Difference between revisions of "Healthcare occupational exposure to blood or other body fluids"
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==Background== | ==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> | ||
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| + | ==Clinical Features== | ||
*Frequently from needlestick injuries or other occupational exposures to bodily fluids | *Frequently from needlestick injuries or other occupational exposures to bodily fluids | ||
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| − | == | + | ==Differential Diagnosis== |
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| + | ==Evaluation== | ||
*In many systems, a standardized baseline lab panel is sent in the ED and then followed up at employee health the next day | *In many systems, a standardized baseline lab panel is sent in the ED and then followed up at employee health the next day | ||
*Frequently, the only actionable lab on the day of exposure is a rapid [[HIV]] test from the source patient (for consideration of [[PEP]]) | *Frequently, the only actionable lab on the day of exposure is a rapid [[HIV]] test from the source patient (for consideration of [[PEP]]) | ||
| + | |||
| + | ===Source labs=== | ||
| + | *Rapid HIV, hepatitis panel, RPR? | ||
*Hepatitis B and C infectivity of source patient | *Hepatitis B and C infectivity of source patient | ||
**HBs-Ag (active infection) | **HBs-Ag (active infection) | ||
**HBc-Ab IgM (window period) | **HBc-Ab IgM (window period) | ||
**HepC-Ab, plus or minus viral load | **HepC-Ab, plus or minus viral load | ||
| − | + | ||
| − | + | ===Exposed labs=== | |
| − | + | *Rapid [[HIV]] (if considering [[PEP]] only), hepatitis panel, RPR? | |
| − | + | *If considering [[PEP]] | |
| − | + | **CBC, C7, LFTs, pregnancy test | |
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==Management== | ==Management== | ||
Revision as of 22:25, 21 January 2017
Contents
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 [1]
Clinical Features
- Frequently from needlestick injuries or other occupational exposures to bodily fluids
Differential Diagnosis
Evaluation
- In many systems, a standardized baseline lab panel is sent in the ED and then followed up at employee health the next day
- Frequently, the only actionable lab on the day of exposure is a rapid HIV test from the source patient (for consideration of PEP)
Source labs
- Rapid HIV, hepatitis panel, 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 labs
- Rapid HIV (if considering PEP only), hepatitis panel, RPR?
- If considering PEP
- CBC, C7, LFTs, pregnancy test
Management
HIV
- Consider HIV post-exposure prophylaxis
Hep B
Dosing if indicated
- HBIG dose: 0.06mL/kg IM
- Vaccination serires: Recombivax HB 10mcg IM or Engerix-B 20mcg IM at month 0,1, and 6
Unvaccinated Patient
- If source is HBsAg+ then give HBIG x 1 and start HBV vaccine series
- If source is HBsAG- then initiate HBV vaccine series
- If source of unknown status then start HBV vaccine series
Previously Vaccinated Patient
- No treatment if source is HBsAG+/- or if source is unknown
Partially Vaccinated (one series) or Non-Responder
Non responder defined as anti-HBs<10IU/ml
- If source HBsAg+ then give HBIG and start HBV vaccine series
- Alternatively patients can have a HBIG vaccine with another dose in one month
- If source is HBsAg- then no treatment is needed
- If source is high risk then give HBIG and start HBV vaccine series
Partially Vaccinated (two series) or Non Responder
Non responder defined as anti-HBs<10IU/ml
- If source HBsAg+ then give two doses of HBIG (now and in 1 month)
- If source is HBsAg- then no treatment needed
- if source is high risk then treat if HBsAg+
Hep C
- No prophylaxis regimen has any benefit
- Draw anti-HCV on the source and the exposed patient
- Draw ALT level on exposed patient and repeat in 6 months or perform HCV RNA PCR in 4 weeks
- If the patient is anti-HCV positive then confirm the diagnosis with HCV RNA PCR.