View source for Healthcare occupational exposure to blood or other body fluids

==Background==
*The majority of persons (e.g. source patients) chronically infected with hepatitis B and C (65% to 75%) are not aware of their infection <ref>[https://www.ncbi.nlm.nih.gov/pubmed/23740193 Fretz R, Negro F, Bruggmann P et al. Hepatitis B and C in Switzerland - healthcare provider initiated testing for chronic hepatitis B and C infection. Swiss Med Wkly. 2013 May 17;143:w13793.]</ref>
*The CDC has a [https://www.cdc.gov/hiv/library/hotlines.html post exposure prophylaxis hotline] at 1-888-448-4911

==Clinical Features==
*Frequently from needlestick injuries or other occupational exposures to bodily fluids

==Differential Diagnosis==
*[[Laceration]]
*Retained [[foreign body]]

==Evaluation==
''Most commonly, the only actionable lab on the day of exposure is a rapid [[HIV]] test from the source-patient (for consideration of [[PEP]])''
*Less severe percutaneous exposures are associated with solid and blunt tip needles
*More severe percutaneous exposures are associated with deep punctures, large bore hollow needles, visible blood on the device, and needles used in patients arteries and veins.
*Smaller volume (few drops) exposures are considered to be lower risk than higher volume (major blood splash) for mucous membranes and non-intact skin exposures. 
*Most occupational exposures to HIV are not associated with transmission. 
===Source-patient labs===
*Rapid HIV
*Consider [[hepatitis]] panel and possibly RPR
**Hepatitis B and C infectivity of source patient:
***HBs-Ag (active infection)
***HBc-Ab IgM (window period)
***HepC-Ab, plus or minus viral load

===Exposed-patient labs===
*In some systems, NO immediate laboratory testing is performed
*In many systems, a standardized baseline lab panel is sent in the ED and then followed up at employee health the next day
*If giving HIV [[PEP]]:
**Rapid [[HIV]] (to confirm they do not ''already'' have HIV)
**CBC, C7, LFTs, pregnancy test

==Management==
===[[HIV]]===
*Consider [[HIV post-exposure prophylaxis]]

{{HIV post-exposure prophylaxis regimens}}

===[[Hepatitis B]]===
*Not normally indicated, assuming patient has had full course of Hepatitis B vaccination (as all healthcare workers should have)
**If exposed-patient NOT already vaccinated, see [[Hepatitis_B#Hepatitis_B_Post-Exposure_Prophylaxis|Hepatitis B Post-Exposure Prophylaxis]]

===[[Hepatitis C]]===
*No prophylaxis regimen has any benefit

==Disposition==
*Outpatient management with employee health follow-up

==See Also==
*[[HIV post-exposure prophylaxis]]

==References==
<references/>

[[Category:ID]]