Guidelines for the care of patients hospitalized with viral hepatitis

For years patients hospitalized with viral hepatitis have been placed in two categories of isolation--enteric precautions and blood precautions. This strategy was based on the inability to differentiate between hepatitis A and B and on the assumption that feces and blood from patients with either type might be infective. It is now known that patients with hepatitis A do not pose a problem of disease transmission through direct contact with blood, and although blood of patients with hepatitis B may be infective, the virus is not transmitted via feces. The enteric route is the principal mode of transmission for hepatitis A, but maximal levels of hepatitis A virus excretion occur before the onset of jaundice. Non-A, non-B hepatitis is similar epidemiologically to hepatitis B. Thus, the major thrust for caring for patients hospitalized with viral hepatitis is toward blood precautions; the same precautions used when handling feces, urine, and excretions from all other hospitalized patients are appropriate for patients admitted with a diagnosis of hepatitis A.