I. General Information:

A. All employees should avail themselves of current information related to working with people who have contracted diseases such as Human Immunodeficiency Virus, AIDS, Hepatitis and other communicable diseases.

B. Information is available through the Department of Labor and Economic Growth, Office of Personnel and Labor Relations; the Michigan Department of Community Health; local, county or city health departments; union contracts; and the Center for Disease Control in Atlanta, Georgia.

C. Since information related to AIDS and related complications is constantly emerging, this procedure should be reviewed and modified as necessary.

D. Information in this procedure regarding hepatitis was obtained from a pamphlet entitled "Hepatitis B, A Disease in Need of Prevention", presented as a service to the medical

E. The Michigan Department of Community Health, Special Office on AIDS Prevention, reviewed this information and added significant information to this policy.

F. Michigan Commission for the Blind staff should, as other health providers do, consider that each and every individual with whom they come in contact could potentially have a communicable disease and should act accordingly.

II. General Procedures

A. Hand washing is essential for the protection of individuals and staff.

B. If the handling of body fluids is within the scope of a staff member's job responsibility (e.g. nurse, janitor), gloves must be worn when in contact with these body fluids.

C. If a staff member is to have physical contact with an individual and has open lesions, cuts, scratches or other openings on the hands or other body parts, which may be contacted in the course of instruction, the staff member is encouraged to appropriately cover these lesions.

D. Each staff person should utilize a kit consisting of rubber gloves, disposable Towlettes, disposable plastic bags, etc., provided by the agency.

E. Staff should receive instructions in the proper use and disposal of gloves, Towelettes, etc. (Place in plastic bags and dispose).

F. Staff members, who provide services in the home setting, should arrange to provide services when a care provider is present, if possible.

G. If the individual has a blood spill, emesis, etc., when a staff member is present, the individual should clean up the spill, emesis, etc., if he/she is able. If the individual is unable to care for himself/herself, then his/her care provider should be asked to do so.

H. Hand-held and other low vision devices, which could become contaminated, should be cleansed with an appropriate disinfectant after use and before being used with another client. Check manufacturer's recommendation for proper cleaning products.

I. Staff who have colds or other contagious infections, should avoid contact with the individual until recovered. This is for the protection of the individual. In addition, due to the constantly changing status of the individual's health, each staff person should confer with the individual (i.e. telephone or direct conversation) before each contact or training session occurs to verify that the individual's and staff's health status is appropriate for carrying out the planned activity.

III. Viral Hepatitis

A. Hepatitis, an inflammation of the liver caused by any one of several viruses, is found throughout the world. Its occurrence is highest in some African and Asian countries, but it strikes at least one million individuals in the United States each year.

B. Hepatitis A and C

1. Hepatitis A: This form of hepatitis is caused by the hepatitis A virus. It usually is spread by the fecal-oral route, for example, by eating food which has been contaminated with feces. It causes a gastrointestinal illness, which is usually not life-threatening.

2. Hepatitis C: This form is caused by one or more viruses and seems to be spread mainly through blood transfusion.

C. Hepatitis B

1. Hepatitis B is usually spread by contact with infected blood or blood products in such ways as illicit injectable drug use, tattooing, and ear piercing. Transmission can also occur through close contact, including sexual contact, and the sharing of razors or toothbrushes. The disease can be very serious and even fatal, or could lead to chronic liver problems. Of the three common forms of viral hepatitis, Hepatitis B appears to be the most serious because of its potential for complications.

2. There are now vaccines available that provide active immunity against Hepatitis B for most susceptible individuals who are at increased risk of contracting the disease.

3. Although Hepatitis B infection is an unpredictable disease that may incapacitate a person for weeks or months and lead to complications, most patients recover. However, five to ten percent of individuals who become infected with Hepatitis B virus become chronic carriers capable of spreading the disease to others for an indefinite period of time. This group usually has no symptoms but has the greatest potential for developing long term complications, such as chronic active hepatitis, chronic persistent hepatitis, cirrhosis, and primary cancer of the liver. It is estimated that almost 4,000 individuals in the United States die from Hepatitis B-related cirrhosis every year. In addition, carriers have a risk 273 times greater than that of the general population of contracting liver cancer.

4. The chronic carrier state now exists in 1 out of every 200 individuals in the United States, and this group is growing by 2 to 3 percent each year. Although carriers usually have no symptoms, they can transmit the disease to others for a long period of time. Carriers can be detected only by a blood test.

5. Considering the various modes of transmission of hepatitis B, it's not surprising that individuals at increased risk of contracting the disease are those who frequently handle blood and other body fluids in the course of their work or who live in crowded conditions, have poor hygiene, or have many sexual contacts. Individuals at increased risk of contracting Hepatitis B include:

a. Physicians and surgeons.

b. Dentists, oral surgeons, and dental hygienists.

c. Nurses and other hospital personnel.

d. Blood bank workers.

e. Paramedical personnel.

f. Patients and staff in hemodialysis units.

g. Residents and staff of institutions.

h. Certain immigrant populations (Indo-Chinese and Haitian refugees and Alaskan Eskimos).

i. Individuals who repeatedly contract sexually transmitted diseases, homosexually active males, and female prostitutes.

j. People who have household and other intimate contacts with Hepatitis B carriers.

IV. Other Communicable Diseases

A. Pediculosis (Head Louse Infestation), Sarcoptes Scabiei (Scabies), Tinea (ringworm) represent a group of communicable diseases that are not life threatening but are definitely of the nuisance variety. The Michigan Commission for the Blind staff may be exposed to these and other similar diseases in the individual's home, in the office, at the Michigan Commission for the Blind Training Center or other places where the general public congregate. If staff contract any of these conditions, they should contact their personal physician for resolution of the problem.

B. Another group of communicable diseases such as syphilis, gonorrhea, clap, congenital herpes, etc. are transmitted through sexual activity. Individuals who have these infections do not represent any significant health concern to individuals who may interact with him/her in a teaching or counseling role. Because some of these conditions can be corrected, appropriate medical intervention should be required during the rehabilitation process.