Hospital and Other Health-Care Facilities

Health-care workers and their patients are at risk for exposure to infected blood and body fluids and therefore vulnerable to infection with HBV and HCV. As discussed in Chapter 2, there have been several outbreaks of hepatitis B and hepatitis C in health-care settings in recent years (CDC, 2003b, 2003c, 2005, 2008a, 2009a; Fabrizi et al., 2008; Thompson et al., 2009). Hospitals and nonhospital health-care facilities (such as dialysis units, endoscopy clinics, and long-term-care facilities) should develop educational programs to reinforce the importance of adhering to recommended standard precautions and procedures to prevent the transmission of bloodborne infections in both inpatient and outpatient health-care settings (Thompson et al., 2009). Health-care workers should be routinely vaccinated to protect them from hepatitis B. Although the ACIP recommends that health-care workers receive the hepatitis B vaccine, and the Occupational Safety and Health Administration requires employers to offer the hepatitis B vaccine to all health-care workers who may be exposed to blood (29 CFR 1910.1030), about 25% of health-care workers remain unvaccinated (Simard et al., 2007). Successful interventions to prevent exposures known to transmit bloodborne infections have included general safety training; training specific to prevention of needle-stick injuries; modification of practice, staffing, and workload adjustments; and use of protective devices, such as needles that automatically retract (Clarke et al., 2002; Holodnick and Barkauskas, 2000; Hooper and Charney, 2005; Stringer et al., 2002; Trim, 2004).

Substance-Abuse–Related Service Providers

Staff of drug-treatment programs, needle-exchange programs, and correctional facilities should be participants in viral-hepatitis educational programs. Studies have shown that IDUs who used needle-exchange programs or who had been in drug treatment were more likely than others to report their HCV-antibody status accurately (Hagan et al., 2006). Very high proportions of IDUs have been in jail or prison (Milloy et al., 2008); therefore, periods of incarceration may present a prime opportunity for providing hepatitis C education to this high-risk population. In many communities that have needle-exchange programs, the majority of IDUs have participated in them (Hagan et al., 1999; Lorvick et al., 2006). Over the period during which a person may inject illicit drugs, the likelihood that he or she has been in a drug-treatment program rises (Galai et al., 2003; Hagan et al., 1999). Thus, the committee believes that providing standardized education to staff of drug-treatment and needle-exchange programs and correctional



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