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Specific Bloodborne Pathogens

Hepatitis B
Hepatitis B Virus Structure.
(Click to enlarge)
Chart of HBV Incidence
Incidence of acute HBV.
(Click to enlarge)

Hepatitis B Virus (HBV)

The hepatitis B virus (HBV) is one of the primary causes of Hepatitis, an infection which causes inflammation of the liver. Complications of Hepatitis include cirrhosis (scarring) of the liver, liver cancer, and liver failure. There is no known cure for the hepatitis B virus. In the United States, approximately 15 to 25 percent of people infected with HBV will die because of the illness.

Hepatitis B can be either acute or chronic.

  • Acute hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis B virus. Acute infection can, but does not always, lead to chronic infection.
  • Chronic hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in a person's body. Chronic hepatitis B is a serious disease that can result in long-term health problems, and even death.

According to the Hepatitis B Foundation, thousands of people in the United States and 600,000 people worldwide die from hepatitis B-related liver disease annually. In 2016, a total of 3,218 cases of acute hepatitis B were reported to CDC. CDC estimates the actual number of acute hepatitis B cases was almost 20,900 in 2016.

1. The hepatitis B virus causes an inflammation and possibly cirrhosis of the _____.

a. lungs
b. heart
c. liver
d. kidneys

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Hepatitis B Virus (HBV) (continued...)

Jaundice
The appearance of jaundice in the eyes.
(Click to enlarge)

Symptoms of HBV

Symptoms of HBV infection include, but are not limited to:

  • loss of appetite
  • fatigue
  • fever
  • nausea, vomiting and/or abdominal pain
  • joint pain
  • jaundice seen in the eyes

Jaundice, also called icterus, is a yellowing of the skin or eyes and occurs in the more serious phase of Hepatitis B virus. Hepatitis B can damage the liver, resulting in decreased liver function. As the liver's ability to filter waste from the blood decreases, the concentration of waste in the blood increases.

Jaundice, a symptom of hepatitis B, often first appears in the eyes.

Only about 30 to 50 percent of individuals infected with Hepatitis B virus show symptoms. It is important to understand even without symptoms, HBV-infected individuals are still infectious to others.

Click here to view the CDC fact sheet for Hepatitis B. (PDF)

2. What is often the first symptom that appears when an employee is infected with hepatitis B?

a. Loss of appetite
b. Fatigue
c. Jaundice seen in the eyes
d. Nausea and vomiting

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Hepatitis B Virus (HBV) (continued...)

Exposure

An exposure that might place a worker at risk for HBV, HCV, or HIV infection is defined as:

  1. A percutaneous injury (e.g., a needlestick or cut with a sharp object); or
  2. Contact of mucous membrane or nonintact skin (e.g., exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or other body fluids that are potentially infectious.
  3. Indirect exposure from contaminated objects is a risk because hepatitis B virus can remain infectious on environmental surfaces for up to a week (7 days) in the form of dried blood.

This means you must always treat blood, wet or dry, as infectious!

Vaccination

A vaccination to prevent Hepatitis B virus infection is available. The Hepatitis B vaccine series is a sequence of three shots, typically given one month apart, that stimulate a person's natural immune system to protect against the virus. After the vaccine is given, the body makes antibodies to protect a person against the virus. Antibodies are specialized proteins found in the blood that produce an immune response to a virus invading the body. These antibodies are stored in the body to guard against future infections. They will fight off an infection if a person is exposed to the Hepatitis B virus in the future.


Scenario

Michelle is a custodian in a public elementary school. At the end of each school day, she cleans and vacuums the building, including the school's health room. While cleaning the health room she notices some dried blood on the floor.

Should Michelle be concerned about exposure to hepatitis B virus?

Yes!

Any blood, wet or dry, has the potential to carry infectious hepatitis B virus. As a result, Michelle must take precautions to prevent potential exposure to bloodborne pathogens, including Hepatitis B virus.

3. The hepatitis B virus (HBV) may remain infectious on contaminated objects or surfaces for up to _____.

a. 3 hours
b. 24 hours
c. 3 days
d. 7 days

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Hepatitis C Virus (HCV)

Chart of HCV Incidence
Hepatitis C Virus Structure.
(Click to enlarge)
Chart of HBV Incidence
Incidence of acute HCV.
(Click to enlarge)

The hepatitis C virus (HCV) is also a significant cause of severe liver damage and death.

