Health Care In The Correctional System
Upon incarceration, all adults and the majority of juveniles lose access to the usual public and private health-care and disease-prevention services. Their health care becomes the sole responsibility of either the correctional system , or less frequently, the public health system . For the majority of persons, entry into the correctional system provides an opportunity to access health care. In one series, approximately 78% of newly incarcerated females had abnormal Papanicolaou smears, and > 50% had vaginal infections or STDs . However, the rapid turnover of the incarcerated population, especially in jails, and the suboptimal funding of correctional health and prevention services, often limits the correctional system in providing both curative and preventive care.
Infectious diseases — including acquired immune deficiency syndrome , STDs, TB, and viral hepatitis — are more prevalent among correctional inmates than the general population. In 1997, an estimated 46,000–76,000 prison and jail inmates had serologic evidence of syphilis 8,900 had AIDS and 1,400 had active TB .
Maintaining A Healthy Weight
You may not think that your weight has anything to do with the health of your liver, but being overweight is linked to a buildup of fat in the liver. This is called nonalcoholic fatty liver disease .
Having a fatty liver when you already have hepatitis C may increase your risk of getting cirrhosis. Certain medications used to treat hepatitis C may also not be as effective if youre overweight.
If youre overweight, following a healthy eating plan and exercising regularly can help you lose weight. The recommends that adults should do some moderate-intensity physical activity for at least 30 minutes at least five days of the week.
Some examples of moderate-intensity activities include:
- walking briskly
There are no specific diet and nutrition rules for people with hepatitis C. But eating a good, well-balanced diet can help you reach and maintain a healthy weight and reduce your risk of hepatitis C complications.
Here are some general guidelines for eating well with hepatitis C:
- Choose whole-grain cereals, breads, and grains.
- Eat plenty of fruits and vegetables in a variety of colors.
- Avoid processed foods containing trans fats.
- Go easy on fatty, sugary, or salty foods.
- Resist fad diets, and opt for a food plan that you can live with and follow for the long term.
- Stop eating when youre about 80 percent full. You may actually be fuller than you think you are.
- Boost your energy by eating small meals or snacks every three to four hours.
What To Do If You Live With Someone Who Has Hepatitis C
If you live with someone who has hepatitis C, theres no reason to avoid close personal contact. Feel free to touch, kiss, and cuddle.
The most important thing you can do to prevent getting the virus is to avoid contact with the infected persons blood. Blood can be infectious even when its dry. In fact, the virus can live in blood on surfaces for up to three weeks.
Thats why you should take great care when cleaning up blood spills, however small or old they are.
Here are a few tips for dealing with blood:
- If you see blood, assume its infectious.
- If you have to clean or touch a blood spill, wear disposable gloves. Inspect the gloves for tears and holes before using them.
- Mop up using paper towels or disposable rags.
- Disinfect the area with a solution of 1 part bleach to 10 parts water.
- When finished, dispose of the rags or paper towels in a plastic bag. Remove the gloves carefully and dispose of them as well.
- Wear gloves if you have to touch used bandages or menstrual products that werent disposed of properly.
- Wash your hands thoroughly after coming into contact with blood, even if you wore gloves.
Some personal care items can sometimes contain a small amount of blood. Dont share things like a toothbrush, razor, or manicure scissors.
If you think you may have been exposed to the virus, contact your doctor to find out when you can be tested. Early treatment can help prevent serious liver damage.
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How Do People Get Hepatitis C
Hepatitis C virus is found in the blood of people with HCV infection. It enters the body through blood-to-blood contact.
Until reliable blood tests for HCV were developed , people usually got hepatitis C from blood products and blood transfusions. Now that blood and blood products are tested for HCV, this is no longer the typical means of infection.
Currently, people usually get hepatitis C by sharing needles for injection drug use. An HCV-infected woman can pass the infection to her baby during birth. It is also possible to get hepatitis C from an infected person through sexual contact, an accidental needlestick with a contaminated needle, or improperly sterilized medical, acupuncture, piercing, or tattooing equipment.
Hepatitis C And Health
How can health-care personnel avoid exposure to HCV?
Avoiding occupational exposure to blood is the primary way to prevent transmission of bloodborne illnesses among health-care personnel. To promote blood safety in the workplace, health-care personnel should consult infectious-disease control guidance from the National Institute for Occupational Safety and Health and from CDC. Depending on the medical procedure involved, Standard Precautions may include the appropriate use of personal protective equipment .
What is the risk of acquiring hepatitis C after being accidentally exposed to HCV-contaminated blood or body fluids in the workplace?
Although sharps injuries have decreased in recent decades due to improved prevention measures, they continue to occur, placing health-care personnel at risk for several bloodborne pathogens like hepatitis C. A recent analysis of several studies revealed an overall 0.2% risk for infection among those exposed to HCV-antibody-positive blood through needlestick or sharps injuries . Updated guidelines for management and treatment of hepatitis Cexternal icon are available to provide guidance for health-care personnel who become infected via exposure to contaminated blood at the workplace.
