Reducing the number of HCV infections and HCV-related disease in the United States requires a number of different prevention measures. Primary measures that reduce risks for contracting HCV and secondary measures that reduce risks for liver and other chronic diseases are needed.

Health education programs
There is an ongoing need for comprehensive HCV health education that targets both health and allied workers and high risk groups. Any education program should include the following information:

• Routes of transmission
• Risk factors for infection
• Disease outcomes, the need for medical management and treatment options
• Methods to prevent infections and harm and risk reduction
• The importance of substance abuse treatment, when appropriate
• Sexual precautions including abstinence counseling and condom use
• Risk-reduction counseling, including not sharing drug paraphernalia
• Resources in the community available to support and sustain a reduction in risk behaviors.
  

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Any HCV health education program should be comprehensive and cover risks and precautions.

• Medications should be prepared in a centralized area separate from the treatment area.
• Multi-dose vials should be avoided, if possible, in favor of single dose vials.
• Supplies and equipment should be shared only if they are disinfected between patients, using proper procedures.
• Clean supplies should be stored in a room or separate area from the treatment area.
• If a supply cart is used in the patient treatment area, the cart should remain stationary in a designated area at a sufficient distance from patient stations to avoid contamination with blood.
• Any item taken to a patient's dialysis station should be disposed of, dedicated for use only on a single patient, or cleaned and disinfected before being returned to a common clean area or used for other patients.
• Containers into which priming solution from venous tubing is drained should be discarded or cleaned and disinfected between patients.
  

• HCV-infected people are excluded from donating blood, plasma, organ, tissue or semen.
• Clotting factor concentrates, and other products derived from human plasma, including immunoglobulin products, must have viral inactivation.
• All plasma-derived products that do not undergo viral inactivation should be HCV-RNA negative before release.
  

• Stop using and injecting drugs
• Enter and complete substance-abuse treatment, including relapse prevention programs
• If continuing to inject drugs
• Never share syringes, needles, water, or drug preparation equipment.
• Use only sterile syringes obtained from a reliable source, such as pharmacies.
• Use a new sterile syringe to prepare and inject drugs.
• If possible, use sterile water to prepare drugs; otherwise, use clean water from a reliable source, such as fresh tap water.
• Use a new or disinfected container (“cooker”) and a new filter (“cotton”) to prepare drugs.
• Clean the injection site before injection with a new alcohol swab.
• Safely dispose of syringes after one use.
• If using shared equipment, first clean the equipment with bleach and rinse thoroughly with water.
• Get vaccinated against hepatitis B and hepatitis A.

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Injection drug users should be advised to stop using drugs but also should receive information about using injection drugs safely.

• Have sex with only one uninfected partner or no sex at all.
• Use latex condoms correctly and every time.
• Get vaccinated against hepatitis B, and if appropriate, hepatitis A.

• Gloves
  • Should be used for any treatment or procedures that involve contact with mucous membranes, affected skin, or body fluids or items soiled with body fluids.
  • Should be used only once.
  • Should be discarded in a special container separate from other trash.
• Hand washing
  • Should be done immediately after removing gloves.
  • Should be done immediately if there is a potential or actual contaminiation by blood or body fluid on hands or other body surface.
  • Should be done immediately after each contact with ANY person.
• Protective clothing (masks, goggles, gowns)
  • Surgical mask and eyewear should be worn during any task that may result in exposure of mouth, nose, and eyes to blood or body fluids.
  • Disposable gowns or aprons should be used when blood or body fluids may contaminate clothes.
  • Cloth gowns or aprons should be washed according to instructions for washing linens soiled with blood.
• Safety precautions with needles
  • Should always use disposable needles.
  • Should not recap or purposely bend needles.
  • Should discard needles in the way recommended by health care provider.
  • Should be placed in puncture-proof container, specifically marked, and not overfilled.
  • Needlesticks should be immediately reported to health care providers.
• Disposal of waste products and washing of soiled linens
  • Waste products should be disposed of in red plastic bags, double-bagged.
  • Linens or clothing soiled with blood must be washed separately from other laundry, using detergent and germicide.
• Guidelines for sterilization or disinfection
  • Should use chemical germicides registered with the EPA for sterilization or disinfection.
  • Chemicals should be used only in recommended concentrations and only with proper ventilation.

