defenses. White blood cells, which protect the
body from infections, attack and destroy the infected liver cells. The body also produces
antibodies which circulate in the blood to destroy the virus and protect against future
infections of hepatitis B. During the infection and recovery process, the liver may not
function normally causing illness that affects the entire body.
For reasons that are not completely understood, 10 percent of people who develop hepatitis B
become carriers of the disease. Their blood remains infected for months, years, sometimes for
life. Seventy percent of carriers develop chronic persistent hepatitis B. Most do not appear to
be ill. The remaining 30 percent of carriers experience continuous liver disease. This
condition often progresses to cirrhosis and then, after 30 to 40 years, possibly to liver cancer.
At present, there is no way of curing carriers. The risk of becoming a chronic carrier is
related inversely with a person's age when infected. For example, the risk of an infant
becoming a carrier is 90-95% whereas the risk of an adult becoming a carrier is 3-10%.

There are other kinds of viral hepatitis such as hepatitis A, hepatitis C, hepatitis D (delta), and
hepatitis E. These diseases and the viruses that cause them are not related to hepatitis B even
though they also affect the liver.

How long does it take for hepatitis B to develop?

The incubation period (the time between initial contact with the virus and onset of the
disease) for hepatitis B ranges from 45 to 180 days with an average of 60 to 90 days. The
length of the incubation period depends on the amount of virus to which a person is exposed.
Exposure to a large dose of virus results in a short incubation period.

How common is it?

In 2006, the Public Health Agency of Canada (PHAC) reported the incidence of HBV as 2.0
cases for every 100,000 or about 650 cases reported annually in Canada, but many more
cases probably remain unreported. Incidence of the disease varies from region to region but
has been declining due to increasing use of the vaccine. The incidence rate higher among
males than females and is highest in the 30-39 years age group. Analysis of donated blood
indicates that about 0.15 percent of donors carry the hepatitis B virus, although for patients in
a general hospital it can be as high as 0.80 percent. Blood tests also indicate that about 5
percent of people in Canada have had hepatitis B at some point in their lives.

The annual rate of occupational infections has decreased 95% in health care workers since the
vaccine became available in 1982.

Where is the hepatitis B virus found and how is it

transmitted?
Blood is the major source of the hepatitis B virus in the workplace. It can also be found in
other tissues and body fluids, but in much lower concentrations. The risk of transmission
varies according to the specific source. The virus can survive outside the body for at least 7
days and still able to cause infection.
Blood

Direct contact with infected blood can transmit the hepatitis B virus through:

 Punctures of the skin with blood-contaminated needles, lancets, scalpels, or other

sharps.
 Splashes to skin bearing minute scratches, abrasions, burns, or even minor rashes.
 Splashes to mucous membranes in the mouth, nose, or eyes.

To a lesser extent, indirect contact with blood-contaminated surfaces can also transmit the
hepatitis B virus. The virus may be stable in dried blood for up to 7 days at 25°C. Hand
contact with blood-contaminated surfaces such as laboratory benches, test tubes, or
laboratory instruments may transfer the virus to skin or mucous membranes.

Saliva

Saliva of people with hepatitis B can contain the hepatitis B virus, but in very low
concentrations compared with blood. Injections of infected saliva can transmit the virus, so
bite injuries can also spread the disease. There are no reports of people getting hepatitis B
from mouth contact with infected CPR manikins or mouthpieces of musical instruments.

Other Body Fluids and Tissues

Hepatitis B is found in semen and vaginal secretions. The virus can be transmitted during
unprotected sexual intercourse, and from mother to infant during birth.

Synovial fluid (joint lubricant), amniotic fluid, cerebrospinal fluid, and peritoneal fluid
(found in the abdominal cavity) can contain the hepatitis B virus, but the risk of transmission
to workers is not known.

Feces, nasal secretions, sputum, sweat, tears, urine, and vomit have not been implicated in the
spread of hepatitis B. Unless they are visibly contaminated with blood, the risk of contracting
hepatitis B from these fluids in the workplace is practically nonexistent.