Other than needlesticks, do other exposures place health-care personnel at risk for hepatitis C?
Should HCV-infected health-care personnel be restricted in their work?
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Cases And Clusters Of Potential Public Health Importance
Jurisdictions should review and analyze hepatitis C data regularly to identify cases and clusters of hepatitis C that merit further investigation. When resources are limited, these should be prioritized for investigation according to degree of public health importance. The following are examples of high priority cases and clusters:
- People of childbearing age who are or have the potential to become pregnant, indicating the potential risk for perinatal transmission.
- Children 36 months of age, indicating possible perinatal transmission.
- People in age and demographic groups among whom infection might be acute due to recent transmission. This includes people
- < 40 years of age and
- > 70 years of age .
Surveillance Activities For Chronic Hepatitis C
Due to varying levels of resources, jurisdictions might be at different stages of implementing surveillance activities for chronic hepatitis C. The following section provides best practice models for core and enhanced surveillance activities for consideration by jurisdictions. Enhanced surveillance activities should be identified based on local priorities.
Best Practice Models for Core and Enhanced Chronic Hepatitis C Surveillance
Core Surveillance
Case Ascertainment and Reporting
- Create an electronic system for systematically collecting and storing hepatitis C test results and other case data longitudinally for unique persons.
- Establish a method to receive hepatitis C laboratory data and enter into the hepatitis C system/registry, preferably through an automated ELR system. ELR is the most efficient way to receive these data, especially if the ELR system can automatically enter the hepatitis C records into the surveillance system.
- Jurisdictions with an existing ELR system for other conditions can incorporate hepatitis C testing.
- If ELR is not possible, work with high volume testers to receive data another way .
Investigations
Quality Assurance
Analyses
Policy
Data Sharing
Enhanced Surveillance
Case Ascertainment and Reporting
Analyses
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Get Tested For Hepatitis C And Know Your Status
If you suspect that youve been exposed to the virus at some point, talk to your doctor about getting tested, even if you dont have any symptoms.
This is especially important if you had an organ transplant or a blood transfusion prior to 1992. Before this time, blood and organs werent tested for the virus.
You should also get tested if you develop symptoms of the virus. These include flu-like symptoms, constant fatigue, loss of appetite, and abdominal pain that doesnt improve.
Avoid Direct Exposure To Blood Infected With Hepatitis C
Keep in mind that its also possible for hepatitis C to spread through accidental contact with an infected persons blood. So even if you dont share needles or razors, or get a tattoo, theres the risk of infection if you live with someone infected with the virus, or if you work in healthcare and handle needles but only if you come in contact with infected blood.
To protect yourself at home, wear gloves before tending to cuts and other bloody injuries, and clean contaminated surfaces with bleach. If you have a family member with hepatitis C, encourage them to get treatment, because newer medications are highly effective at curing the infection, thus eliminating any chance of spreading it to others, says Adalja.
Any gloves, bandages, or tissues covered with infected blood should be sealed in a plastic bag and disposed of in the trash, and you should wash any contaminated fabrics at the highest temperature with bleach.
Needle stick injury among healthcare workers is another possible method of transmission, says Dr. Seeni, so these workers should always practice safety. Wear protective gear, especially gloves, when handling blood and blood products as well as sharp items, and always report and get yourself treated if theres any incident of accidental needle stick, she warns.
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Avoid Sharing Personal Care Items
Razors, cuticle scissors, and nail clippers can sometimes cause minor nicks and cuts. If you or someone else has HCV, infected blood can get on these items and spread the virus when shared between people, notes the Hepatitis C Trust.
Be mindful that the virus might also be spread by direct contact with dried contaminated blood, according to the U.K. National Helath Service . So its important to never share razors, nail clippers, scissors, and other personal care items like toothbrushes that may facilitate blood exposure, warns Amesh Adalja, MD, an infectious disease physician and senior scholar at Johns Hopkins Center for Health Security who is based in Pittsburgh.
If personal care items have been contaminated with infected blood, a bleach-based product is a good way to clean these items, continues Dr. Adalja. And once cleaned, store them separately from personal items used by others.
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Hepatitis C And Alcohol
Alcohol can damage cells in the liver. This damage can worsen the effects of hepatitis C on the liver.
Studies have shown that heavy alcohol use in people with hepatitis C can increase your risk of cirrhosis and liver cancer.
Experts are not sure how much alcohol is too much for people with hepatitis C, or whether any level of alcohol consumption is safe. Some studies have found that even light to moderate drinking can increase the risk of liver damage.
For this reason, many doctors recommend that people with hepatitis C dont drink any alcohol.
