Correctional officers and hepatitis C - Hepatitis NSW

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Correctional officers
and hepatitis C
This resource aims to provide correctional officers with health information about hepatitis C, to
enable them to protect themselves against occupational injury. Additionally, correctional officers
have a professional duty of care to take all reasonable steps to protect the health of prisoners.
This is a national document, and is necessarily broad, focusing on hepatitis C, and the principles
of hepatitis C prevention, treatment and care. If jurisdictional detail is required, please refer to your
local policies and procedures. Further information on hepatitis C is available on the ASHM website.
Why is hepatitis C a problem?
Hepatitis C has become one of Australia’s most commonly notified infectious diseases. At the end
of 2007, an estimated 207 600 people were living in Australia with chronic hepatitis C, including 47
600 with moderate to severe liver disease.
Prisons are an identified risk factor for the spread of hepatitis C in Australia. More than half our
prisoners have evidence of hepatitis C, compared with one per cent in the rest of the Australian
community. Prisons concentrate large numbers of injecting drug users together in crowded spaces.
It is fundamental for corrections staff to have a practical knowledge of hepatitis C and its prevention.
Some prisoners continue to illegally inject in prison, and many prisoners and correctional officers
may have other prison-related exposures to blood.
Additionally, prisoners have a much greater chance of being infected while in prison (up to one
out of every three prisoners could be infected each year they are in prison). Although the rate of
infection and the chance of being infected vary across the different jurisdictions, being imprisoned
is uniformly a high risk event for becoming infected with hepatitis C.
Table 1. What happens to people who get hepatitis C?
The natural history of hepatitis C infection and the impact of successful therapy on infection
(modified from HIV, viral hepatitis and STIs : a guide for primary care ASHM 2008)
100 people infected with hepatitis C
75 will have a continuing infection (chronic
25 will clear the virus; no longer infected
~25 will have normal liver
~50 will have abnormal
liver tests
Successful response to
treatment; no longer infected
Good outcome, no disease progression
8-15 will develop cirrhosis (scarred liver) at
20 years
~3 will develop liver failure or liver cancer
after many years
2 Correctional Officers and Hepatitis C
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You CANNOT get hepatitis C by:
 Casual physical contact including, hugging, kissing, shaking hands
 Through the air (not by coughing or sneezing)

Contact with faeces or urine

Sharing food or drink, plates, cups, utensils and glasses

Using the same shower or toilet facilities
 Receiving a blood donation (very, very low risk because all donated blood in Australia is screened at the Blood
How is the hepatitis C virus spread?
Hepatitis C virus is spread through contact with the blood of a person living with hepatitis C. In Australia, re-using
injecting equipment is the most common way of being exposed to hepatitis C. This accounts for more than 80% of all
cases of hepatitis C. It’s estimated that nearly 60% of prisoners have at some stage in their life injected drugs and that
over half of all prisoners have been exposed to hepatitis C.
 Injecting drug use continues in prison and the re-using of injecting equipment is the most common cause of the
ead of hepatitis C virus.
 Unregulated tattooing and body piercing using non-sterile, blood contaminated equipment are high risk activities for
the transmission of hepatitis C. Up t
o 40% of prisoners are tattooed in prison.
 Hepatitis C virus can be transmitted when the skin is broken and then contaminated with infected blood. In the
rectional setting, transmission can occur as a result of fights, assaults, sporting or work–related injuries.
 In prisons, personal hygiene equipment such as razors, toothbrushes, hair cutting equipment and nail clippers are
sometimes shar
ed and can spread hepatitis C virus if blood is on the equipment.
 Following infection control procedures by correctional staff will help protect from exposure to hepatitis C virus. This
activities described above and during cell or prisoner searches, cell extractions or handling bloodied ob-
Risk of hepatitis C infection
No risk
 Casual physical contact including hugging, kissing and shaking hands

Through the air (not by coughing or sneezing)

Hugging, kissing, shaking hands

Contact with faeces or urine

Sharing food or drink, plates, cutlery and glasses

Using the same shower, toilet or laundry facilities
Very, very low risk
 From a mother-to-baby by breastfeeding

Receiving a blood donation or organ transplant in Australia after 1990

Community exposure to discarded injecting equipment
ery low risk
 Through sex (unless blood is present)
ow risk
 Pregnant woman to her baby (5%)

Sharing personal items such as razors, toothbrushes, hair cutting equiptment and nail clippers