Hepatitis B is not transmitted by casual contact. For example, hospital employees who have
no contact with blood, blood products, or blood-contaminated fluids are at no greater risk
than the general public. However, the virus can spread through intimate contact with carriers
in a household setting. Why this happens is not completely understood. Somehow, the virus
can find its way into the bloodstream of fellow family members possibly because of frequent
physical contact with the small cuts or skin rashes. The virus can also spread through biting
and possibly by the sharing of toothbrushes or razors. It is not spread through sneezing,
coughing, hand holding, hugging, breastfeeding, sharing eating utensils, water or food.

What occupations have increased risk of hepatitis B?

The risk of acquiring hepatitis B from the workplace depends on the amount of exposure to:
  Human blood or blood products, or other body fluids and tissues known to transmit
the hepatitis B virus.
 Needlestick injuries or other puncture injuries from sharp instruments contaminated
with blood.
 Close contact with people who carry the hepatitis B virus in family or institutional
residence settings.

Blood tests show that certain occupational groups have different risks of getting hepatitis B.

Table 1
Risks to Occupational Groups

Percentage of people having

evidence of past hepatitis B Occupational Group
infection

High (over 20%) Pathologists, biochemistry and hematology laboratory

personnel, dialysis staff

Intermediate (7-20%) Hospital nurses, laboratory personnel other than those in

high risk groups, staff of institutions for the
developmentally handicapped, dentists

Low (less than 7%) Administrative hospital staff, medical and dental students,
healthy adults

In general, occupational groups with increased risk include:

 Health-care workers repeatedly exposed to blood or blood products or those who are
at risk of needlestick injury.
 Dentists, dental assistants, and dental hygienists.
 Certain staff members of institutions for the developmentally handicapped.
 Staff of institutions where workers may be exposed to aggressive, biting residents.
 Embalmers.

How do you know if you have hepatitis B?

In mild cases, the signs and symptoms are those of a minor infection. In severe cases, they are
extreme reactions resulting from liver failure. The extent of the illness depends on the
original size of the dose of the virus, the route of exposure, and the specific response of the
infected individual.

More than half of hepatitis B infections occur and pass without noticeable symptoms.
Sometimes, only mild symptoms such as a general discomfort occur. Rarely is medical
attention needed. Often, the infection disappears without treatment. In fact, laboratory testing
is often the only way of determining whether someone has had hepatitis B.
When symptoms develop, the earliest ones often include a general discomfort, joint pain,
abdominal pain, fatigue, lack of appetite, skin rash or possibly nausea, vomiting or other flu-
like symptoms.

In relatively few cases, these symptoms are followed by jaundice causing skin and white of
eyes to yellow and urine to darken--typical signs of a malfunctioning liver. An accumulation
of a waste product, called bilirubin, in the blood causes this yellowish colour. Jaundice and
other symptoms usually subside gradually within 3 to 4 weeks and most patients fully
recover, in the process becoming immune to the disease.

People with serious cases of hepatitis B require hospitalization. A very small proportion of
these patients develop a critical form of the disease called "fulminant" hepatitis B. This
condition results from a sudden breakdown of liver function. Fulminant hepatitis B is
extremely serious. Over half of the victims of fulminant hepatitis B die from the disease.

What laboratory tests are available for hepatitis B?

Tests are available to detect three types of antigens used to identify the hepatitis B virus. The
tests determine if the virus is present in the body tissue or blood. The amount of each type of
antigen present indicates how advanced the disease is and how infective the individual has
become.

Other tests are available to detect the body's reaction to the viral infection or the body's
reaction to vaccination against the virus. These tests work by measuring the number of
antibodies present in the blood. Tests also show how effective a vaccine will be.

What is the treatment for hepatitis B?