Hepatitis C kills more Americans than any other infectious disease. Deaths associated with hepatitis C reached 18,153 in 2016, according to surveillance data released by the Centers for Disease Control and Prevention (CDC).

About 3.5 million Americans are currently living with hepatitis C and roughly half are unaware of their infection. Approximately 1 to 5% of people infected with hepatitis C virus die as a result of the long-term damage caused to the liver and body.

Approximately 70%-80% of people with acute hepatitis C do not have any symptoms. Some people, however, can have mild to severe symptoms soon after being infected, including:

  • fever
  • fatigue
  • loss of appetite
  • nausea
  • vomiting
  • abdominal pain
  • dark urine
  • grey-colored bowel movements
  • joint pain
  • jaundice (yellow color in the skin or eyes)

Click here to view the CDC fact sheet for Hepatitis C. (PDF)

4. Which of the following kills more Americans than any other infectious disease?

a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D

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Hepatitis C Virus (HCV) (continued...)

If symptoms do occur, the average incubation period is 45 days after exposure, but this can range from 14 to 180 days.

Many people infected with the hepatitis C virus do not develop symptoms.

Hepatitis C virus-infected individuals are infectious to other people, whether they show symptoms or not. Interestingly, Hepatitis C virus is strictly a human disease. It is not known to cause disease in any animals.

Blood testing for hepatitis C virus was not available until 1992. As a result, blood donation agencies did not screen for hepatitis C virus. Many hepatitis C virus infections occurred as a result of receiving blood products from infected individuals. Today, testing for hepatitis C is common place and should occur after any exposure to potential bloodborne pathogens.

There is no vaccine for Hepatitis C.

Treatment

According to the CDC, approximately 15% to 25% of people infected with acute Hepatitis C will naturally be able to clear the infection from their body without treatment.

There are several medications available to treat chronic hepatitis C, including newer, more effective drugs with fewer side effects.

Around the World

According to the World Health Organization (WHO), 1.75 million people are infected with the hepatitis C virus each year. Approximately 71 million people are chronically infected and at risk of developing liver cirrhosis and/or liver cancer. About 400,000 people worldwide die from hepatitis C-related liver diseases each year.

Decontamination

Any blood spills - including dried blood, which can still be infectious - should be cleaned using a 10% dilution (1 part household bleach to 9 parts water). Gloves should always be worn when cleaning up blood spills.

Scenario

Manuel is a nurse working nights in the local hospital. During a shift in the emergency department he is stuck with a used needle that punctures his skin and draws blood.

Is Manuel at risk for contracting Hepatitis C?

Yes!

After a needlestick or sharps exposure to Hepatitis C-positive blood, the risk of infection is approximately 1.8%. Manuel should immediately report the potential exposure and follow his employer's exposure control plan to ensure he receives proper medical treatment and testing.

5. Infectious blood spills should be cleaned using a _____ dilution (1 part household bleach to 9 parts water).

a. 5%
b. 10%
c. 15%
d. 20%

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Human Immunodeficiency Virus (HIV)

HIV attacking immune cell.
Human Immunodeficiency Virus (green) attacking a healthy immune system cell.
(Click to enlarge)

The Human immunodeficiency virus (HIV) was identified in 1981, and is the virus responsible for causing acquired immunodeficiency syndrome (AIDS). Approximately 1 million people in the U.S. are living with HIV today, and about 15 percent of them are unaware they are infected. As of 2016, there are about 37 million people living with HIV around the world, with only half receiving treatment.

The Human immunodeficiency virus attacks and suppresses the immune system, reducing a person's ability to fight infection. The virus specifically targets the cells crucial for fighting infection from pathogens. This allows diseases and infections to progress without resistance.

Within a few weeks of being infected with HIV, some people develop flu-like symptoms that last for a week or two, but others have no symptoms at all. People living with HIV may appear and feel healthy for several years. However, even if they feel healthy, HIV is still affecting their bodies. Untreated early HIV infection is also associated with many diseases including cardiovascular disease, kidney disease, liver disease, and cancer.


Scenario

Stacy is a police officer employed by the city of Denver, Colorado. She is regularly required to respond to emergency medical situations, often arriving before the local ambulance company. As a result, Stacy is frequently exposed to human blood.

Is Stacy likely to contract HIV from exposure to infected blood?

No!

If Stacy follows universal precautions she is not likely to contract HIV. Universal precautions involve the use of protective barriers such as gloves, gowns, aprons, masks, or protective eyewear.

