The Disease
Hepatitis B is a viral infection caused by the Hepatitis B virus (HBV) which causes death in 1-2% of those infected.  Most people with HBV recover completely, but approximately 5-10% become chronic carriers of the virus.  Most of these people have no symptoms, but can continue to transmit the disease to others.  Some may develop chronic active hepatitis and cirrhosis.  HBV may be a causative factor in the development of liver cancer.  Immunization against HBV can prevent acute hepatitis and its complications.

The Vaccine
The HBV vaccine is produced from yeast cells.  It has been extensively tested for safety and effectiveness in large scale clinical trials.

Approximately 90 percent of healthy people who receive two doses of the vaccine and a third dose as a booster achieve high levels of surface antibody (anti-HBs) and protection against the virus.  The HBV vaccine is recommended for workers with potential for contact with blood or body fluids.  Full immunization requires three doses of the vaccine over a six-month period, although some persons may not develop immunity even after three doses.

There is no evidence that the vaccine has ever caused Hepatitis B.  However, persons who have been infected with HBV prior to receiving the vaccine may go on to develop clinical hepatitis in spite of immunization.

Dosage and Administration
The vaccine is given in three intramuscular doses in the deltoid muscle.  Two initial doses are given one month apart and the third dose is given six months after the first.

Possible Vaccine Side Effects
The incidence of side effects is very low.  No serious side effects have been reported with the vaccine.  Ten to 20 percent of persons experience tenderness and redness at the site of injection and low grade fever.  Rash, nausea, joint pain, and mild fatigue have also been reported.  The possibility exists that other side effects may be identified with more extensive use.

 

 

CONSENT FORM OF HEPATITIS B VACCINATION

I have knowledge of Hepatitis B and the Hepatitis B vaccination.  I have had an opportunity to ask questions of a qualified nurse or physician and understand the benefits and risks of Hepatitis B vaccination.  I understand that I must have three doses of the vaccine to obtain immunity.  However, as with all medical treatment, there is no guarantee that I will become immune or that I will not experience side effects from the vaccine.  I give my consent to be vaccinated for Hepatitis B.

_____________________________________________________                 ___________________
Signature of Employee (consent for Hepatitis B vaccination)                               Date

 

_____________________________________________________                 ___________________
Signature of Witness                                                                                             Date

 

 

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REFUSAL FORM OF HEPATITIS B VACCINATION

I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring the Hepatitis B virus infection.  I have been given the opportunity to be vaccinated with Hepatitis B vaccine at no charge to myself.  However, I decline the Hepatitis B vaccination at this time.  I understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease.  If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with the Hepatitis B vaccine, I can receive the vaccination series at no charge to me.

 

_____________________________________________________                 ___________________
Signature of Employee (refusal for Hepatitis B vaccination)                                 Date

 

_____________________________________________________                 ___________________
Signature of Witness                                                                                             Date

 

I refuse because I believe I have (check one)

                  started the series                                              completed the series

 

 

RELEASE FORM FOR HEPATITIS B MEDICAL INFORMATION

I hereby authorize                                           (individual or organization holding Hepatitis B records and address) to release to the                                Community School District, my Hepatitis B vaccination records for required employee records.

I hereby authorize release of my Hepatitis B status to a health care provider, in the event of an exposure incident.

 

_____________________________________________________                 ___________________
Signature of Employee                                                                                          Date

 

_____________________________________________________                 ___________________
Signature of Witness                                                                                             Date

 

 

 

_____________________________________________________                 ___________________
Employee Name (last, first, middle)                                                                   Social Security No.

Job Title:  ________________________________________________________________________

     Hepatitis B Vaccination Date               Lot Number                        Site                Administered By

1________________________          ______________          ___________          ________________

2________________________          ______________          ___________          ________________

3________________________          ______________          ___________          ________________

 

Additional  Hepatitis B status information:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Post-exposure incident:  (Date, time, circumstances, route under which exposure occurred)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Identification and documentation of source individual:

_________________________________________________________________________________

Source blood testing consent:

_________________________________________________________________________________

Description of employee's duties as related to the exposure incident:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Copy of information provided to health care professional evaluating an employee after an exposure incident:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Attach a copy of all results of examinations, medical testing, follow-up procedures, and health care 
professional's written opinion.

