Back to Hepatitis
B
Christine M. Kukka
HBV Project Manager
Hepatitis B is a liver infection caused
by the hepatitis B virus (HBV). In the United States, about
one in 20 people has been infected with HBV, one-third of
them say they do not know how they became infected.
Most experienced short-term or “acute”
HBV infections. But about 1.25 million Americans are chronically
infected with HBV, which means they have long-term infections
and can infect others.
While there is a safe and effective vaccine
that prevents hepatitis B, to date the vaccination program
has focused primarily on newborns and school-age children.
Many teens and adults in the United States have not yet been
vaccinated. In 2001, for example, about 78,000 Americans became
infected with HBV, according to the Centers for Disease Control
and Prevention (CDC).
HBV is easily spread through blood-to-blood
contact, sharing needles during injection drug use, and sexual
activity, which accounts for about one-third of all new infections
each year in the United States. When infected mothers give
birth, they almost always infect their newborns unless the
infant is immunized against hepatitis B within 12 hours of
birth, and is given hepatitis B immune globulin (HBIG), which
contains hepatitis B antibodies to help prevent infection.
While many children and adults with hepatitis
B have no symptoms, over time this liver infection can cause
cirrhosis (liver scarring) and liver cancer.
How is hepatitis B spread?
Hepatitis B is spread through contact with
blood or body fluids (excluding urine, feces, tears and saliva)
of an infected person. For example, you can become infected
if you touch HBV-infected blood and you have a cut or rash
on your hand that allows the virus to enter your body. You
could also become infected if body piercers or tattooists
fail to clean their needles. A high school student could contract
hepatitis B if he or she shared pierced earrings or even toothbrushes
with an infected friend.
Hepatitis B is far more infectious than
hepatitis C or HIV, because there are very high concentrations
of hepatitis B viruses in the blood and body fluids of infected
people. Hepatitis B viruses are also far more resilient than
hepatitis C viruses or HIV. CDC has reported that hepatitis
B viruses can live for several days in dried blood on table
surfaces, needles, syringes and razors.
You never know who has hepatitis B and
who does not, because the infection often causes no symptoms
for years or decades. Also, about 5 to 10 percent of people
who are immunized against hepatitis B never develop enough
protective antibodies from the vaccine to protect them from
infection. That is why it is important for everyone to practice
safer sex, never to re-use personal care items, and use standard
precautions so there is always a barrier between them and
potentially infectious blood and body fluids. You really never
know who has a bloodborne infection and who does not.
How is HBV Transmitted in Daily
Life?
Because hepatitis B is found in infected
blood at high concentrations, it can be transmitted by personal
care items such as razors and equipment used by manicurists,
estheticians, barbers and cosmetologists. This can happen
when even a small amount of infected blood, so tiny it cannot
be seen, stays on equipment and comes into contact with an
open cut or sore, rash or eyes, mouth or nostrils (mucous
membranes) of another person.
Other equipment that comes into contact
with blood includes tattooing and body piercing needles, cuticle
scissors, nail files and emery boards, razors and hair clippers,
hair removal tools such as tweezers and electrolysis equipment
and even hair-cutting scissors and combs.
The transmission of HBV through personal
care procedures has not been well studied. The CDC continues
to study these practices and the risk tattooing and piercing
practices pose. What has been well-documented is the rampant
spread of HBV through improper sterilization and re-use of
medical equipment, including needles, syringes, IV tubes and
other medical equipment.
Keeping It Safe in Personal Care
Settings
Disposable Items:
Most tools used by tattooists, body piercers, manicurists,
and barbers should be used only once, on a single person.
Most professional tattooists, piercers, and electrologists
use new, disposable needles for each customer; disposable
ink pots also should also be used. Paper emery boards, files,
orange wood sticks, cotton balls or swabs, sponges, neck strips,
and other items that cannot be cleaned should be used on only
one person and then thrown away. Whenever possible, substitute
single-use items for reusable items. Make sure a tattooist
always opens and uses new ink.
Risky Items:
Blade or scraper tools used to trim calluses (such as Credo
blades) are especially likely to come into contact with blood.
