Transmission Prevention

Preventing the transmission of hepatitis C is largely common sense. It basically involves being aware of anything that has come into contact with your blood:

• Anything that has cut you
• Anything that you drip blood on or has soaked up your blood
• Anything that you have inserted through your skin into your body

and making sure that it is properly cleaned or properly disposed of before it comes into contact with anyone else.

In general you need to be aware that if you are infected with hepatitis C a tiny drop of your blood could infect someone else if it gets into their body. So it's obviously better to take precautions and this section examines ways to be really safe. However, it is far from clear that all these precautions are strictly necessary but it's important to be careful rather than paranoid about the risk of infecting others.

You may also feel you would like to warn people so that they can take extra precautions. This would include:

• Phlebotomists (nurses who take your blood), who would be at risk if they accidentally prick themselves
• Tattooists
• Body/ear piercers
• Acupuncturists, who might transfer the virus to someone else if they have not taken adequate sterilisation precautions
• Dentists

The risk of sexual transmission is very low in the absence of any other complicating factors - see research paper below. Even so the best way to be absolutely certain that you do not transmit hepatitis C is to use barrier contraception such as a condom or femidom (female condom).

The complicating factors that may increase the risk of transmission are:

1. The presence of blood from menstruation or anal sex, particularly fisting (the lining of the anus is thin and prone to tears).
2. The presence of ulcers or sores on your genitalia i.e. from a sexually transmitted infection such as gonorrhoea, herpes, genital warts.
3. If either partner is co-infected with HIV the risk of sexual transmission of both viruses appears to increase.

It is important to bear in mind that condoms can break and you may want to consider using a heavy duty variety, particularly if there is a higher risk of transmission. A heavy duty condom is a much safer alternative than using two condoms, one inside the other, as the friction between them can in fact cause them to tear.
To read the results of a trial on sexual transmission of hepatitis C click here

The risk of transmission from mother to child is thought to be approximately 5%. The risk is higher in women who are co-infected with HIV. If you are pregnant or planning to have a child and are hepatitis C positive, it is important to discuss this with your consultant. Whether there is anything you can do to lessen the transmission risk is uncertain. There is some evidence that mothers with lower viral loads are less likely to transmit infection. It is not believed that caesarean delivery makes any difference. On the other hand breastfeeding if your nipples are bleeding is also believed to pose a risk.

If you are intravenously injecting drugs and share any equipment that could come into contact with your blood, you can expose others to infection with hepatitis C. This obviously applies to the needle and syringe you use but also applies to both water, filters and spoons even if you are using a new needle. Any needle that has been used before could still have invisible drops of blood attached to it. When this is placed in a spoon the blood can dissolve again into the water and be deposited on the spoon or the filter ready for someone else to draw it up.

The best way to avoid transmitting the disease is to use new syringes, new needles, a clean spoon, sterile water and a new filter. If for some reason you are sharing spoon, water or filter and do not have access to a new syringe and needle the next best thing is to thoroughly clean the ones you have. Unfortunately hot water by itself will not kill hepatitis C and is not an efficient way of sterilising. Try as a minimum to use bleach, drawing it in and flushing it out several times but remember then to do the same thing with hot water to flush out the bleach.

Because anyone who gets pricked by one of your discarded needles could become infected it is important to dispose of used needles carefully and safely. The best place is a proper sharps bin, which you can get from your local needle exchange and some chemists. The next best thing is to recap the needle and put it in a sealed hard plastic container.

If you share a rolled up note or straw for snorting drugs you risk exposing yourself and others to hepatitis C. This is especially true if your nose is bleeding. Cocaine in particular is very alkaline and corrosive to the thin membranes in the nose. If even tiny drops of your blood, too small to see, get onto the straw or note and someone else then uses it, it is quite possible for them to make blood to blood contact through their own nasal membranes.

Accidents happen at home. People cut themselves, get nose bleeds and so on. If you have hepatitis C and you have an accident that causes bleeding it is important to be aware of what your blood has come into contact with. If it is an implement that has cut you, clean it thoroughly with bleach and rinse off the bleach with equal thoroughness. Then clean any surface that your blood may have dripped onto again with bleach. If you have used anything to staunch the flow such as tissues or sticking plasters ideally dispose of them in a sealed plastic bag. This applies to used sanitary towels and tampons also. If it is not disposable then wash it at the highest possible temperature and if possible add bleach.

Hospitals and dental practices are strictly regulated to prevent blood borne virus transmission and in theory it should not be necessary to inform them that you have hepatitis . In practice however, this may not always be the case so it is responsible to tell them though they are likely to ask you anyway. However, they should not treat you any differently once they know because this suggests that their normal practice is inadequate.

It is responsible to tell your acupuncturist if you have hepatitis C because awareness of infection control varies widely from one practitioner to another.

Razors, hair and nail clippers, scissors and toothbrushes will, at times, come into contact with blood. Even tiny traces of dried blood may be sufficient to cause infection so it's best if you have hepatitis C not to share any of these articles, and ideally to keep them separately so that no one will borrow them by mistake, especially children.

For example, toothbrushes can easily carry droplets of dried blood if your gums bleed during brushing and so are best not put in a shared mug where they can easily come into contact with other people's brushes. Razor blades are particularly vulnerable to accumulating specks of dried blood so it's important at least to make sure if someone borrows your razor to use a new blade.

If you have hepatitis C and want to get a tattoo, piercing or have electrolysis, then the responsible thing to do is to inform the person carrying out the procedure. They should be taking adequate precautions anyway to prevent the spread of blood borne diseases (if not, then you are also at risk of catching something else).

The precautions they should be taking are:

1. Using new sterile needles each time
2. Properly sterilising re-usable equipment
3. Using new jewellery
4. Using new ink for each person and cleaning the containers between customers.

If you are going to pierce or tattoo at home, it is best to use new equipment for each person and dispose of everything with care. For example to dispose of a piercing needle safely, put a cork over the point and place it ideally in a sharps bin or otherwise in a thick plastic container with a top or lid and put in the rubbish.