Needlestick injury (2-10%)
High risk

Tattooing or body piercing with contaminated equipment (cannot be done safely in prison setting)
ery high risk
 Re-using injecting equipment.
Correctional Officers and Hepatitis C 
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The body’s response to hepatitis C
Once the hepatitis C virus has entered the bloodstream, it enters the liver and begins to reproduce. The body’s
immune system senses an ‘invader’ and responds by producing antibodies to kill the virus. It can take up to six
months for the body to produce enough antibodies to be measured in a blood test. An antibody test is the first test
used to diagnose hepatitis C infection. This test confirms that a person has been exposed to the virus but not if they
are currently infected. A second test called a hepatitis C PCR is used to confirm the presence of the hepatitis C virus
indicating current infection. People with current infection are infectious to others.
Approximately one in four people will clear the virus naturally. They will not have the virus anymore and cannot
transmit it to others. Hepatits C antibodies will remain in their bloodstrem but these antibodies will not prevent a
person from getting hepatitis C again if re-exposed.
Appoximately three in four people cannot defeat the virus and go onto have chronic hepatitis C. Over time, this may
cause damage to the liver and effect their health. People with chronic hepatitis C are infectious to others.
Treatment for hepatitis C
Treatment is available for people with chronic hepatitis C . Some people may have significant side effects, but the
medicines are continually improving. Recent advances in treatment now mean that between 50 and 80% of those
who complete treatment are cured. Hepatitis C’s treatment success is unique among viral infections.
There is no post-exposure prophylaxis (treatment to reduce risk of infection) for hepatitis C exposures.
Prevention of hepatitis C infection in the correctional setting
Correctional officers who understand how staff and prisoners may be exposed to hepatitis C are better able to pre-
vent blood exposure and subsequent infections. Effective infection control procedures will help reduce the spread
of hepatitis C virus in correctional environments.
Infection control procedures require that all blood and body fluids be considered potentially infectious. You can-
not determine who has hepatitis C by looking at someone. To be safe the rule is: consider all prisoners and staff as
potentially infectious.
Correctional officers and prisoners are put at risk if infection control procedures are limited to prisoners who are sus-
pected of having hepatitis C. There is no reason to separate or isolate prisoners from the main population because
of known or suspected hepatitis C infection.
There is no vaccine to prevent hepatitis C. However, safe and effective immunisation is available against hepatitis B
virus infection and is strongly recommended for all new corrections staff during their induction training.
Preventing hepatitis C infection
 Gloves and protective personal equipment should be used when there is a chance of being exposed to blood

Broken skin should be covered with waterproof dressings

An adequate supply of new toothbrushes and razors should be available
 Sharp objects (needles, blades) should be safely handled and disposed
 Blood and body substance spills should be dealt with according to procedures.
4 Correctional Officers and Hepatitis C
General infection control precautions
The following work practices are minimum requirements for infection control. They ensure a high level
of protection against transmission of infection including blood-borne viruses.
a) Personal protective equipment (gloves and protective clothing)
Correctional officers and prisoners should wear latex gloves in situations where they may be exposed to blood or
body fluids. The gloves don’t have to be sterile. Personal protective equipment, such as eyewear and face shields,
should be wor
n when there is the chance of being splashed or sprayed in the face/eyes with blood or body fluids
containing blood.
b) Covering exposed broken skin
Cover all open wounds with waterproof dressings and check they are intact and adherent. This is especially
important for injuries to hands (e.g. wounds from fighting or other cuts, burns, blisters or abrasions). Please refer to
page 5 for management of injuries and other blood exposures.
c) Safe barbering
Barbering has been identified as a risk factor for hepatitis C infection. Barbering must be regulated to a community
standard. Your support for activities that eliminate equipment sharing will reduce the spread of hepatitis C. These
 Easy access to personal items like razors
 Adopting a system where hairdressing is provided by trained prisoners or hairdressers from the community.
 Educating prisoners on how to reduce cross contamination of equipment by

