Difference between revisions of "Healthcare occupational exposure to blood or other body fluids"

(Background)
Line 1: Line 1:
 
==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>
 +
 +
==Clinical Features==
 
*Frequently from needlestick injuries or other occupational exposures to bodily fluids
 
*Frequently from needlestick injuries or other occupational exposures to bodily fluids
*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>
 
  
==Workup==
+
==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
 
*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
*Source labs
+
 
**Rapid HIV, hepatitis panel, RPR?
+
===Exposed labs===
*Exposed labs
+
*Rapid [[HIV]] (if considering [[PEP]] only), hepatitis panel, RPR?
**Rapid [[HIV]] (if considering [[PEP]] only), hepatitis panel, RPR?
+
*If considering [[PEP]]
**If considering [[PEP]]
+
**CBC, C7, LFTs, pregnancy test
***CBC, C7, LFTs, pregnancy test
 
  
 
==Management==
 
==Management==

Revision as of 22:25, 21 January 2017

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

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.

See Also

References