Training Record: (date, time, instructor, location of training summary)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

 

Universal precautions (UP) are intended to prevent transmission of infection, as well as decrease the risk of exposure for employees and students.  It is not currently possible to identify all infected individuals, thus precautions must be used with every individual.  UP pertain to blood and other potentially infectious materials (OPIM) containing blood.  These precautions include and are not limited to other body fluids and wastes (OBFW) such as saliva, sputum, feces, tears, nasal secretions, vomitus and urine unless blood is visible in the material.  However, these OBFW can be sources of other infections and should be handled as if they are infectious.  The single most important step in preventing exposure to and transmission of any infection is anticipating potential contact with infectious materials in routine as well as emergency situations.  Based on the type of possible contact, employees and students should be prepared to use the appropriate precautions prior to the contact.  Diligent and proper hand washing, the use of barriers, appropriate disposal of waste products and needles, and proper decontamination of spills are essential techniques of infection control.  All individuals should respond to situations practicing UP followed by the activation of the school response team plan.  Using common sense in the application of these measures will enhance protection of employees and students.

Hand Washing

Proper hand washing is crucial to preventing the spread of infection.  Textured jewelry on the hands or wrists should be removed prior to washing and kept off until completion of the procedure and the hands are rewashed.  Use of running water, lathering with soap and using friction to clean all hand surfaces is key.  Rinse well with running water and dry hands with paper towels.

• Hands should be washed before physical contact with individuals and after contact is completed.
• Hands should be washed after contact with any used equipment.
• If hands (or other skin) come into contact with blood or body fluids, hands should be washed immediately before touching anything else.
• Hands should be washed whether gloves are worn or not and, if gloves are worn, after the gloves are removed.

Barriers

Barriers anticipated to be used at school include disposable gloves, absorbent materials and resuscitation devices.  Their use is intended to reduce the risk of contact with blood and body fluids as well as to control the spread of infectious agents from individual to individual.  Gloves should be worn when in contact with blood, OPIM or OBFW.  Gloves should be removed without touching the outside and disposed of after each use.

Disposal of Waste

Blood, OPIM, OBFW, used gloves, barriers and absorbent materials should be placed in a plastic bag and disposed as is outlined in universal precautions training manual.  When the blood or OPIM is liquid, semi-liquid or caked with dried blood, it is not absorbed in materials, and is capable of releasing the substance if compressed, special disposal as regulated waste is required.  A band aid, towel, sanitary napkin or other absorbed waste that does not have the potential of releasing the waste if compressed would not be considered regulated waste.  It is anticipated schools would only have regulated waste in the case of a severe incident.  Needles, syringes and other sharp disposable objects should be placed in special puncture-proof containers and disposed of as regulated waste.  Bodily wastes such as urine, vomitus or feces should be disposed of in the sanitary sewer system.

Clean up

Spills of blood and OPIM should be cleaned up immediately.  The employee should:

• Wear gloves.
• Clean up the spill with paper towels or other absorbent material.
• Use a solution of one part household bleach to one hundred parts of water (1:100) or other EPA-approved disinfectant and use it to wash the area well.
• Dispose of gloves, soiled towels and other waste in a plastic bag.
• Clean and disinfect reusable supplies and equipment.

Laundry

Laundry with blood or OPIM should be handled as little as possible with a minimum of agitation.  It should be bagged at the location.  If it has the potential of releasing the substance when compacted, regulated waste guidelines should be followed.  Employees who have contact with this laundry should wear protective barriers.

Exposure

An exposure to blood or OPIM through contact with broken skin, mucous membrane or by needle or sharp stick requires immediate washing, reporting and follow-up.

• Always wash the exposed area immediately with soap and water.
• If a mucous membrane splash (eye or mouth) or exposure of broken skin occurs, irrigate or wash the area thoroughly.
• If a cut or needle stick injury occurs, wash the area thoroughly with soap and water.

The exposure should be reported immediately, the parent or guardian is notified, and the person exposed contacts a physician for further health care.