Increased testing

Identifying people infected with Hepatitis C is one of the primary goals in prevention. Healthcare workers need to be aware of the need for testing and be familiar with factors that put people at risk. Patients and clients in all settings should be routinely assessed and advised to be tested if any risk factors exist. Outreach should be done to reach people who might not be seen in the primary care setting:

• Correctional facilities
• HIV counseling and testing sites
• Substance abuse programs
• Programs for people with sexually transmitted diseases

A coordinated program for testing needs to be established so that people who test positive can receive counseling and referral for medical management.

• Procedures should be established to notify people who might have become infected with HCV through transfusion of blood or blood components. There are targeted approaches that notify people who received a transfusion from recipients who tested positive after screening tests were implemented. A general approach is to notify all people that they should be tested, if they received transfusions before July 1991. There are advantages to a general education program because it does not depend on donor testing status and availability of records. It potentially reaches people who received infected blood from donors who tested falsely negative on the less sensitive early tests, as well as from donors before testing was available. The same approaches can be used for those who received organ or tissue transplants.
  
• Children born of HCV positive mothers should be routinely tested. Testing of infants for antigens should be done no earlier than 12 months of age, when the passively received antigens from the mother declines below detectable levels. HCV RNA tests can be done between 1 to 2 months, if earlier diagnosis is desired. Umbilical cord blood should not be used for testing because it can be contaminated by the mother's blood. If positive, children should be evaluated for the presence or development of liver disease and those with a persistently elevated liver enzyme test (ALT) should be referred to a specialist for medical management.
  
• Post exposure follow-up for healthcare workers, emergency medical, and public safety works for HCV should include the following:
• Source: baseline testing for HCV antigen (anti-HCV)
• Person exposed: baseline and follow-up testing:
  
  • Baseline testing for anti-HCV and ALT
  • Follow-up testing for anti-HCV at 4-6 months and ALT activity
  • HCV RNA may be performed at 4-6 weeks if early diagnosis desired
    
• Confirmation of positive results with supplemental testing.
  
• Some people do not need to be referred for routine testing unless there are risk factors involved:
  • Health care, emergency medical, and public safety workers.
  • Pregnant women
  • Household (non-sexual) contacts of HCV-positive persons
  • General population.
    
• There are other persons for whom HCV testing is of uncertain need and should be individually evaluated:
  • Recipients of transplanted tissue
  • Intranasal cocaine or other non-injecting illegal drug users
  • Persons with a history of tattooing or body piercing.
  • Persons with a history of multiple sex partners or sexually transmitted diseases.
  • Long-term steady sex partners of HCV-positive persons.
    
• While there has been HCV infection from tissue transplants, the risks are quite low. Some have suggested an association of HCV with intranasal cocaine from the sharing of nasal straws, but this is inconclusive. In the United States, there is no documentation of people being infected from tattooing or piercing. However, if it is done in an unregulated manner, (e.g. sharing needles in correctional institutions), there may be a risk.

Testing for HCV
Consent should be obtained, as for all procedures, and should include measures to ensure confidentiality. Persons should be provided with the following information:

• Exposures associated with the transmission of HCV, including behaviors or exposures that might have occurred infrequently or many years ago.
• The test procedures and the meaning of the test results.
• The nature of hepatitis C and chronic liver disease.
• The benefits of detecting infection early.
• Available medical treatment.
• Potential adverse consequences of testing positive, including disrupted personal relationships and possible discriminatory action (loss of employment, insurance, educational opportunities).

Ideally, comprehensive information about hepatitis C should be provided before testing, but if that is not practical or possible, the person should be informed of 3 things:

• Testing for HCV will be done
• Individual results will be kept confidential
• Appropriate counseling and referral will be offered if results are positive.