cleaning with disinfectants
 not allowing the use of metal combs directly contacting the scalp (no ‘zero’ haircuts; electronic hairclippers
should be used with plastic safety guard in place)
 ensuring access to running water
 preventing rushing – supporting a queuing system.
d) Tattooing and body piercing
Being tattooed in Australian prisons has a high risk of hepatitis
C infection. Up to 40% of prisoners are tattooed while in prison.
Currently, there is no regulated tattooing in Australian prisons.
Whilst strategies exist in the general community to ensure that
tattooing and body piercing practices don’t lead to the sharing
of blood-contaminated equipment, they are not readily available
to the prisoner population.
In reality, regularly educating prisoners of the risks of ‘do it yourself’
tattooing and body piercing and strongly recommending that
they delay these activities until they are back in the community,
are the only preventive measures available to corrections staff.
e) Management of contraband sharp objects including needles, syringes, blades and shivs
It is estimated that nearly 60% of prisoners have ever injected and up to a half of all fulltime prisoners have been
exposed to hepatitis C. Injecting equipment that is potentially contaminated with hepatitis C is present in prisons.
Poor handling and disposal of sharp contraband objects such as needles, blades, shivs and glass vials by correctional
officers can transmit the hepatitis C virus.
 Sharp contraband objects should be handled as little as possible.
 Officers should wear protective equipment and items should not be passed between staff.
 Officers must dispose of items into a rigid sided container immediately (purpose built and labelled for biohazard);
or alt
ernatively place them in specifically designed evidence tubes.
 Needles must not be re-sheathed, destroyed by hand or removed from the syringe.
 Approved sharps containers (yellow coloured receptacles are in all clinical areas) should be located within easy
Correctional Officers and Hepatitis C 5
Prevention of needlestick and sharps injuries when doing searches:
 Do not put your hands in places where you cannot see
 Use tools, instead of your hand, to assist with hard-to-access areas
 Empty the contents of bags and containers onto a flat surface
or inspection – rather than putting your hands in to feel when
 Use mirrors and adequate lighting (including torches) to assist with
the sear
The chance of being infected with hepatitis C depends on each
individual exposure - the depth of the injury, how much blood
entered the bloodstream and the amount of virus in that blood. The
risk of infection from a needlestick injury is considered low, with a risk
rate of 2-10%. Frequently, correctional officers have no idea of the
source of the contaminated item and attempts to identify that person
are not productive.
f) Environmental blood and body substance spills
Blood and body substance spills should be dealt with as soon as is
practicably possible. A ‘spills kit’ should be easily available for blood
spills. Refer to your own policy and procedures for further detail. Procedures should include:
 Correctional officers and prisoners to wear personal protective equipment (gloves, goggles etc.)
 Contain the spill
 Mop up spills with paper towels

Wash down with detergent and water, allow to dry
 Disinfect if contaminated surfaces will be in contact with bare skin; allow to dry
 Secure all cleaning waste in waterproof, leak proof rubbish bags
 Contaminated towels and clothes are placed in leak proof plastic bags and sent to the prison laundry
 Furnishings such as chairs and mattresses can be washed with water and detergent and allowed to dry. Leather
goods (belts, shoes) can be washed with soap and water. Canvas shoes can be machine washed. Uniforms can
be laundered or may need to be dry cleaned.
There is no disinfectant that has been shown to kill the hepatitis C virus - this includes bleach (which is effective
against HIV).
Needlestick injuries and other blood exposures
If you sustain a needlestick injury or exposure to your mouth or eyes, it is important that you follow your local
procedure and guidelines which will include:
 Removal of contaminated clothing
 Washing the injured area with soap and running water

Rinsing your mouth, nose and eyes with water or saline if they were exposed to blood
 S
eeking medical advice immediately for assessment of the exposure and necessary testing and treatment
 Informing your manager of your occupation exposure
 If possible, determine the source of the exposure
 Reporting the incident and follow your occupational health protocol.
our rights to privacy and confidentiality need to be protected and respected. You will require medical follow-up
after a needlestick injury for approximately 12 months.
Having accurate information and education enables you as correctional officers to protect your own health
and safety in the workplace, and that of the prisoners.
6 Correctional Officers and Hepatitis C
What can you do?
 Be well informed about hepatitis C to protect yourself and others

Support and act on the recommended protective strategies

Familiarise yourself with workplace policy and undertake relevant training
 Uphold the confidentiality of both staff and prisoners who may have hepatitis C.
Correctional officers with hepatitis C
 You need to be informed about your professional and personal roles and responsibilities
 You have no legal responsibility to reveal to your employer that you have hepatitis C; you must not be
ced to do this
 You can get information from:

