# Situation: A 29-year-old woman has a pre-employment medical examination at a private manufacturing company. Her hepatitis B surface antigen (HBsAg) test is positive. Her alanine aminotransferase (ALT) level is normal, she has no symptoms, and she recalls no past illness with jaundice. The occupational health nurse counsels her. The company manager asks the nurse for her test result and whether the company should accept her for a job on the packing line. Which response by the nurse is consistent with the Department of Labor and Employment (DOLE) workplace policy on hepatitis B?

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> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 29-year-old woman has a pre-employment medical examination at a private manufacturing company. Her hepatitis B surface antigen (HBsAg) test is positive. Her alanine aminotransferase (ALT) level is normal, she has no symptoms, and she recalls no past illness with jaundice. The occupational health nurse counsels her.

The company manager asks the nurse for her test result and whether the company should accept her for a job on the packing line. Which response by the nurse is consistent with the Department of Labor and Employment (DOLE) workplace policy on hepatitis B?

## 보기

1. Recommend assigning her to work alone, away from co-workers
2. Keep her result private; it is no basis for rejecting her **✔ 정답**
3. Share the result so the company can arrange her follow-up
4. Advise waiting until a repeat HBsAg test becomes negative

**정답: 2**

## 해설

Under DOLE Department Advisory No. 05, series of 2010, workers may not be discriminated against in hiring, promotion, or assignment because of hepatitis B status, cannot be compelled to disclose their status, and their results are confidential. An HBsAg-positive worker may not be declared unfit without proper medical evaluation and counseling. Hepatitis B spreads through blood and sexual contact, not through ordinary work on a packing line.

## 심화 해설

The response consistent with DOLE policy
The Department of Labor and Employment (DOLE) Department Advisory No. 05, series of 2010, sets the workplace policy on hepatitis B. Under it, workers may not be discriminated against in hiring, promotion, or assignment because of their hepatitis B status, they cannot be compelled to disclose their status, and their results are confidential. An HBsAg-positive worker may not be declared unfit without proper medical evaluation and counseling. The nurse keeps her result private and explains that it is no basis for rejecting her.

Why hepatitis B status alone does not affect fitness for this job
Hepatitis B spreads through blood and sexual contact, and from mother to child at birth. It is not spread through ordinary work contact, sharing a workspace, or handling products on a packing line. This woman has a positive HBsAg with a normal ALT and no symptoms, which suggests chronic infection without active liver inflammation at this time. She needs medical follow-up for her own health, but her infection poses no risk to co-workers in ordinary work.

Why the other responses are wrong

| Response | Problem |
| --- | --- |
| Assign her to work alone, away from co-workers | Discrimination in assignment; casual contact does not spread hepatitis B |
| Share the result so the company can arrange follow-up | Breaches confidentiality; workers cannot be compelled to disclose status |
| Wait until a repeat HBsAg test is negative | Chronic infection may never clear; this is discrimination based on status |
| Keep the result private; it is no basis for rejection | Consistent with DOLE policy |

Watch out! Sharing the result so that the company can arrange follow-up sounds helpful, which makes it an attractive distractor. Good intentions do not override confidentiality. The occupational health nurse can report to the manager only whether the applicant is fit to work, without giving the diagnosis.

Counseling the worker
The nurse explains what a positive HBsAg means, refers her for medical evaluation including liver tests and hepatitis B markers, and teaches how to prevent transmission: not sharing razors or toothbrushes, covering cuts, practicing safer sex, and advising vaccination of household and sexual contacts. If she becomes pregnant, her baby will need the hepatitis B birth dose and hepatitis B immune globulin promptly after birth. She is reassured that she can work normally.

Exam takeaway
Under DOLE policy, hepatitis B status is confidential and cannot be used to refuse hiring, deny promotion, or change assignments. Key point! The occupational health nurse reports fitness for work, not the diagnosis.

## 임상 시나리오

Hepatitis B in Pre-Employment ScreeningDOLE workplace policy on hepatitis B
Under DOLE Department Advisory No. 05, s. 2010, workers may not be discriminated against in hiring, promotion, or assignment because of hepatitis B status.

Results are confidential, and workers cannot be compelled to disclose them. Report only fitness for work to the employer.

Refer her for medical evaluation and teach prevention: no sharing of razors or toothbrushes, safer sex, and vaccination of contacts.

CautionHepatitis B is not spread through ordinary work contact. Do not isolate her or delay hiring until the test turns negative.

## 핵심 개념

- **HBsAg** — Hepatitis B surface antigen, a marker of current hepatitis B infection.
- **ALT** — Alanine aminotransferase, a liver enzyme that rises with liver inflammation.
- **Chronic hepatitis B** — Hepatitis B infection lasting more than 6 months, which may persist for life.
- **Occupational health nurse** — A nurse who protects and promotes the health and safety of workers in the workplace.

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