California, for example, prohibits the use of such tools in
nail salons. Needle-like instruments used to extract skin
blemishes are also prohibited. Cutting cuticles presents a
risk for contact with blood, and many experts recommend that
nail salon workers should not cut cuticles. Straight razors
also are likely to draw blood; therefore, disposable blades
or safety razors should be used and discarded after each client.
Cleaning and Disinfecting:
Equipment that is used on more than one person should be properly
cleaned and disinfected between users. For procedures that
pierce the skin, disposable tools should be used unless they
can be completely sterilized. Sterilization can be done using
steam or dry heat. An autoclave is a machine that sterilizes
using both heat and pressure.
Tools should be cleaned with a disinfectant
solution. Commercial products such as Barbicide disinfect
rather than sterilize. Although not well studied, research
suggests that commercial solutions may not kill all hepatitis
viruses. Look for an EPA-registered hospital grade product
that kills bacteria (bactericide), viruses (virucide), and
fungi (fungicide). Immerse items in the solution for at least
10 to 20 minutes. Small items may be stored in the disinfectant
solution between uses. Commercial solutions should be changed
at least once per week or when visibly dirty.
Although the actual needles and blades
are disposable, tattoo guns, razor blade handles, and electrolysis
machines should be thoroughly cleaned with a disinfectant
solution between uses. Don’t be afraid to ask about
a business’ disinfectant practices; your health depends
on it.
Work Space Precautions:
Work spaces should be disinfected after each client and organized
so used or dirty equipment is separated and never mixed up.
Lotions, powders, and other products should be kept in containers
that allow for dispensing a portion of the product without
contaminating the container, and sanitary applicators should
be used for cosmetics.
Manicurists should not use soaking water
for more than one customer. Soaking bowls and foot spas should
be disinfected after each user. Counters, chairs, lamps, and
other surfaces should be cleaned regularly with a disinfectant
solution. Used razor blades and other sharp items should be
discarded in a puncture-proof container. Nail and hair cuttings
should be disposed of properly. Used towels, sheets, and gowns
should be kept in a covered receptacle and washed in hot water
with detergent.
Personal care professionals should be educated
about disease transmission and trained to use proper health
and safety procedures. Manicurists, cosmetologists, barbers,
estheticians, and electrologists must be licensed in all states.
Workers should wash their hands with soap and water before
each customer and, if appropriate, wear disposable gloves.
Any cuts or sores should be covered with a waterproof bandage.
To be as safe as possible, some customers
bring their own equipment with them to the nail salon or barbershop.
This is especially important for items like cuticle scissors
and razors that are likely to come into contact with blood.
Some professionals will keep personal “client packs”
or kits at the salon with tools to be used only for a specific
customer.
Keeping Your Home Safe
Disinfection is also important in the home,
especially if a family member has hepatitis B or some other
blood borne infection.
Never share personal care items:
For the reasons already mentioned, neither adults nor children
should ever share nail clippers, nail files, pierced earrings
or toothbrushes. Gums can bleed and HBV can remain on toothbrushes
after use.
Have latex gloves readily available
in your home and car to handle blood spills.
If you don’t have gloves, grab a plastic bag to use
as a make-shift glove. Remember to wash your hands afterwards.
Bandage and cover all open
cuts or bruises. These serve as entry and exit
points for viruses. Keep them clean and covered to prevent
infection.
Use bleach disinfecting solutions
in bathrooms, diapering areas and other places where germs
are found. Here is a recipe for a disinfecting
solution that can be used for general disinfection: Mix ¼
cup of bleach (5.25% sodium hypochlorite) with one gallon
of cool water, or for a smaller portion mix one tablespoon
of bleach with a quart of cool water.
If there has been a blood spill, make a
solution of one-part bleach and nine-parts water. Soak the
blood-exposed area for about 20 minutes. Then clean with soap
and water. Remember to wear gloves, carefully dispose of contaminated
clothing, and wash your hands after you remove your gloves.
Teach your children age-appropriate
standard precautions. Teach them never to touch
blood, and to get an adult whenever someone is bleeding. Remember,
you never know who has a blood borne infection, and who has
or has not been immunized.
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B
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