Risky Business: The Truth About Hepatits B Vaccine
Risky Business: The Truth About Hepatits B Vaccine
There seem to be many questions recently regarding the Hepatitis B vaccine protocol so it’s time to review this safety issue. The offering of this vaccine is one of the requirements of OSHA’s Bloodborne Pathogen Standard (BPS) at 29 CFR 1910.1030. The BPS requires the employer to define the tasks in the workplace where potential exposure to bloodborne pathogens may occur. At SafeLink we have defined those tasks for the typical dental laboratory as:
- Pick-up and delivery
- Unpacking and disinfecting in receiving
- Die trimming clinically poured models
- Trimming back over-extended borders on impressions
- Repairing dentures that have been worn by patients
- Performing shade verifications
Workers who are performing these tasks are classified as Category I workers and must be offered the Hepatitis B vaccine series within 10 days of hire. Just offering the vaccine is not sufficient, however. The employer must educate Category I workers about how the risks of exposure may occur and inform the worker on how to protect themselves through work practices, administrative controls, engineering controls, and personal protective equipment. This training must occur upon hire, if an employee is moved into one of the risk areas after hire, and annually.
The employer must make arrangements with a healthcare facility and take or send the workers to that facility. The healthcare facility should require payment from the employer, not the employee. The time for the workers to receive this vaccine must be paid by the employer.
The vaccine consists of three injections. The first, then one month later, the second and, five months after the second, the third. Four to eight weeks after the third injection, the worker must return to the health care facility to receive a blood test (titer test) to determine if the worker responded to the vaccine series. According to the Centers for Disease Control (CDC), a person who responds to the vaccine series does not require a booster in following years so this is an excellent reason to check for sufficient antibodies. If the results of the titer test are not sufficient for protection, then a second full series of the vaccine will be started. This is paid for by the employer. The titer test is then repeated. If sufficient antibodies are not present after the second series, then the CDC does not recommend a third series. This worker must ensure that they understand safe work practices for their protection.
For some reason, a number of workers recently have refused the titer test. The titer test only tests for the Hepatitis B antibodies. The employer should educate the worker prior to starting the vaccine series that a titer test will be performed. If the worker needs additional information about the titer test, then the health care personnel at the facility where the vaccine is administered should also be able to address any concerns that the worker may have regarding the vaccine and/or the titer test.
If a worker declines participation in the vaccine series and titer test, then a refusal must be signed by the worker. OSHA’s language for this refusal is specific. As of this writing the Web site address for this refusal is: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&....
Education of workers prior to acceptance or refusal of a vaccine is critical; therefore, your facility’s safety training program must be thorough in regard to this information. The CDC provides a wealth of information about Hepatitis B along with the American Liver Foundation. Some Web sites that may be helpful for this type of information are: www.liverfoundation.org, www.immunize.org and www.cdc.gov/hepatitis.