Your local hepatitis council
 The health department in your state or territory
 The Anti-Discrimination Board, Human Rights Commission or Equal Opportunity Board in your
e or territory
 Your union and occupational health and safety representative.
Hepatitis C is highly stigmatised and many people living with hepatitis C experience discrimination. The effects of
discrimination are extensive. They may be physical (such as restricting medical treatment), psychological and social
(e.g. breaching confidentiality about a medical condition). Treating people less favourably because of their medical
condition is unprofessional and unlawful.
Hepatitis C Prevention, Treatment and Care: Guidelines for Australian Custodial Settings
Available from
Correctional Officers and Hepatitis C 7
References and further reading
Butler T, Papanastasiou C. National Prison Entrants’ Bloodborne Virus and Risk Behaviour Survey Report 2004 & 2007.
Blood Rules, OK. Protect yourself in sport and play.
Bradford D, Hoy J, Matthews G. HIV, viral hepatitis and STIs; a guide for primary care 2008. Australiasian Society for HIV
Medicine. Available at
Australian National Council on Drugs.
Australian Government. Department of Health and Ageing. Infection control guidelines for the prevention and transmission
of infectious diseasesin the health care setting. Endorsed by the Communicable Diseases Network Australia, the National
Public Health Partnership and the Australian Health Ministers’ Advisory Council. January 2004.
Available at http://w, Section 2, pp.-4
Australian Government. Department of Health and Ageing. National Hepatitis C Testing Policy 2007.
Available at
Hepatitis Australia. Resources for educators working with people in custodial settings.
Available from:
General and specific advice and answers to frequently asked questions about hepatitis B immunisation. .
Law MG, Dore GJ, Bath N, Thompson S, Crofts N, Dolan K, et al. Modelling hepatitis C virus incidence, prevalence and long-term
quelae in Australia, 2001. Int J Epidemiol 200; 2:717–24.
Larney S, Dolan K. An exploratory study of needlestick injuries among Australian prison officers. Int J Prison Health (2008) Vol.
National Centre for HIV Epidemiology and Clinical Research HIV/AIDS, viral hepatitis and sexually transmissible infections in
Australia Annual Surveillance Report.
Hepatitis C Resource Manual 2nd Edition. Chapter 7. Preventing discrimination and reducing stigma and isolation.
Available at:
isons Hep C helpline: 1800 80 990
8 Correctional Officers and Hepatitis C
Hepatitis Australia
Tel: 61 2 622 4257
Fax: 61 2 622 418
Australian Capital Territory
Tel: 02 6257 2911
100 01 8 (Hepline)
Fax: 02 6257 1611
New South Wales
Tel: 02 92 1599
1800 80 990 (Freecall country)
Fax: 02 92 170
Northern Territory
NT AIDS and Hepatitis Council
Tel: 08 8941 1711
1800 880 899 (Freecall)
Fax: 08 8941 2590
Tel: 07 26 0610
1800 648 491 (Freecall country)
Fax: 07 26 0614

South Australia
Tel: 08 862 844
1800 021 1 (Freecall country)
Fax: 08 862 8559
Tasmanian Council on AIDS,
Hepatitis and Related Diseases
Tel: 0 624 1242
1800 005 900 (Freecall country)
Fax: 0 624 160
Tel: 0 980 4644
1800 70 00 (Freecall country)
Fax: 0 980 4688
Western Australia
Tel: 08 9227 9800
08 928 858 (Infoline)
1800 800 070 (Freecall country)
Fax: 08 9227 6545
ASHM offers training in HIV, viral hepatitis and
blood-borne viruses around Australia.
For further information on upcoming courses
visit or contact
the ASHM Professional Education Division
on or phone 02 8204 0700.
Hepatitis C and related organisations/groups can be contacted for further resources and support information

Hepatitis C Councils
National Viral Hepatitis Education Program
ISBN: 978 1 92077 65 7
ABN: 48 264 545 457
March 2009
Australasian Society for HIV Medicine (ASHM)
Tel: 02 8204 0700
Australian Injecting and Illicit Drug Users League (AIVL)
Tel: 02 6279 1600
Fax: 02 6279 1610
Australian Drug Foundation
Tel: 0 9278 8100
100 858 584 (Infoline)

Gastroenterological Society of Australia
Tel: 02 9256 5454

National Centre for Education and Training on Addictions
Tel: 08 8201 755
Additional copies of this resource may be ordered online at:
Australasian Society for HIV Medicine Inc (ASHM)

LMB 5057 Darlinghurst NSW 100
Tel: 61 2 8204 0700
Fax: 61 2 9212 282
Journal Supplements
• Prehospital Care Workers and Blood-borne Viruses
• Dental Health and Hepatitis C
• Nurses and Hepatitis C
• GPs and Hepatitis C
• An Overview of Hepatitis C - clinical management in opiate
pharmacotherapy settings
• Hepatitis C in brief – a factsheet
• Coinfection: HIV & Viral Hepatitis – a guide for clinical management
• HIV and viral hepatitis C: policy, discrimination, legal and ethical issue
• HIV Management in Australasia: a guide for clinical care
• HIV, Viral Hepatitis and STIs: a guide for primary care
• B Positive - all you wanted to know about hepatitis B: a guide for primary care

Australasian Contact Tracing Manual, Edition 3 2006
Other ASHM resources, including the following hepatitis C-
related publications, are available from the ASHM website:

ASHM would like to thank Associate Professor Michael Levy, Vanessa Read and
Doreen Rae for their support in the development of this resource. ASHM is grateful
for the input provided by those involved in the focus testing and online feedback
questionnaire for the pilot of this resource.