Reducing HCV Transmission by Reducing Exposure

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Our vision is the prevention of HCV infection and transmission in Egypt.

Changing prevention from people to providers

The following is a vision of how in public health terms to help Egypt prevent HCV and reduce transmission. 

This would be an action intervention project in Egypt to reduce and prevent Egyptians from becoming infected with HCV. The most significant HCV transmission in Egypt is through exposure to blood in the health and dental care system. Reducing this exposure will prevent the transmission of HCV. In epidemiologic terms, reducing  the on going transmission of HCV in Egypt is the goal. 

Core Project Objectives and Strategy  

1. Action Intervention project at the health care worker (HCW) - patient level where HCV exposure is occurring and reduce exposure. (see field team approach below)
2. Redirect public awareness to where HCV exposure is occurring, that is at the HCW - patient level.
3. Empower people with knowledge on how to avoid HCV exposure in the health care setting.
4. Develop an Egyptian HCV catalog of blood borne pathogen exposures in health care settings and self implementing prevention program for health care providers.
5. National Curriculum component: Retrain and update curriculum to empowerment by knowledge

• General Curriculum - teach how to avoid exposure in the health and dental care setting
• Profession Curriculum - upgrade infection control for prevention of HCV transmission for medical, dental, nursing, medical and dental assistant, and pharmacy student programs

6. Strengthening evaluation methodology and application for HCV prevention
7. The project will identify practical and sustainable interventions which will be adapted to various health care settings across Egypt.
8. Training: offer free rapid training courses for all levels of health care personal to show how to reduce and prevent exposure.
9. Develop check list handouts for health care setting to reduce exposure to HCV infection.
10. Develop handouts for people to so they will know how to avoid HCV infection when seeking health care.

• Multiple field team approach is a good approach because it is action oriented. 
• Select health care facilities to test sustainable interventions.
• Practical and sustainable interventions will be identified collectively by the project team working with the facility personnel.
• Identify the range of both unique and typical exposures occurring in medical, dental, pharmaceutical and nursing settings.
• Collective implementation will be made by facility and team personnel. 
• Sustainable and easy to use evaluation methods for exposure reduction will be developed.
• Certification: The health care facility and its employees can post that it has identified and taken measures to reduce HCV transmission at their facility.
• Replication: Successful facilities will be used as a demonstration and will provide additional support as a training site. Successful experiences will be applied to larger and more complex facilities.  

• Understanding HCV blood borne exposures is simple but not recognized at the HCW – patient level.
• Development of an Egyptian HCV catalog of blood borne pathogen exposures in health care settings is needed.
• This will be a self implementing prevention program for health care providers.
• develop a working definition of HCV exposure for the catalog
• compile, review, pilot and publish catalog
• The completed catalog will be a document available for other prevention efforts (this will facilitate initiative by others to develop prevention projects in their facilities)
• details for compiling this catalog and its applications for control have been prepared in a larger comprehensive project document by F. DeWolfe Miller and is an ongoing work in progress (Reducing HCV Transmission by Reducing Exposure: a Comprehensive Manual.doc)

• National Curriculum component:  empowerment by knowledge

• Curriculums at all educational levels need to modified to include prevention of HCV.
• This should be on the national level and include the public education system.
• This objective has a secondary implementation priority.  

• Evaluation of HCV prevention measures is essentially non existent. Develop and strengthening evaluation methodology and application for different health care settings and health care workers.
• The Project has many Opportunities for Prevention

Technical References 

The project will use methods that have already been published by Egyptian investigators to identify HCV exposures in health and dental care facilities [1-6].

1.         Ismail, N.A., A.M. Aboul Ftouh, and W.H. El Shoubary, Safe injection practice among health care workers, Gharbiya, Egypt. J Egypt Public Health  Assoc, 2005. 80(5-6): p. 563-83.

2.         Ismail, N.A., et al., Safe injection practice among health-care workers in Gharbiya Governorate, Egypt. East Mediterr Health J, 2007. 13(4): p. 893-906.

3.         Talaat, M., et al., Overview of injection practices in two governorates in Egypt. Trop Med Int Health, 2003. 8(3): p. 234-41.

4.         Talaat, M., et al., Surveillance of catheter-associated urinary tract infection in 4 intensive care units at Alexandria university hospitals in Egypt. Am J Infect Control, 2009.

5.         Talaat, M., et al., Occupational exposure to needlestick injuries and hepatitis B vaccination coverage among health care workers in Egypt. Am J Infect                     Control, 2003. 31(8): p. 469-74.

6.         Talaat, M., et al., Evolution of infection control in Egypt: achievements and challenges. Am J Infect Control, 2006. 34(4): p. 193-200.