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05
Feb 2019
What police officers need to know about hepatitis A
In this Sept. 28, 2017, photo, Stephen Schofield looks on as police officials encourage him to get a Hepatitis A vaccination near where is living along the San Diego River in San Diego. (AP Photo/Gregory Bull)
Lt. Don Lowenthal RN, BSN, PCCN, P1 Contributor

Whether it is a pedestrian investigation on a busy street, taking the report of a crime or placing a person in custody, police officers have physical contact with people throughout their busy work day. With that contact, comes the risk of being exposed to various infections such as hepatitis A.

As a registered nurse working on a floor in a hospital, the training I’ve received reminds me almost automatically to wash my hands before making contact with patients in their hospital rooms. If any of my equipment such as my stethoscope or blood pressure cuff becomes dirty, I know to clean it before using it with another patient. I don’t believe this type of training is commonplace in law enforcement. In my 29 years as a police officer, I can’t recall receiving very much training about keeping my hands or equipment clean. It is possible to be infected with diseases with only casual contact. Even though there is a risk of contracting communicable diseases, there are ways to mitigate your risk of being infected and bringing disease home to your family.

HEPATITIS A OUTBREAK IMPACTS CALIFORNIA
In 2017, California experienced one of the largest person-to-person hepatitis A outbreaks in the country, which began in San Diego County in November 2016 and spread to Santa Cruz, Los Angeles and Monterey counties. The outbreak led former governor Jerry Brown to declare a state of emergency. This was soon followed by an urgent request from the Los Angeles police union to vaccinate more than 1,000 officers against hepatitis A after an officer contracted the virus. This outbreak led to 704 cases, 461 hospitalizations and 20 deaths.

WHAT IS HEPATITIS A?
Hepatitis literally means inflammation of your liver. Your liver performs many functions in your body such as clearing your blood of alcohol and other drugs, regulates blood clotting and helps remove bacteria from your bloodstream. [1]

Hepatitis A (HAV) is spread through the oral-fecal route. Unfortunately, the way HAV is spread is as nasty as it sounds. HAV is commonly spread when you have physical, however slight, contact with a person who did not wash their hands properly (or at all) and have traces of feces on their skin. A person can have an occupational exposure to HAV after having a significant blood exposure to people who use illegal intravenous drugs or eating food contaminated with HAV. [2]

Although there is cause for concern when discussing HAV, the Centers for Disease Control and Prevention (CDC) has issued precautions that if taken, can lessen your risk to be infected with HAV. There is a HAV vaccination currently available and has shown to be effective. [2] If your law enforcement agency does not offer this vaccination, contact your family physician about getting vaccinated.

One of the main recommendations of the after-action report in regard to the HAV outbreak in San Diego County was that receiving the vaccination can be instrumental in preventing HAV infection. [3] HAV is not considered a chronic disease and if you are infected with HAV, you will have a life-long immunity to the disease. [4] The same precautions you can take to prevent HAV can also prevent you from being infected with other illnesses.

One of the most overlooked things you can do to prevent the spread of HAV and other diseases is routine hand-washing. Wearing nitrile gloves is no substitute for washing your hands. You should wash your hands even if you wore nitrile gloves during physical contact with another person. A grand jury convened in San Diego County after the hepatitis A epidemic concluded and faulted the City and County for not providing handwashing stations in a timely manner, which lead to the deaths of 20 homeless people and intravenous drug users during the outbreak. [5]

While it is much easier for registered nurses to wash their hands because of the availability of soap and water and hand disinfectants, police officers can also take steps to clean their hands and equipment. Getting vaccinated against hepatitis A and keeping anti-microbial wipes or gels in your work bag can go a long way to stop the spread of disease.

Another way to prevent the spread of disease is to not only clean your equipment when it becomes visibly dirty but to also routinely clean your equipment. It is best to clean your equipment as recommended by the equipment manufacturer or the policy of your department.

Since you will never know if a person you come in contact with has hepatitis A, make sure you are vaccinated, keep your hands as clean as you can (especially before you eat) and wipe down your equipment on a routine basis in order to give yourself the best opportunity to stay healthy and safe.

REFERENCES
1. Liver: Anatomy and Functions. Johns Hopkins Medicine.

2. Viral Hepatitis. Centers for Disease Control and Prevention.

3. Hepatitis A Outbreak – After Action Report. County of San Diego.

4. Hepatitis A. World Health Organization.

5. San Diego County Grand Jury, 2017/2018. Filed May 17, 2018.

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