At present, there is no specific treatment for patients with acute hepatitis B although research
is continuing. Physicians commonly recommend that patients with the disease limit their
physical activity although they do not necessarily restrict them to bed-rest. They also advise
patients to drink clear liquids during the early stages of the infection and to avoid high-
protein diets and alcohol. Hospitalization may be required for patients who suffer from severe
vomiting and who are unable to maintain adequate nutritional levels. It may also be required
to prevent the development of complications.

For chronic infection, there are two standard treatments in Canada. Interferon may be given
for short periods and if effective, results in suppression of the virus. Lamivudine can be used
the same way or for long-term control of the virus. Other treatments are currently approved
for adult patients with chronic HBV infection in the United States. Physicians may do regular
monitoring for signs of liver disease progression.
How can the spread of hepatitis B be prevented in the
workplace?
The risk of hepatitis B can be significantly reduced by:

 Implementing infection control guidelines suitable for the specific workplace.

 Immunizing workers at risk.

Infection Control

Infection control precautions are the first line of defense to protect workers from hepatitis B
and other blood-borne diseases. For this reason, the Laboratory Centre for Disease Control at
Health Canada and the United States Department of Health and Human Services developed a
uniform approach called "routine practices".

Originally developed for hospitals, routine practices have been adapted to a wide range of
workplaces. They apply to all situations where workers have risk of exposure to blood or
certain body fluids.

The purpose of routine practices is to prevent exposure to blood-borne diseases transmitted

by needlestick accidents or fluid contact with an open wound, non-intact skin, or mucous
membranes. Routine practices are to be used in conjunction with other control measures. An
example is washing hands whenever gloves are removed or whenever the skin contacts
potentially infectious fluids.

Routine practices recommend the use of engineering controls, safe work practices, and
personal protective equipment to suit the specific task and workplace.

Engineering controls include the use of equipment to isolate or contain the hazard, such as
puncture-resistant containers for disposing of used sharps, or biological cabinets for certain
procedures in laboratories.

Safe work practices are required for all tasks involving possible exposure to blood or certain
body fluids. They include:

 Safe collection of fluids and tissues for disposal in accordance with local, provincial,
territorial, or federal regulations.
 Safe removal and disposal or decontamination of protective clothing and equipment.
 Procedures to follow in the event of spills or personal exposures such as needlestick
injuries.
 Specific and detailed procedures to observe when using and disposing of needles and
other sharp objects.

Personal protective equipment provides a barrier to blood and certain body fluids. Equipment
recommended by routine practices include:

 Gloves to protect the hands and skin.

  Masks and eye protection together or a face shield (with safety glasses or goggles) to
protect mucous membranes of the eye, nose and mouth in any situation where
splashes of blood or body fluids may occur.
 Aprons to protect clothing from splashes with blood, or gowns if large quantities of
blood are present or anticipated.

Please see the OSH Answers document Routine Practices for more information.

Specific routine practices have been developed for:

 Health care workers.

 Emergency personnel, firefighters, and police.
 Laboratory personnel.
 Pathology personnel.
 Dentists and dental assistants.
 Workers in correctional institutions.
 People required to perform CPR.
 Embalmers and morgue attendants.

Immunization

Hepatitis B vaccines are licensed in Canada. They provide safe, reliable protection from
hepatitis B when used either before or immediately after exposure to the virus. Tests show 90
to 95 percent of vaccinations of healthy people result in the development of resistance against
hepatitis B. At present, vaccination is the surest way to avoid acquiring hepatitis B as an
occupational disease.

Side effects are usually mild with soreness at the injection site being the most commonly
reported. Studies show no link between the hepatitis B vaccine and multiple sclerosis, chronic
fatigue syndrome, rheumatoid arthritis or Guillain-Barré syndrome. The vaccine may very
rarely cause a severe life-threatening, whole-body allergic reaction (anaphylaxis). People
with allergies to any hepatitis B vaccine ingredients, for example, yeast, should not receive
the vaccine. Check with your health professional for more information.

Protection from the vaccine lasts at least fifteen years. Booster doses are generally not
recommended for people with normal immune status.

