* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *  
*                                                                   *  
*                        INFORMATION ALERT                          *  
*                                                                   *  
*  Produced by:  Saskatchewan Human Resources,                      *  
*                Labour and Employment                              *  
*  Provided by:  Canadian Centre for Occupational Health and Safety *  
*                                                                   *  
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *  
  
  
HEPATITIS B VACCINATIONS FOR NON-HEALTH CARE WORKERS  
Guidelines for Employers  
  
  
  This guide will help employers to determine the need for hepatitis B  
  vaccinations at the workplace.  
  
  
*** THE DISEASE:  ***  
  
  Hepatitis B virus is contracted from exposures to contaminated body  
  fluids, notably blood.  It causes serious liver damage and may enter  
  the body through:  
  
                - the eyes;  
                - mucous membranes;  
                - damaged skin;  and/or  
                - skin punctures.  
  
  Urine, vomitus, tears, sweat, sputum, faeces or nasal secretions are  
  not considered potentially infectious unless they are visibly  
  contamintaed with blood.  
  
  
*** HEPATITIS B CASES IN SASKATCHEWAN:  ***  
  
  Saskatchewan Worker's Compensation Board records report 28 cases of  
  work related hapatitis B since 1969.  This includes 2 deaths.  Most  
  cases occurred among health care workers in:  
  
                - hospitals;  
                - other health care facilities (including institutions  
                  for the developmentally disabled);  and  
                - clinical laboratories.  
  
  A few cases occurred among nurses in correctional centres and workers  
  in funeral homes.  No cases occurred among ambulance, police or fire  
  control personnel.  
  
  
*** REQUIREMENTS:  ***  
  
  Hepatitis B vaccinations should be offered to workers at risk in  
  health care and other high risk industries.  These are identified in  
  a guideline issued by the National Advisory Committee on Immunization.  
  Non-health care workers identified as being at risk by this guideline  
  must also be offered immunization.  
  
  
*** THE VACCINE:  ***  
  
  The vaccine is available in pharmacies.  Three doses are given at 0,  
  1 and 6 months.  A booster vaccination should also be taken.  This  
  should be provided 5 years after the initial series of vaccinations.  
  
  
*** REGULATIONS:  ***  
  
  
  An employer is required to ensure, as far as is reasonably  
  practicable, that a person's health is not affected by work.  
  
  'The Occupational Health and Safety Act' defines reasonably  
  practicable as practicable unless the person on whom a duty is placed  
  can show that there is a gross disproportion between the benefit of  
  the duty and the cost, in time, trouble and money, of the measures to  
  secure the duty.  Cost is considered in the definition.  
  
  Hepatitis B vaccine appears to be cost effective when more than 1% of  
  an exposed population is infected in a year.  This infection rate  
  normally occurs where workers are exposed to the disease once or twice  
  each month.  In such cases it is considered to be reasonably  
  practicable for the employer to provide vaccinations.  
  
  However, the number who will contract hepatitis in an exposed  
  workforce may not be known.  In such cases, the need for vaccinations  
  will have to be determined from several factors including how often  
  workers are exposed.  
  
  
*** WORKERS WHO SHOULD BE CONSIDERED FOR VACCINATION:  ***  
  
  1.  Those who may be exposed to blood and other potentially infectious  
      body fluids often while on the job.  
  
  2.  Those who may be exposed to the blood or body fluids of high risk  
      people such as:  
  
                - intravenous drug users;  
                - the institutionalized developmentally disabled;  and  
                - prisoners.  
  
  3.  Workers who have daily contact with possibly violent people.  
  
  
*** EXAMPLES OF OCCUPATIONS WHERE VACCIANTION SHOULD BE CONSIDERED:  ***  
  
  PARAMEDICS  
  
                Paramedics and others who have paramedical duties must be  
             offered the vaccine.  Examples include:  
  
                                - ambulance attendants;  
                                - rescue workers;  and  
                                - emergency response teams, etc.  
  
                There is no evidence that industrial first aid attendants are  
                at risk.  Workers in this group will likely need vaccination  
                only in unusual circumstances.  
  
  FUNERAL HOME WORKERS  
  
                There have been some reported cases of hepatitis B among  
                embalmers and funeral home workers.  Embalmers who are exposed  
                to blood and body fluids on a daily basis must be offered the  
                vaccine.  
  
  POLICE OFFICERS  
  
                Officers who are most at risk are those on ordinary street  
                patrol who may contact aggressive carriers of the virus.  The  
                vaccine must be offered to this group in communities where  
                violent crime is common.  Officers in other duties may also  
                be at risk.  The decision to offer immunization should be  
                based on how often officers are exposed to suspected carriers.  
  
  PRISON GUARDS  
  
                The number of corrections workers and prison guard who  
                contract hepatitis B each year is unknown.  Their risk of  
                contracting the disease is also unknown.  It may similar to  
                that of police officers.  The history of exposure to sharp  
                contaminated objects and contact with violent prisoners  
                should be considered when determining the need for  
                immunzaiton.  
  
                However, workers who are required to provide emergency medical  
                assitance to inmates must be offered the vaccine.  
  
  FIRE FIGHTERS  
  
                Fire fighters who provide paramedical services must be offered  
                the vaccine.  Their exposure risk is similar to that of  
                paramedics.  
  
  STAFF OF CENTRES FOR THE DEVELOPMENTALLY DISABLED  
  
                Staff of institutions for persons with developmental  
                disablities are at a marginally higher than average risk.  The  
                vaccine must be provided to wokers who normally handle:  
  
                                - violent residents;  
                                - patients who are prone to biting;  or  
                                - hapatitis B carriers  
  
  OTHER WORKERS  
  
                Workers who are exposed to blood or other potentially  
                infectious material 1 or more times per month should be  
                vaccinated.  These include medical equipment repair workers,  
                research laboratory workers, house keeping and administrative  
                workers in some workplaces, etc.  
  
  
*** OCCUPATIONS WHERE VACCINATION IS NOT NORMALLY REQUIRED:  ***  
  
  FIRST AID ATTENDANTS  
  
                There is no evidence that industrial first aid attendants are  
                at a high risk of contracting hepatitis B.  The decision to  
                offer immunzation must be base don the risks of the workplace.  
  
  SEWAGE TREATMENT PLANT WORKERS AND PLUMBERS  
  
                Infectious fluids in sewage are believed to be diluted below  
                the danger point.  Sewage plant workers do not appear to be  
                at risk of contracting the disease.  There is no evidnece to  
                support the need for hepatitis B immunization for this group.  
  
  TEACHERS AND DAY-CARE WORKERS  
  
                Exposure to carriers in the school or day-care environment is  
                not considered to involve any substantial risk.  
  
*** OCCUPATIONAL HEALTH AND SAFETY BRANCH:  ***  
  
  Regina  
  1870 Albert Street  
  S4P 3V7  
  
  Regina Office Inquiry 787-4496  
  
  
Bulletin TU 20, Sept. 1990  
  
  
            * * * * * * * * * * * * * * * * * * * * * * * *