Fatigue or extreme tiredness is one of the most common symptoms of hepatitis C.
If youre feeling fatigued, try these methods:
- Take short naps during the day.
- Dont plan too many activities for one day. Try to space strenuous activities out over the week.
- If your workday is tiring, ask about flexible hours or telecommuting options.
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What Should I Tell My Healthcare Provider Before Taking Epclusa
Tell your healthcare provider about all of your medical conditions, including if you have ever had hepatitis B infection, liver problems other than hepatitis C infection, or a liver transplant if you have kidney problems or are on dialysis if you have HIV or if you are pregnant or breastfeeding, or plan to become pregnant or breastfeed. It is not known if EPCLUSA will harm your unborn baby or pass into your breast milk.
Tell your healthcare provider about all of your medical conditions, including if you have ever had hepatitis B infection, liver problems other than hepatitis C infection, or a liver transplant if you have kidney problems or are on dialysis if you have HIV or if you are pregnant or breastfeeding, or plan to become pregnant or breastfeed. It is not known if EPCLUSA will harm your unborn baby or pass into your breast milk. If you take EPCLUSA with ribavirin, you should also read the ribavirin Medication Guide for important pregnancy-related information.
Tell your healthcare provider and pharmacist about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. EPCLUSA and certain other medicines may affect each other, or may cause side effects.
Look Out For Your Liver
Hepatitis C can make it harder for your liver to do its main job: break down and filter out substances from your bloodstream. As a result, medications, herbs, drugs, and alcohol may stay in your system longer, and have a more powerful effect. Some substances pose the risk of serious liver damage.
Common painkillers and cold remedies with acetaminophen can be toxic to people with damaged livers, especially if you take them with alcohol or in greater than recommended doses. Be careful with herbal remedies, too. They can be powerful medicine, and some of them can do real harm.
Don’t assume that over-the-counter medications are safe, either. Never take any drugs, supplements or alternative medicines before talking to your doctor.
If you’re a smoker, try to quit. If youâre using illegal drugs, get into a treatment program. Ask your doctor whether you should cut out alcohol completely, or limit drinks to special occasions.
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Vaccination For Hepatitis A And Hepatitis B
Vaccines for hepatitis A and hepatitis B are the most effective preventive measures against those viruses. The U.S. Centers for Disease Control and Prevention has recommended these vaccines for all babies as part of routine healthcare since the 1990s.
The vaccine can be administered to people of any age. If you were not vaccinated as a baby, it is fine to be vaccinated now. Vaccination provides long-term protection from infection.
Even if you have recently been exposed to the virus, the vaccine may prevent infection. Ideally, vaccination takes place within 24 hours of a possible exposure.
There is no vaccine for hepatitis C. Our doctors recommend adopting certain behaviorssuch as avoiding shared needles and other risk factorsto prevent infection.
How Is Hepatitis C Transmitted
Because HCV is primarily spread through contact with infected blood, people who inject drugs are at increased risk for HCV infection. HCV can also be transmitted from an infected mother to child at the time of birth, from unregulated tattoos or body piercings, and from sharing personal items that may be contaminated with infected blood, even in amounts too small to see. Much less often, HCV transmission occurs through sexual contact with an HCV-infected partner, especially among people with multiple sex partners and men who have sex with men. Currently in the United States, health care related transmission of HCV is rare, but people can become infected from accidental needle sticks and from breaches in infection control practices in health care facilities.
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Rationale For Prevention And Control Of Viral Hepatitis In Correctional Settings
The high prevalence of chronic HBV and HCV infections and risk factors for their transmission make prevention and control of these infections high priorities for correctional health programs. In addition, because a substantial proportion of releasees to the community continue to acquire or transmit these infections at a high rate, correctional efforts should become part of prevention and control efforts in the broader community.
Highly effective and safe vaccines are available to prevent HAV and HBV infections. Identification of risk factors and infection status, combined with harm- and risk-reduction counseling, and substance-abuse treatment, have the potential to prevent HCV infections in the same manner they have reduced the risk of HIV/AIDS. In addition, identification of persons with chronic HBV and HCV infection provides opportunities for medical evaluation and treatment of chronic liver disease, and measures to prevent further transmission.
The feasibility of including viral hepatitis prevention activities in existing prevention programs has been demonstrated. However, the challenges to integration of a comprehensive viral hepatitis prevention and control program in correctional health settings are substantial. They include budgetary and staffing constraints, priorities that compete with preventive health care, and lack of communication among correctional health, public health, and private health-care systems.
Adult Health Education And Release Planning
— counseled regarding preventing transmission to household, sexual, and drug-use contacts, including risk reduction and condom use — provided referral for hepatitis B vaccination of contacts — counseled regarding ways to reduce further liver damage, including limiting alcohol and drug use, and afforded substance-abuse treatment when appropriate and — provided aftercare that includes medical follow-up .
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