Immunization Before Contact

The National Advisory Committee on Immunization (NACI) recommends the vaccination of

people who are at increased risk of contracting hepatitis B because of exposure to the virus in
their work. They also recommend vaccination for people who are sexual or household
contacts of carriers of hepatitis B.

Since the risk varies from workplace to workplace, institutions should review their situations
and develop their own vaccination priorities. Hospital employees who have no contact with
blood, blood products, or blood-contaminated body fluids and who are not at risk of
needlestick injuries, are at no greater risk of hepatitis B than the general population.

Immunization After Contact

Workers who experience needlestick injuries, splash exposures to blood from carriers, or bite
injuries should immediately seek medical attention. In some jurisdictions, local legislation
outlines the procedure for treating these injuries.

If the blood is known to contain the hepatitis B virus, and the exposed worker has not been
vaccinated or does not have antibodies against hepatitis B, post-exposure immunization is
strongly recommended to prevent the development of hepatitis B.

National immunization guidelines recommend post-exposure vaccination when the source of

blood is unknown. Vaccination against hepatitis B is usually recommended within seven days
of exposure. Depending on the specific circumstance, hepatitis B immunoglobulin is
sometimes recommended also. Immunoglobulin is a preparation containing antibodies which
attack the hepatitis B virus. It is usually given as quickly as possible, preferably within 24
hours of the incident.

If the worker's blood has antibodies against hepatitis B, or if the contaminated blood is free of
virus, further treatment may be unnecessary.

In summary, hepatitis B is a serious occupational concern for workers who may be exposed
to blood or certain body fluids. However, the use of routine practices for blood and certain
other body fluids, and immunization (complete hepatitis B vaccine series) including post-
vaccination testing to document immunity, greatly reduces and can eliminate the risk of
hepatitis B.

Hepatitis C

What is hepatitis C?
Hepatitis C is an infectious liver disease caused by the hepatitis C virus (HCV). Infections of
hepatitis C occur only if the virus is able to enter the blood stream and reach the liver.

For reasons that are not completely understood, about half of all people who develop hepatitis
C never fully recover and can carry the virus for the rest of their lives. These people have
chronic hepatitis C, and some may eventually develop cirrhosis of the liver and liver failure.

There are other kinds of viral hepatitis such as hepatitis A, hepatitis B, hepatitis D, and
hepatitis E. These diseases and the viruses that cause them are not related to hepatitis C even
though they also affect the liver. They may have other, different symptoms and different
modes of transmission. This means that there are different ways of spreading the disease and
different means for preventing and controlling these diseases.

How long does it take for hepatitis C to develop?

The incubation period (the time between initial contact with the virus and the onset of the
disease) for hepatitis C ranges from 2 weeks to 6 months, most commonly 6 to 9 weeks.
What are the symptoms of hepatitis C?
The symptoms of hepatitis C infection include fever, nausea and vomiting, loss of appetite,
stomach pain, extreme fatigue, and yellowing of the skin and eyes (jaundice).

Some people who are infected with hepatitis C virus have no symptoms and can infect others
without knowing it. These persons are at risk of becoming ill at some time in the future. It has
been estimated that it may take 10 years to develop symptoms.

What tests are available for hepatitis C?

The common tests for hepatitis C are the antibody test, the polymerase chain reaction (PCR)
test, liver function test and the liver biopsy test. When a person becomes infected, the body
creates antibodies to protect itself from the virus. There is a blood test available to measure
these antibodies. However, sometimes a "false negative" test can result if there are not
enough antibodies in the blood for the tests to detect accurately. A doctor should also do a
complete medical examination and get information about your activities in order to make a
clinical diagnosis of hepatitis C.

How is hepatitis C transmitted?

The hepatitis C virus is spread primarily by exposure to blood. Some people who get hepatitis
C do not know how they were infected with the virus.

People may get hepatitis C by sharing needles to inject drugs, through exposure to blood in
the workplace, from unsterile equipment used for body piercing, tattoos or acupuncture,
exposure to dental or medical practices with poor infection control practices or by sharing
personal care items including nail clippers, razors, scissors with infected people. The risk of
getting this virus from a blood transfusion is minimal but still exists. All donated blood is
now screened for the hepatitis C virus.

