What protocols should a patient with hepatitis B (HBV) infection follow after discharge to prevent virus spread and manage their condition?

Home Management Protocols for Patients with Hepatitis B Infection

Patients with hepatitis B infection should follow specific protocols at home to prevent transmission to others, including notifying close contacts for testing and vaccination, avoiding sharing personal items that may be contaminated with blood, and practicing proper hygiene and wound care. 1

Prevention of Transmission to Others

Contact Notification and Testing

• Notify household members, sexual partners, and needle-sharing contacts that they should be:
  • Tested for markers of HBV infection
  • Vaccinated against hepatitis B if susceptible
  • Complete the full hepatitis B vaccine series 1

Blood and Body Fluid Precautions

• Cover all cuts and skin lesions to prevent spread of infectious secretions or blood
• Clean blood spills with bleach solution (1:10 dilution)
• Dispose of blood, body fluids, and medical waste properly 1, 2
• Refrain from donating blood, plasma, tissue, or semen 1

Personal Items

• Do not share household articles that could become contaminated with blood, such as:
  • Toothbrushes
  • Razors
  • Personal injection equipment 1

Sexual Precautions

• Use barrier methods (e.g., condoms) to protect non-immune sexual partners until they can be vaccinated and their immunity documented
• Be aware that condoms also reduce risk of HIV and other STDs 1

Liver Protection Measures

Medical Care

• Seek healthcare services from a provider experienced in hepatitis B management 1, 3
• Inform healthcare providers of HBsAg-positive status when seeking medical or dental care 1
• Follow recommended monitoring schedule:
  • Laboratory tests (ALT and HBV DNA) every 3-6 months
  • HBeAg/anti-HBe status every 6-12 months
  • Renal function monitoring every 6 months (especially if on tenofovir) 3

Lifestyle Modifications

• Avoid or limit alcohol consumption due to effects on the liver
• Seek evaluation or treatment for alcohol abuse if needed 1, 3
• Obtain vaccination against hepatitis A (2 doses, 6-18 months apart) if chronic liver disease is present 1

Special Considerations

For Pregnant Women

• Ensure newborns receive:
  • Hepatitis B vaccine at birth
  • Hepatitis B immune globulin at birth
  • Complete the hepatitis B vaccine series according to the recommended schedule 1

For Immunocompromised Patients

• If receiving immunosuppressive therapy or chemotherapy:
  • Antiviral prophylaxis with entecavir, tenofovir, or TAF should be administered
  • Continue prophylaxis for at least 12 months after completion of immunosuppressive treatment 1, 3
  • Monitor HBV DNA levels closely during and after treatment 1

Common Misconceptions to Address

HBV is not spread by:

• Breastfeeding
• Kissing, hugging, or coughing
• Ingesting food or water
• Sharing eating utensils or drinking glasses
• Casual touching 1

Monitoring for Disease Progression

• Be aware of symptoms that require medical attention:

  • Jaundice (yellowing of skin or eyes)
  • Persistent fatigue
  • Abdominal pain
  • Dark urine
  • Clay-colored stools 4

• Adhere to surveillance for hepatocellular carcinoma with ultrasound every 6 months if you are:

  • Asian male >40 years
  • Asian female >50 years
  • A patient with cirrhosis
  • Have a family history of HCC
  • African American >20 years
  • A carrier >40 years with elevated ALT or high HBV DNA 3

Medication Adherence

• Take antiviral medications exactly as prescribed
• Never stop antiviral medications abruptly due to risk of severe hepatitis flares 3
• Report any side effects to healthcare provider promptly

By following these protocols, patients with hepatitis B can significantly reduce the risk of transmission to others and protect their own health by preventing complications of chronic infection.