systems have reduced the risk of spreading this infection from one patient to

Systems have reduced the risk of spreading this

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systems have reduced the risk of spreading this infection from one patient to another or to health care personnel during the collection of blood samples or the administration of parenteral therapy. In the clinical laboratory and the hemodialysis unit, work areas are disinfected daily. Gloves are worn when handling all blood and body fluids, as well as HBAg–positive specimens, or when there is potential exposure to blood (e.g., blood drawing) or to patients’ secretions. Eating is prohibited in the laboratory and in other areas exposed to secretions, blood, or blood products. Patient education regarding the nature of the disease, its infectiousness, and prognosis is a critical factor in preventing transmission and protecting contacts (see Chart 49-6 ). Active Immunization: HBV Active immunization is recommended for people who are at high risk for HBV (e.g., health care personnel, patients undergoing hemodialysis). In addition, people with HCV and other chronic liver diseases should receive the vaccine. A yeast-recombinant hepatitis B vaccine (Recombivax HB) is used to provide active immunity and has shown rates of protection greater than 90% in healthy people ( Chan, Wong, Qin, et al., 2016 ; Dan et al., 2015 ; Mandell et al., 2014 ). Although antibody levels may become low or undetectable, immunologic memory may remain intact for at least 5 to 10 years. Measurable levels of antibodies may not be essential for protection. In general, in those with normal immune systems, booster doses are not required, and no data support the use of booster doses of hepatitis B vaccine among immunocompetent people who have responded to the vaccination series. However, booster doses are recommended for people who are immunocompromised ( Chan et al., 2016 ; Mandell et al., 2014 ). Additional information is required to determine if booster injections are 9
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needed for adults 15 years or more after initial vaccination as well as those at high risk for HBV infection. A hepatitis B vaccine prepared from plasma of humans chronically infected with HBV is used only rarely in patients who are immunodeficient or allergic to recombinant yeast-derived vaccines. Both forms of the hepatitis B vaccine are given intramuscularly in three doses; the second and third doses are given 1 and 6 months, respectively, after the first dose. The third dose is very important in producing prolonged immunity. Hepatitis B vaccination should be given to adults in the deltoid muscle. Antibody response may be measured by anti-HBs levels 1 to 3 months after completion of the basic course of vaccine, but this testing is not routine and is not currently recommended. People who do not respond may benefit from one to three additional doses ( Mandell et al., 2014 ). People at high risk, including nurses and other health care personnel exposed to blood or blood products, should receive active immunization. Health care workers who have had frequent contact with blood are screened for anti-HBs to determine whether immunity is already present from previous exposure. The vaccine produces active
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