6. Which virus specifically targets the cells crucial for fighting infection from pathogens?

a. Human Immunodeficiency Virus (HIV)
b. Hepatitis C Virus (HCV)
c. Hepatitis B Virus (HBV)
d. Hepatitis A Virus (HAV)

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Human Immunodeficiency Virus (HIV) (continued...)

HIV Virus Structure
Human Immunodeficiency Virus structure.
(Click to enlarge)

It can take many years before an HIV-infected person displays symptoms of the disease.

Symptoms include:

  • enlarged lymph nodes
  • fatigue
  • frequent fevers
  • persistent or frequent yeast infections of the mouth or vagina
  • persistent or frequent skin rashes
  • short-term memory loss
  • weight loss
  • enlarged liver and spleen

Presently, there is no known cure for HIV. Treatment for HIV is called antiretroviral therapy or ART. If people with HIV take ART as prescribed, their viral load (amount of HIV in their blood) can become undetectable. If it stays undetectable, they can live long, healthy lives. Today, someone diagnosed with HIV and treated before the disease is far advanced can live nearly as long as someone who does not have HIV.

HIV cannot reproduce outside the human body. It is not spread by:

  • air or water
  • insects, including mosquitoes: studies conducted by CDC researchers and others have shown no evidence of HIV transmission from insects
  • saliva, tears, or sweat: there is no documented case of HIV being transmitted by spitting
  • casual contact like shaking hands or sharing dishes
  • closed-mouth or "social" kissing

All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated by state and local health departments with assistance, guidance, and laboratory support from the CDC.

Disease Comparison

Of the three major bloodborne pathogens, hepatitis B virus is the most contagious. Approximately 33% of individuals exposed to hepatitis B virus will become infected. Of those individuals exposed to hepatitis C virus, only about 2% will become infected. Comparatively, human immunodeficiency virus is much less contagious than either form of hepatitis. About 0.33%, or 1 in 300, people exposed to HIV will become infected with the virus. Despite these statistics, every exposure has the potential to transmit bloodborne pathogens and must be considered significant.

7. Which of the following is TRUE regarding a cure for HIV?

a. There is no known cure
b. Those successfully treated can live long lives
c. HIV readily reproduces outside the body
d. You can catch HIV if bitten by insects

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Methicillin-resistant Staphylococcus aureus (MRSA)

Methicillin-resistant Staphylococcus Aureus is a common multi-drug-resistant bacterium that causes staph infections (MRSA) in different parts of the body. It is carried by about 2‰ of the population in the U.S. with nearly 19,000 infections resulting in sepsis causing death.

Staph infections are common among the general population, and since the 1970s, there has been a dramatic increase in infections caused by MRSA in hospitals and clinics, nursing homes, laboratories, and housekeeping, and is becoming more common in locker rooms and laundry facilities. The MRSA bacterium has become resistant to many antibiotics and is now considered a "superbug."

HIV Virus Structure
MRSA is drug-resistant.
(Click to enlarge)

MRSA can cause severe problems including:

  • bloodstream infections
  • pneumonia
  • skin/injury site infections
  • sepsis
  • death

Preventing the Spread of MRSA

  • Cover your wounds with clean, dry bandages until healed.
    • Follow your healthcare provider's instructions about proper care of the wound. Pus from infected wounds can contain MRSA.
    • Do not pick at or pop the sore.
    • Throw away bandages and tape with the regular trash.
  • Clean your hands often. Wash hands often with soap and water or use an alcohol-based hand rub, especially:
    • after changing a bandage
    • after touching an infected wound
    • after touching dirty clothes
  • Do not share personal items such as towels, washcloths, razors, and clothing, including uniforms.
  • Wash laundry before use by others and clean your hands after touching dirty clothes.

8. Which of the following bloodborne pathogens has become drug-resistant and is considered a "superbug?"

a. Hepatitis B Virus (HBV)
b. Hepatitis C Virus (HCV)
c. Human Immunodeficiency Virus (HIV)
d. Methicillin-resistant Staphylococcus aureus (MRSA)

Check your Work

Read the material in each section to find the correct answer to each quiz question. After answering all the questions, click on the "Check Quiz Answers" button to grade your quiz and see your score. You will receive a message if you forgot to answer one of the questions. After clicking the button, the questions you missed will be listed below. You can correct any missed questions and check your answers again.

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Hepatitis C Infection - 3D Medical Animation

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