[MCOH-EH] Hep C positive HCW

[KMccracken at mcleodhealth.org]

We draw titers at hire and repeat series for negative titers as indicated.



From:
"Long, Deryl" <Deryl.Long at wellstar.org>
To:
'MCOH/EH' <mcoh-eh at mylist.net>
Date:
01/20/2015 10:51 AM
Subject:
Re: [MCOH-EH] Hep C positive HCW
Sent by:
"MCOH-EH" <mcoh-eh-bounces+kmccracken=mcleodhealth.org at mylist.net>



All- We are following the recent guidelines and drawing titers on new 
hires at risk who are without Hep B titer results.  You are correct in 
that the guidelines are vague but we are erring on the side of caution to 
establish a baseline immunity for employees at risk of exposure. 
 
As far as the employee positive for Hep C we use the SHEA guidelines as a 
reference.
 
Deryl
 
Deryl Long, RN, COHN
Director of WellStar Employee Health Services
677 Church Street
Marietta, Georgia  30060
Office -770-793-7227
Fax-770-793-7952
 Deryl.Long at Wellstar.org
 
The Flu Ends with You! Get Vaccinated!
It¡¯s the right thing to do for our patients, our families, and our 
community.
 
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Barb K. 
Grabenbauer
Sent: Friday, January 16, 2015 3:49 PM
To: MCOH/EH
Subject: [MCOH-EH] Hep C positive HCW
 
Do you allow Hep C positive HCW's start IV's?
Is that fall into: Digital palpation of a needle tip in a body cavity 
 
Thank you!
Barb Grabenbauer, RN
Quality Director
Marshalltown Medical & Surgical Center
Marshalltown, IA 50158

From: MCOH-EH [mcoh-eh-bounces at mylist.net] on behalf of Brenda Kantner 
[bkantner at schuylkillhealth.com]
Sent: Wednesday, September 24, 2014 8:44 AM
To: MCOH/EH
Subject: Re: [MCOH-EH] Hepatitis B and titers
It is unfortunate that even though there were new 2013 CDC 
recommendations, there are still so many individual decisions that need to 
be made with regard to Hep B for healthcare workers. Nothing is ever 
totally clear-cut, but there are still so many questions. 
 
We still struggle with many new hires not having documentation of their 
Hep B vaccines given in the past. Previously, we would titer new hires
if the employee ¡°was sure¡± they completed the series in the past. In most 
cases now, based on the newest recommendations, we repeat the series or 
get a declination rather than titer if there is no documentation of the 
three vaccines.
 
 
Brenda Kantner RN COHN-S/CM
Employee Health Coordinator
Schuylkill Medical Center
700 East Norwegian St
Pottsville, PA 17901
Phone 570-621-4351
Fax   570-621-4257
bkantner at schuylkillhealth.com

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Adamo, 
Philip
Sent: Wednesday, September 24, 2014 8:40 AM
To: 'mcoh-eh at mylist.net'
Subject: Re: [MCOH-EH] Hepatitis B and titers
 
Good morning all:
I am interested in how your institution handles Hep B titers at 
pre-placement
The 2013 CDC recommendations state: 
¡°All HCP recently vaccinated or recently completing HepB vaccination who 
are at risk for occupational blood or body fluid exposure should undergo 
anti-HBs testing. Anti-HBs testing should be performed 1¨C2 months after 
administration of the last dose of the vaccine series when possible. HCP 
with documentation of a complete ¡Ý3-dose HepB vaccine series but no 
documentation of anti-HBs ¡Ý10 mIU/mL who are at risk for occupational 
blood or body fluid exposure might undergo anti-HBs testing upon hire or 
matriculation. Testing should use a quantitative method that allows 
detection of the protective concentration of anti-HBs (¡Ý10 mIU/mL) (e.g., 
enzyme-linked immunosorbent assay [ELISA]).¡±
The word ¡°might¡± is not good especially when mid level providers work off 
protocols. This is also different then what figure 6 implies.We also know 
and the literature supports that the measurement of immunity wanes over 
time. My recall is that after 7 years it is difficult to measure the 
immunity greater than 10. There is also literature that those who receive 
the vaccine in infancy have undetected immunity in adulthood; however, 
they are immune to Hep b. 
Based on this information, I have in previous hospitals set a standard of 
giving a booster for those with documented 3 doses and more than 7 years 
and then checking the immunity with a titer rather than checking a  titer, 
getting an non immune response, administering a booster and checking 
again. Any thoughts on this?
 
Thanks,
Phil
 
 
Philip Adamo, M.D., MPH, FACOEM
Associate Vice President and 
Medical Director, Employee Health &
Occupational Injury Care and Wellness
UMass Memorial Medical Center
Hahnemann Campus Suite 201
291 Lincoln Street
Worcester, MA 01605
Phone: 508-334-6179 
FAX: 508-334-6433 
cell 508-713-3993 
philip.adamo at umassmemorial.org
 
"THE GREAT USE OF LIFE is to spend it for something that will outlast it."
William James
 
 
 

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