PROFESIONALNI RIZIK ZA INFEKCIJU VIRUSOM HEPATITISA C U ZDRAVSTVENIH RADNIKA
Aščerić M 1, Mulabegović N 2, Pranjić N 3.
1 Zavod za farmakologiju i toksikologiju Medicinskog fakulteta Univerziteta u Tuzli
2 Institut za farmakologiju i toksikologiju Medicinskog fakulteta Univerziteta u Sarajevu
3 Katedra za medicinu rada Medicinskog fakulteta Univerziteta u Tuzli, Bosna i Hercegovina

Infekcija hepatitis C virusom je ozbiljan zdravstveni problem. Odgovorna je za 20% akutnih hepatitisa, 80% hroničnih hepatitisa, 40% ciroze, 70% hepatocelularnih karcinoma i 30% slučajeva transplantacije jetre. Procjena je da oko 170 miliona osoba inficirano hepatitis C virusom koji je uzročnik 400 000 smrti godišnje. Hepatitis C pozitivni bolesnici na hroničnoj hemodijalizi predstavljaju profesionalni rizik od hepatitisa C za osoblje zaposleno na Odjelu za hemodijalizu.

CILJ: Cilj rada je da se ukaže na visok profesionalni rizik oboljevanja zdravstvenog osoblja od hepatitisa C.

ISPITANICI I METODE: Ispitivanjem smo obuhvatili 120 pacijenata, uključenih u kontinuiran program hemodijalize, srednje životne dobi 48, 22 ± 18, 2 godina (raspon 18 - 75). Muškaraca je bilo 71 (59 %), a 49 žena (41 %). Svim ispitanicima sprovedena je detekcija anti-HCV antitijela i HBsAg po metodi ELISA serološlim testom treće generacije. Nismo bili u mogućnosti sprovesti detekciju anti-HCV uzdravstvenih radnika Odjela hemodijalize.

REZULTATI: U ispitivanoj populaciji pacijenata na dijalizi bila je izrazito visoka prevalenca pozitivnih anti-HCV pacijenata 92 od 120 (77,6%),a HBSAG pozitivnih 5 od ukupno 120 pacijenata (4%).

ZAKLJUČAK: Vakcinacijom se uspjelo kontrolirati i zaustaviti širenje hepatitisa B, kako u osoblja, tako i u pacijenata. Jedina preventivna mjera, uz dobre higijenske uslove, protiv rizika od nastanku hepatitisa C u zdravstvenih radnika na odjelu hemodijalize jeste princip izolacije pozitivnih anti-HCV pacijenata i što se hemodijaliza provodi uvijek na istom aparatu. Međutim to nije zaštitna mjera za prevenciju hepatitisa C u zdravstvenih radnika, jer svaka incidentna situacija s iglom predstavlja sigurnu transmisiju virusa u krv zdravstvenog radnika. Obzirom da nema vakcine za hepatitis C, neophodno je provoditi stalni monitoring anti-HCV antitijela u zdravstvenih radnika zaposlenih na Odjelu za hemodijalizu prilikom preventivnih pregleda. Postavlja se pitanje prethodnog lanca širenja infekcije hepatitisom C u pacijenata, koliko je na drugoj strani zdravstvenih radnika na Odjelu za hemodijalizu anti-HCV pozitivno ili već profesionalno oboljelo od hepatitisa C.

OCCUPATIONAL RISK FOR HEPATITIS C IN HEALTHCARE WORKERS STAFF
Aščerić M 1, Mulabegović N 2, Pranjić N 3.
1 Departement of Pharmacology Medical Faculty University of Tuzla
2 Departement of Pharmacology Medical Faculty University of Sarajevo
3 Departement of Occupational Medicine Medical Faculty University of Tuzla, Bosnia and Herzegovina

HCV infection is a serious health problem, accounting for 20 % acute hepatitis, 40 % of chronic hepatitis, 40 % cirrhosis, 70 % hepatocellular carcinoma and 30 % of liver transplantation. It is estimated that as many as 170 million persons wide- world are infected with HCV, which causes 400 000 deaths per year. HCV positive patients on chronic hemodialysis are occupational risk factors for hepatitis C in staff employed on hemodialysis department.

OBJECTIVE: The aim of this study is to determine the occurrence anti-HCV positive patients, as risk for occupational hepatitis C disease in healthcare staff on hemodialysis department.

SUBJECTS AND METHODS: 120 subjects of middle age 48,22 +/- 18,2 (between 18 - 75) were involved in this study. Out of that 71 subjects were male (59 %), and 49 subjects were female (41 %). All subjects were on chronic dialysis program. The main assay for detection anti-HCV antibodies and HBsAg was the ELISA of the third generation. We have not possibility to conduct detection in healthcare staff.

RESULTS: There was the high prevalence of anti-HCV positive patients 92 positive of out 120 subjects (77,6%). There was 5 HBsAg positive of total 120 examined patients (4 %).

CONCLUSION: With vaccine climbed control and stopped expansion of hepatitis B between patients and healthcare staff. The only one existed precaution measure, except good hygiene procedures, in prevention of HCV infection is isolation of patients and dialysis treatment on the same dialysis apparatus. But that measure is not well enough for prevention of HCV infection in healthcare staff because all accident with needle is sure source of transmission of virus. Since, there is no existing vaccine for HCV it is necessary to conduct continuous monitoring of anti-HCV antibodies in healthcare staff employed in the hemodialysis department during preventive examining. Now exist the question how way was early expansion of infection hepatitis C in patients, how many members of the medical staff employed in the hemodialysis department anti-HCV positive and how many infected with HCV are already with occupational diseases hepatitis C.