Preventive Measures of Hepatitis B

2. PREVENTIVE MEASURES OF
HEPATITIS B
Prepared By: Babita Poudel
MSc Nursing 2nd Year
Medical Surgical Nursing

3. HEPATITIS
• The term ‘Hepatitis’ refers to the inflammation of the liver. Hepatitis
may be caused by viruses, alcohol, drugs, autoimmune diseases
and metabolic diseases.
• The most common cause of hepatitis is viral infection.

4. CLASSIFICATION OF HEPATITIS
Types Sources of virus Route of transmission
Hepatitis A Feces Fecal- oral route
Hepatitis B Blood/ Blood derived body
fluids
Percutaneous
Permucosal
Hepatitis C Blood/ Blood derived body
fluids
Percutaneous
Permucosal
Hepatitis D Blood/ Blood derived body
fluids
Percutaneous
Permucosal
Hepatitis E Feces Fecal- oral route

6. HEPATITIS B
• It is an inflammation of the liver caused by the Hepatitis B virus
(HBV).
• It is the leading cause of cirrhosis and liver cancer.
• Hepatitis B is a communicable disease.

7. DEFINITION
According to WHO ;
“Hepatitis B is a potentially life- threatening liver infection, caused by
HBV (HEPATITIS B VIRUS).” It is a major global health problem. It
can cause chronic infection and puts people at high risk of death from
cirrhosis and liver cancer.

8. TYPES OF HEPATITIS B
 Acute Hepatitis B: Hepatitis B is termed acute hepatitis when the
duration of illness is short term (less than 6 months).
 Chronic Hepatitis B: If the virus remains in the blood for more
than six months, then it is considered a chronic infection.

9. CAUSES/ MODES OF TRANSMISSION
A. PARENTRAL ROUTE B. PERINATAL ROUTE C. SEXUAL CONTACT
1. Blood transfusion From mother who is carrier of
Hepatitis B Virus to their
baby.
On having intimate contact
specially in male
homosexuals and having
more than one sex partners.
2. Pricks/ penetration of
infected needles
3. Dialysis
4. Circumcision
5. Any surgical procedure

10. CLINICAL MANIFESTATIONS
 Nausea and vomiting.
 Abdominal pain or discomfort.
 Dark urine.
 Loss of appetite.
 Jaundice
 Fever
 Extreme fatigue.
 Hepatomegaly.
 Joint pain.

11. DIAGNOSTIC EVALUATIONS
 History Taking.
 Physical examination.
 Detection of viral markers in blood
> HbsAg (hepatitis B surface antigen)
> HbeAg (hepatitis B e-antigen)
> HbcAg (hepatitis B core antigen)

12. CONT…
 Viral DNA polymerase
 PCR
 Liver function test :Increased Alanine transaminases (ALT)
 Liver biopsy
 Liver ultrasound

13. MANAGEMENT
MEDICAL MANAGEMENT
People who test positive for Acute Hepatitis B are usually treated
through supportive care like rest, adequate nutrition and fluids etc.
to help relieve symptoms. There is no specific medication available.
 People with Chronic Hepatitis B can be treated with Antiviral
Drugs such as Entecavir, Tenofovir, Lamivudine.
 Interferon injections: alpha- 2b interferone.

14. CONT…
SURGICAL MANAGEMENT
 Liver transplants: Severely damaged liver can be transplanted.

15. CONT…
NURSING MANAGEMENT:
o Perform history taking and physical examination.
o Ask the patient to avoid smoking and the alcohol consumption.
o Tell patients to use safety measures while having sex.
o Maintain hygienic needs and nutritional status.
o Eat healthy, avoid lipid rich foods and maintain nutritional status.

17. PREVENTIVE MEASURES
Preventive measures that can help protect against hepatitis B are:
• Vaccination: The hepatitis B vaccine is highly effective and is
recommended for all infants, children, and adults who have not
been vaccinated.
• Safe sex: Hepatitis B can be transmitted through sexual contact,
so it's important to practice safe sex by using a barrier method such
as condoms.
• Know the HBV status of a sexual partner.

18. CONT…
• Safe injection practices: Use sterile needles and syringes for
each injection, and never share needles or syringes with others.
• Consider the risks if you are thinking about tattooing, body piercing,
or acupuncture: are the instruments properly sterilized?
• Do not share personal care items that might have blood on them
(razors, toothbrushes).