Hepatitis C has been transmitted between sex partners and among household members.
However, the degree of this risk still needs to be accurately defined. An infected mother can
pass HCV to her child at birth.

There is no evidence that hepatitis C virus is spread by casual contact. Sneezing, coughing
and hugging do not pose the risk for hepatitis C. In addition, there is no evidence that
hepatitis C virus is spread by food or water.

How common is it?

In Canada, between 3,200 and 5,000 people are infected with hepatitis C annually. As of
2008, an estimated 250,000 people are infected with HCV. Less than 25% of those initially
infected have symptoms and 75-85% progress to the carrier (chronic) state. It is estimated
that 35% of those with chronic hepatitis do not know they are infected and may not have
symptoms for many years. Rates of hepatitis C between 1999 and 2006 in Canada are highest
in the 40-59 age group and higher in males than females. The total rate of infection is
declining during this period.

What occupations have increased risk of hepatitis C?

The risk of acquiring hepatitis C from the workplace depends on the amount of exposure to
human blood or blood products and needlestick injuries. In general, occupational groups with
increased risk include workers such as dentists, nurses, and laboratory personnel who are
repeatedly exposed to human blood and who are at risk of needlestick injuries.

How can we prevent hepatitis C in the workplace?

There is currently no vaccine for hepatitis C. The risk of hepatitis C can be significantly
reduced by implementing infection control guidelines suitable for the specific workplace.

Infection control precautions are the first line of defense to protect workers from this virus
and other blood-borne diseases. For this reason, the Laboratory Centre for Disease Control at
Health Canada and the United States Department of Health and Human Services have
developed a uniform approach called "Routine Practices"

Originally developed for hospitals, routine practices have been adapted to a wide range of
workplaces. They apply to all situations where workers have risk of exposure to blood or
certain body fluids, including:

 Semen.
 Vaginal secretions.
 Synovial fluid.
 Cerebrospinal fluid.
 Pleural fluid.
 Peritoneal fluid.
 Pericardial fluid.
 Amniotic fluid.

Routine practices do not apply to situations where workers may be exposed to:

 Feces.
 Nasal secretions.
 Sputum.
 Sweat.
 Tears.
  Urine.
 Vomitus.
 Saliva (except in the dental setting, where saliva is likely to be contaminated with
blood).

The purpose of routine practices is to prevent exposure to blood-borne diseases transmitted

by needlestick accidents or fluid contact with an open wound, non-intact skin (e.g., cuts or
skin rashes), or mucous membranes. Routine practices are to be used in conjunction with
other control measures. An example is washing hands whenever gloves are removed or
whenever the skin contacts potentially infectious fluids.

Routine practices recommend the use of engineering controls, safe work practices, and
personal protective equipment to suit the specific task and workplace. Engineering controls
include the use of equipment to isolate or contain the hazard, such as puncture-resistant
containers for disposing of used sharps, or biological cabinets for certain procedures in
laboratories.

Safe work practices are required for all tasks involving possible exposure to blood or certain
body fluids. They include:

 Safe collection of fluids and tissues for disposal in accordance with local, provincial,
territorial, or federal regulations.
 Safe removal and disposal or decontamination of protective clothing and equipment.
 Procedures to follow in the event of spills or personal exposures such as needlestick
injuries.
 Specific and detailed procedures to observe when using and disposing of needles and
other sharp objects.

Personal protective equipment provides a barrier to blood and certain body fluids. Equipment
recommended by routine practices include:

 Gloves to protect the hands and skin.

 Masks and eye protection together or a face shield (with safety glasses or goggles) to
protect mucous membranes of the eye, nose and mouth in any situation where
splashes of blood or body fluids may occur.
 Aprons to protect clothing from splashes with blood, or gowns if large quantities of
blood are present or anticipated.

Additional general information on Routine Practices is available on this web site.