The Los Angeles County Department of Public Health has notified the Emergency Medical Services (EMS) Agency of 10 cases of Hepatitis A amongst our homeless population or others at risk for Hepatitis A infections.
In San Diego County 421 cases of Hepatitis A infections including 16 deaths, primarily affecting homeless persons, injection and non-injection illicit drug users and individuals in dense living conditions with shared restrooms, were reported since November 2016.
At this time we recommend that all EMS Provider Agencies and Police Departments notify their staff who have direct contact with individuals from the identified population, of this outbreak and the need for vigilance relative to PPE use and hand hygiene. Although hand hygiene should be a part of daily clinical care both for the protection of the provider and the patient/client, outbreaks such as these bring this practice into the forefront of prehospital care. Hepatitis A virus is spread by oral contamination with feces which occurs when a person puts their contaminated hand in their mouth. This transmission can be prevented by PPE and good hand hygiene practices. These same practices are important for law enforcement personnel to follow to prevent exposure to disease.
The Center for Disease Control (CDC) recommends the following best practice related to hand hygiene and use of gloves for health care providers:
When and How to Wear Gloves
- Wearing gloves is not a substitute for hand hygiene. Dirty gloves can soil hands.
- Always clean your hands after removing gloves.
- Steps for Glove Use:
- Choose the right size and type of gloves for the task
- Put on gloves before touching a patient’s non-intact skin, open wounds or mucous membranes, such as the mouth, nose, and eyes
- Change gloves during patient care if the hands will move from a contaminated body-site (e.g., perineal area) to a clean body-site (e.g., face)
- Remove gloves after contact with a patient and/or the surrounding environment (including medical equipment) using proper technique to prevent hand contamination
- Failure to remove gloves after caring for a patient may lead to the spread of potentially deadly germs from one patient to another
- Do not wear the same pair of gloves for the care of more than one patient
When Should an EMS providers and Law Enforcement Personnel Use Alcohol Based Sanitizers or Wash Hands
- Before eating
- Before and after having direct contact with a patient’s intact skin (taking a pulse or blood pressure, performing physical examinations, lifting the patient in bed)
- After contact with blood, body fluids or excretions, mucous membranes, non-intact skin, or wound dressings
- After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient
- If hands will be moving from a contaminated-body site to a clean-body site during patient care
- After glove removal
- After using a restroom
When using alcohol-based hand sanitizer:
- Put product on hands and rub hands together
- Cover all surfaces until hands feel dry
- This should take around 20 seconds
Each EMS Provider Agency should alert their providers to the CDC recommendations on who should be vaccinated against Hepatitis A.
Currently the Hepatitis A Vaccine is recommended for the following persons aged 1 year and older:
- Persons who live/work in a community with a high rate of Hepatitis A (HAV)
- For men having sex with other men.
- For drug users.
- Travelers to countries with high rates of Hepatitis A.
- Persons with chronic liver disease.
- Persons who receive blood products to help your blood clot (e.g. Hemophilia).
- Persons working with HAV-infected animals or work with HAV in research setting.
The Hepatitis A vaccine is currently given to all children after 1 year of age – this occurred after 2000 – thus many of our EMS providers and law enforcement personnel may be unvaccinated. The Hepatitis A vaccine is given in two injections 6 months apart and confers 25 year immunity in most adults.
For the latest updates and recommendations please visit the EMS Agency website at:
Under Important Notice on the landing page is an area listed as Hepatitis A Update. You can click on this to be linked to the most current information from the Department of Public Health. If you have specific questions please send them to HepAinfo@dhs.lacounty.gov and EMS Agency staff will get back to you with a response.
* Message from the Medical Director — October 6, 2017