19. CONT…
• Screening of blood products: Blood donors are tested for
hepatitis B, but it's still important to make sure that blood products
are screened for the virus.
• Wash your hands thoroughly with soap and water after any
potential exposure to blood.
• Proper disposal of sharps: Needles and other sharps should be
disposed of in a sharps container to prevent accidental needle
sticks.

20. CONT…
• Education: Learn about the risks and transmission routes of
hepatitis B. Educate others to prevent the spread of the virus.
• Discard sanitary napkins and tampons into plastic bags.
• By taking these preventive measures, you can protect yourself and
others from hepatitis B. If you believe you may have been exposed
to hepatitis B, consult with a healthcare provider and get tested for
the virus.

21. CONT…
As a nurse, it's important to take preventive measures to protect yourself from
hepatitis B, which is a serious viral infection that affects the liver. Here are some
preventive measures you can take:
• Vaccination: The hepatitis B vaccine is highly effective and can prevent
infection. Ensure that you have completed the full vaccine series.
• Personal Protective Equipment (PPE): Use PPE such as gloves, masks,
goggles, and gowns when dealing with patients who have or may have hepatitis
B. PPE should be used when handling blood or body fluids, and when performing
procedures that may cause splashing or spraying of body fluids.

22. CONT…
• Hand hygiene: Always wash your hands before and after patient
contact, before putting on and after removing PPE, and after
handling contaminated materials.
• Safe injection practices: Follow universal blood/ body fluid
precautions and use sterile needles and syringes for each patient,
and never reuse or share needles or syringes. Dispose of needles
and other sharp objects in a sharps container

23. CONT…
• Avoid direct contact with blood and bodily fluids.
• Cover all cuts carefully.

24. CONT…
• Education: Ensure you understand the risks and transmission
routes of hepatitis B. Keep yourself updated with the latest
guidelines and procedures related to infection control.
• By taking these preventive measures, you can reduce the risk of
contracting hepatitis B and protect yourself, your colleagues, and
your patients.

25. POST EXPOSURE PROPHYLAXIS OF
HEPATITIS B
• After exposure to hepatitis B virus (HBV), appropriate and timely
prophylaxis can prevent HBV infection and subsequent
development of chronic infection or liver disease.
• The mainstay of post exposure prophylaxis (PEP) is hepatitis B
vaccine, but, in certain circumstances, hepatitis B immune globulin
is recommended in addition to vaccine for added protection.

26. CONT…
• Post Exposure Prophylaxis (PEP) Protocol: For those
experiencing a direct percutaneous inoculation or trans mucosal
exposure to HBsAg positive blood or body fluids (e.g., accidental
needle stick, other mucosal penetration, or ingestion), a single IM
dose of HBIG, 0.06 mL/kg, administered as soon after exposure as
possible, is followed by a complete course of hepatitis B vaccine
to begin within the first week.

27. CONT…
• In case of immunization of infants in India : a pentavalent
vaccine consisting of Hepatitis B, Haemophilus influenza B,
Diptheria, Tetanus toxoid and Pertusis is given at 6, 10 and 14
weeks.

28. CONT…
• For perinatal exposure of infants born to HBsAg positive
mothers: a single dose of HBIG, 0.5 mL, should be administered
intra muscularly in the thigh immediately after birth, followed by a
complete course of three injections of recombinant hepatitis B
vaccines approved for children to be started within the first 12
hours of life.

29. SUMMARY
Hepatitis B is a viral infection that affects the liver. It is caused by the
hepatitis B virus (HBV), which is transmitted through contact with
infected blood or bodily fluids, including unprotected sexual contact,
sharing needles or syringes etc. The clinical manifestation includes
nausea, vomiting, fatigue, jaundice etc. Management of hepatitis B
includes supportive , medical and surgical management. In addition,
a vaccine is available to prevent hepatitis B infection.

31. REFERENCES
o https://www.cdc.gov/hepatitis/hbv/pep.htm
o https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
o Harrisons Principles of Internal Medicine , 21st edition, page no 957, Mc Grow
Hill LLC. 2022
o Hepatitis B Epidemiology and Prevention of Vaccine- Preventable Diseases, The
Pink Book: Course Textbook- 12th edition second printing (May 2012) Center Of
Diseases Control
o EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus
infection , European Association for the Study of the Liver, Journal of Hepatology
2017 vol. 67 j 370–398