Chester Clinic

Microsoft word - position statement hepatitis c.doc

Hepatitis C


Background
Hepatitis C (HCV) is now recognised as a serious public health problem
world-wide and the World Health Organisation estimates that around 170
million people are chronically infected with the virus (WHO, 2003).
Estimates vary from between 200,000 to 500,000 people infected with HCV
in England and Wales. There is also variation in prevalence between groups;
for example, 0.4% in women attending antenatal clinics in inner London, and
up to 50% in intravenous drug users (National Institute for Clinical
Excellence 2006). HCV is a blood-borne virus with infection occurring
through the transfer of body fluids. Intravenous drug users are more at risk
of contracting the virus through the sharing of needles (Hope VD, et al.
2001). Health care workers are also at risk from 1exposure prone procedures
and through occupational injuries such as needle stick injuries.
In 2004, 1624 hepatitis C infections were confirmed in Scotland with 851
new cases between during January and June of 2005; 8240 cases of hepatitis
infections were reported in England and Wales, and 100 in Northern Ireland.
Given that most hepatitis C infections are asymptomatic, reports of new
infections reflect increase in testing patterns rather than trends in
incidence. (Advisory Group on Hepatitis, 2005).
Some people infected with the HCV may clear the virus in the acute stages
of the infection. However, most people infected with HCV are unaware that
they carry the virus as they remain well and may only develop symptoms of
chronic liver disease many years after the initial infection. There is no
known available vaccine to prevent transmission of HCV, however, the
National Institute of Clinical Excellence (NICE) has recommended a
combination of treatment for moderate to chronic hepatitis C,
There is no routine testing UK for detecting HCV in asymptomatic pregnant
women. Mother to child transmission (vertical transmission) is known to
occur but is less common and estimated to be around 6% and higher if there
is parallel infection such as with the HIV virus.
1 Exposure prone procedures are those where there is a risk that injury to the health care worker could result in their blood contaminating a patient's open tissues.

In addition, no significant association has been found between modes of
delivery. Studies that have evaluated breastfeeding in infants born to HCV-
infected women, suggest an average rate of infection of 4% in both
breastfed and bottle-fed infants (Bhola K, Mcguire W, 2007,
www.cdc.gov/hepatitis)
Health care workers who carry out exposure prone procedures and are
aware that they are HCV positive but refuse to be tested, should not be
permitted to carry out exposure prone procedures. However, those who are
HCV positive have received treatment and remain negative for six months
after treatment, can resume exposure prone procedures (HSC2002/010).
The UK Departments of Health also recommend that all occupational
exposure to blood or body fluids be followed up with the offer of
appropriate testing if there is a risk that the patient is a carrier of hepatitis
C infection (HSC 1998/063, Ramsay M, 1999).
The Nursing and Midwifery Council (NMC) advises registrants of their legal
and professional duty to protect the health and safety of their patients by
seeking confidential advice if they believe that they have been exposed to,
or at risk of HCV rather than self-asses the risk they may pose to others
(NMC, 2006).

RCM Position
The RCM supports specific antenatal testing for hepatitis C (HCV) for
pregnant women and their babies appropriate to their individual risks.
Testing must be undertaken with the woman's explicit informed consent
after detailed discussions of the implications of HCV for mother and baby
and treatment options. This should be supported with clear and concise
written information in a format that the woman can understand.
While testing for HCV may be in the interest of the woman and her baby,
the RCM respects a woman's right to decline testing.
The RCM urges employers to maintain the confidentiality of HCV infected
health care workers.

RCM recommends that:
Women infected with HCV should be appropriately referred for discussion on
investigations, treatment options, and the implications for themselves, their
sexual partners and family. Where possible, this discussion and any written
information should be available in the mother's first language.
Midwives offer women specialist advice and counselling services appropriate
to the woman's individual needs.
Midwives support women who have chosen to breast feed as breastfeeding is
not contraindicated in HCV infected women.

Midwives assure confidentiality of clients' who are HCV positive and disclose
information only on a need to know basis and with the woman's consent
Midwives adhere to universal precautions in order to minimise the risk of
occupational exposure to HCV.
Midwives familiarize themselves with UK departments of health policies and
guidance relating to exposure prone procedures and HCV infected health
care workers.
Midwives contact their RCM representative in situations where they perceive
an employment relations issue arising as a result of testing or treatment for
HCV.
Prospective midwifery students who are HCV positive declare their status
before commencing training.
Midwives seek medical advice and consider testing if they are aware that
they may be at risk of HCV infection.
Employers provide midwives with full and clear information on the risks of
occupationally acquired hepatitis C infection, long-term implications and
treatment options.




References and related documents

Advisory Group on Hepatitis (2005) (AGH)
http://www.advisorybodies.doh.gov.uk/agh/
(accessed June 2008)
Bhola K, McGuire W (2007) Does avoidance of breastfeeding reduce mother to infant transmission of hepatitis C virus infection? Archives of disease in childhood 92 (4) 365-6 Department of Health (2004) Hepatitis C: Essential information for
professionals and guidance on testing. London, Department of Health.
Department of Health (2002) Hepatitis C infected health care workers:
Implementing getting ahead of the curve; action on blood borne viruses.
London, Department of Health.

Global surveillance and control of hepatitis C. Report of a WHO Consultation
organized in collaboration with the Viral Hepatitis Prevention Board,
Antwerp, Belgium. J Viral Hepat. (1999) 6(1):35-47 (no author listed)
Health Protection Agency (2007) Cumbria and Lancashire Health Protection
Unit - Hepatitis C Policy
http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947357785
(accessed February 2008)

Hope VD, Judd A, Hickman M, et al (2001) Prevalence of hepatitis C virus in
current injecting drug users in England and Wales: is harm reduction
working? Am J Public Health 91: 38-42.

Neal KR, Dornan J, Irving WL (1997) Prevalence of hepatitis C antibodies
among health care workers in two teaching hospitals. Who is at risk? BMJ;
314 (7075): 179
NICE (2006) Hepatitis C - peginterferon alfa and ribavirin; Peginterferon alfa
and ribavirin for the treatment of mild hepatitis C, TA106
www.nice.org.uk/TA075guidance/TA106 (accessed February 2008)
Ramsay ME (1999) Guidance on the investigation and management of
occupational exposure to hepatitis C. Commun Dis Public Health 2(4)258-622
Zuckerman J, Clewley G, Griffiths P et al (1994) Prevalence of hepatitis C
antibodies in clinical health workers. Lancet 343(8913) 1618-20
Nursing and Midwifery Council (2006) A-Z advice sheet B, Blood-borne
viruses www.nmc-org.uk accessed June 2007.

First Published: October 2008
Review Date: October 2011
Approved by the RCM Professional Policy Committee

Source: https://www.rcm.org.uk/sites/default/files/POSITION%20STATEMENT%20Hepatitis%20C.pdf