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World J Hepatol. Feb 18, 2016; 8(5): 273-281
Published online Feb 18, 2016. doi: 10.4254/wjh.v8.i5.273
Hepatitis B virus and hepatitis C virus infection in healthcare workers
Nicola Coppola, Stefania De Pascalis, Lorenzo Onorato, Federica Calò, Caterina Sagnelli, Evangelista Sagnelli
Nicola Coppola, Stefania De Pascalis, Lorenzo Onorato, Federica Calò, Evangelista Sagnelli, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
Caterina Sagnelli, Department of Clinical and Experimental Medicine and Surgery “F. Magrassi e A. Lanzara”, Second University of Naples, 80131 Naples, Italy
Author contributions: Coppola N, De Pascalis S, Onorato L, Calò F, Sagnelli C and Sagnelli E were based on: (1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published.
Conflict-of-interest statement: All the authors of the manuscript declare that they have no conflict of interest in connection with this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Nicola Coppola, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Via: L. Armanni 5, 80131 Naples, Italy. nicola.coppola@unina2.it
Telephone: +39-081-5666719 Fax: +39-081-5666013
Received: July 26, 2015
Peer-review started: July 27, 2015
First decision: September 30, 2015
Revised: October 25, 2015
Accepted: January 8, 2016
Article in press: January 11, 2016
Published online: February 18, 2016
Abstract

Approximately 3 million healthcare workers per year receive an injury with an occupational instrument, with around 2000000 exposures to hepatitis B virus (HBV) and 1000000 to hepatitis C virus (HCV). Although an effective HBV vaccine has been available since the early eighties, and despite the worldwide application of universal vaccination programs started in the early nineties, HBV still remains a prominent agent of morbidity and mortality. There is no vaccine to limit the diffusion of HCV infection, which progresses to chronicity in the majority of cases and is a major cause of morbidity and mortality worldwide due to a chronic liver disease. Healthcare workers are frequently exposed by a mucosal-cutaneous or percutaneous route to accidental contact with human blood and other potentially infectious biological materials while carrying out their occupational duties. Mucosal-cutaneous exposure occurs when the biological material of a potentially infected patient accidentally comes in contact with the mucous membranes of the eyes or mouth or with the skin of a healthcare worker. Percutaneous exposure occurs when an operator accidentally injures himself with a sharp contaminated object, like a needle, blade or other sharp medical instrument. About 75% of the total occupational exposure is percutaneous and 25% mucosal-cutaneous, the risk of infecting a healthcare worker being higher in percutaneous than in mucosal-cutaneous exposure. All healthcare workers should be considered for HBV vaccination and should meticulously apply the universal prophylactic measures to prevent exposure to HBV and HCV.

Keywords: Hepatitis B virus infection, Hepatitis C virus infection, Needle-stick injury, Healthcare workers

Core tip: Preventing the transmission of hepatitis B virus (HBV) or hepatitis C virus infection from source patients to healthcare workers is of vital importance in all healthcare settings worldwide, since these workers are exposed daily to these infections over a period of almost four decades. Needle pricks with contaminated needles, cuts from sharp instruments and blood splashes to the conjunctiva are the most frequent causes of exposure, injuries largely preventable by taking the standard universal precautions. HBV vaccination of anti-HBs-negative healthcare workers is recommended in all countries, but numerous healthcare workers remain exposed to infection because they have eluded HBV vaccination.