Occupational health – Hep B update

Occupational Health Re: Shortage of hepatitis B vaccines, implications and advice for health care pre-registration students

As you may be aware, there is a global shortage of hepatitis B vaccine which is currently impacting severely on the UK supply. The situation has become particularly critical during August but limitations on supply are likely to continue until early 2018

Following advice produced by Public Health England, we have put in place measures so that the NHS can vaccinate those at highest risk. This does mean that those at lower risk (which includes all new health care pre-registration students) will not be able to be vaccinated until supplies are available.

For those health care pre-registration students who start clinical contact early in their programme, a risk assessment of the type and level of contact needs to be undertaken.

Procedures that involve a high risk of exposure should not be undertaken until you are fully vaccinated. (Exposure Prone Procedures). Exposure Prone Procedures (EPP) are those procedures where the worker’s gloved hands 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.

As always, all pre-registration students will be prepared so that you are able to minimise exposure and know what to do if you are exposed.

For the following professions: student midwives, paramedics and operating department practitioners, you will have specific preparation to reduce any risk, and this will follow the usual information provided to any student whose immunity to hepatitis B is not secured through vaccination (as some people, even with full vaccination, never achieve immunity).

Examples of exposure prone procedures

• Episiotomy repairs for midwives
• Handling acute trauma patients with open wounds where there is the unpredictable risk of injury from sharp tissues such as fractured bones
• Internal cardiac massage
• Assisting in open surgical procedures

Advice on infection and control

• Reinforce the use of standard precautions by all staff e.g. wearing gloves
• Reinforce the use of safety needles and near-patient sharps disposal units for clinical staff
• Reinforce the importance of immediate reporting of needlestick and other significant exposures so that a timely risk assessment for post exposure vaccination can be done.
• Undertake an individual risk assessment if working with Hepatitis B positive patients

Hepatitis B – the disease

Hepatitis B is caused by the hepatitis B virus. Infection doesn’t often cause symptoms but when it does it leads to flu-like symptoms, including tiredness, fever, loss of appetite, sickness and diarrhoea, tummy (abdominal) pain and yellowing of the skin and eyes (jaundice). These symptoms usually appear two to three months after ‘exposure’ to the infection and normally pass after one to three months.

Hepatitis B – how it is spread?

Hepatitis B is uncommon in the UK and so the risk of catching infection in the UK is low. The virus is present in the blood of infected people, and in some other body fluids which may be contaminated with tiny amounts of blood. The infection spreads by blood to blood contact – for example when the virus gets into your bloodstream through a cut, scratch, or a contaminated needle.

It cannot be spread by kissing, holding hands, hugging, coughing, sneezing, or sharing crockery and utensils.

How to reduce the risk of becoming infected

Certain jobs can put people at risk because they involve contact with body fluids. This includes healthcare workers. Ideally, you should avoid activities where you may be exposed to blood and body fluids until you are fully vaccinated. You should also protect yourself and others by taking care when handling and disposing of sharp instruments (e.g. by wearing gloves and washing your hands). Ensure all surfaces are disinfected properly and dispose of contaminated waste safely.

Medical conditions that require procedures involving transfer of blood, for example renal dialysis, increase the risk of passing on infection. The risk from renal dialysis in the UK is extremely low, as all staff and patients are vaccinated, patients are tested regularly and those with hepatitis B infection are dialysed separately. Despite this, you should avoid contact with surfaces or objects that may be contaminated with blood and take precautions such as wearing gloves.

What to do if you are exposed

If, you have not been vaccinated and then you are exposed to hepatitis B infection (if, for example, you sustain a needlestick injury/splash), you should report immediately through your placement provider and seek urgent advice from the Centre of Occupational Health and Wellbeing. Having a dose of vaccine promptly after the incident can still help to protect you from hepatitis B.