Hepatitis B in the workplace - Frequently asked questions

Many people with Hepatitis B are unaware of their status. There are often no symptoms for years on end. The most common symptoms occur within the first few months of being infected, after which most people may go through long periods of looking or feeling fine. Common symptoms may include:-

• fever (high temperature)
• extreme tiredness for weeks or months
• loss of appetite, nausea (feeling sick) and vomiting
• joint pains
• eyes or skin turning yellow (jaundice).

The majority of adults who are infected with Hepatitis B do not go on to suffer a serious illness and may not develop jaundice. If an illness does develop, the severity can vary but it may result in serious liver conditions such as cirrhosis (scarring), liver cancer or liver failure. Some of those infected may never recover and become long term carriers of the disease.

Hepatitis B is easier to contract than most other blood borne viruses. The Hepatitis B virus is mainly spread through:-

• direct contact with infected blood and blood products, but a person can also be infected through sexual fluids such as semen and vaginal fluid
• material contaminated with infected blood or blood products or sexual fluids such as:-
  • soiled linen
  • sanitary waste
  • used needles and other sharps such as broken glass, blades, etc.

Hepatitis B can be contracted from a tiny amount of blood, too small to see. The Hepatitis B virus can live for up to seven days outside the body even in dried blood. The most common route of infection is via a break or cut in the skin. A job that involves possible contact with human blood, other body fluids or contaminated material carries a risk of infection.

Any employee who is likely to come into contact with blood, blood products, sexual fluids or contaminated materials in the workplace is at risk. Most potential work related exposures are unlikely to result in transmission but an occupation that involves potential exposure should be risk assessed.

The National Code of Practice for the Control of Work-related Exposure to Hepatitis and HIV (Blood-borne) Viruses [NOHSC:2010(2003)] lists a wide range of occupations requiring a specific risk assessment. These include:-

• accommodation staff
• first aid providers
• care workers
• laundry staff
• cleaning staff
• parks and garden employees
• correctional centre workers
• security workers
• health sector workers
• sex workers
• emergency care workers
• waste and recycling industry staff

Codes of practice provide guidance for employers, contractors, people in control of workplaces and workers on the management of safety and health hazards and risks associated with an issue and some of the relevant requirements under the legislation. 

The National Code of Practice for the Control of Work-related Exposure to Hepatitis and HIV (Blood-borne) Viruses [NOHSC:2010(2003)] has been approved under section 57 of the Occupational Safety and Health Act 1984(OSH Act). It applies to all workplaces in Western Australia covered by the OSH Act. 

Exposure to Hepatitis B (and other blood-borne viruses such as Hepatitis C and HIV) can be prevented and managed by following the principles of a three-step risk management process:

1. Hazard identification
2. Risk assessment
3. Risk control

There are many practicable ways to reduce the transmission of such infectious diseases, such as training in safe work practices, the use of personal protective equipment and the implementation of a vaccination program.

The risk of infection in the workplace can be reduced by taking reasonably practicable measures to minimise the likelihood of exposure and of harm from exposure. This should include the following practices:

• Ensure work practices are designed to minimise exposure to blood and other body fluids/substances and that these practices are communicated and understood by employees.
• Ensure the use of standard precautions in all situations. Treat all blood products and potentially contaminated materials as infectious.
• Cover all breaks and cuts in the skin with waterproof dressings.
• Development of appropriate workplace policies and procedures.
• Provision of comprehensive training and education.
• Ensure availability and appropriate use of personal protective equipment (PPE) such as gloves, eye protection and aprons.
• Good housekeeping and personal hygiene.
• A vaccination program.
• Supervision and monitoring of employees.
• Appropriate waste management, including sharps handling and disposal.

All workers at risk of contact with blood and body fluids/substances, or contaminated materials in the course of their work must be provided with information, education and training in relation to disease risks and control measures.

The workplace education and training should be included as part of a new employee induction program. Periodic refresher training should also be provided to maintain and update knowledge. This refresher training can be provided in the form of a toolbox talk.

The content of the training should relate to workplace activities and specific tasks and should include:-

• Information about the types of infectious diseases employees might encounter in the workplace, how they are contracted and their effects and symptoms.
• Information about procedures and workplace practices.
• Updates or changes to procedures or practices.
• Responses to exposure incidents including appropriate first aid.
• Post–exposure testing, counselling and follow up processes.
• Details of vaccination programs and encouragement for vaccination.
• Where employees can find further sources of information.

All training should take into account the language and literacy issues employees might have.

This training can be provided by HepatitisWA free of charge. See www.hepatitiswa.com.au for further details.

Exposure in the workplace may occur through a needlestick or sharps injury. It may also occur through splashes involving contact with the eyes, mouth or nose with blood or other body fluids.

Where a needle stick injury has occurred:-

• Promptly flush the wound under running water.
• Wash the wound using warm water and liquid soap (except for the eyes, mouth and nose).
• Thoroughly pat-dry the area.
• Apply a sterile waterproof dressing (such as an adhesive plaster), as necessary, and apply pressure through the dressing if bleeding is still occurring.
• Collect the needlestick or sharp appropriately. It should be handled only using the designated equipment such as gloves or tongs and placed in a sealed container.

Where a splash exposure has occurred:-

• Remove contaminated clothing.
• Promptly flush cuts or broken skin and treat as for needlestick injuries.
• If the eyes, nose or mouth are affected rinse thoroughly with warm water (without soap) or saline.

When an exposure has occurred:-

• Ensure the employee is provided with immediate medical advice by a registered health professional.
• Ensure that the employee goes straight to a doctor or to the emergency department.
• Ensure the doctor is provided a sealed container with the sharp inside.
• Offer the employee access to a trauma counselling service.
• Ensure the incident is investigated and, where practical, steps taken to prevent a reoccurrence.

A vaccination for Hepatitis B is available. The Hepatitis B vaccination is safe and effective, providing almost 100% protection against Hepatitis B. It involves 3 injections over 6 months for adults. There is no need for a booster injection.

A joint vaccination for Hepatitis A and B is available. There is currently no vaccination for the prevention of HIV and Hepatitis C infection.

Where there is a significant risk of contracting Hepatitis B at work, a vaccination protocol should be included in a policy for prevention and control of infectious disease for the workplace.

Where needed, vaccination should be available free of charge to employees.

For exact costs, employers should consult their chosen medical provider. The cost of a vaccination is considered a practicable control against infection and should not be considered a reason not to vaccinate at-risk workers.

If you have been previously exposed to the Hepatitis B virus or if you have had the vaccination already, you will be protected against the virus. Some younger workers may have received the vaccination as part of a school vaccination program.

There is an antibody test which can be carried out which will identify the presence of antibodies in the blood.  

Existing employees can refuse to be vaccinated. In this case an employer should carry out a risk assessment to determine the most appropriate way to protect these employees against infection.

Employees should always be given comprehensive information, education and training regarding Hepatitis B and vaccinations to allow them to make an informed decision as to whether they should have the vaccination. They should also be advised to discuss vaccinations with a medical practitioner. The training they receive should encourage them to opt for the vaccination.

In industries where employers have identified the risk to be significant, employers can make participation in a Hepatitis B vaccination program an employment prerequisite and request that new employees undertake the vaccination program at the employers’ expense.