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

(Differential Diagnosis)
(Evaluation)
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*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===
+
===Source-patient labs===
 
*Rapid HIV, hepatitis panel, RPR?
 
*Rapid HIV, hepatitis panel, RPR?
 
*Hepatitis B and C infectivity of source patient
 
*Hepatitis B and C infectivity of source patient
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**HepC-Ab, plus or minus viral load
 
**HepC-Ab, plus or minus viral load
  
===Exposed labs===
+
===Exposed-patient labs===
*Rapid [[HIV]] (if considering [[PEP]] only), hepatitis panel, RPR?
+
*Most require NO laboratory testing
*If considering [[PEP]]
+
*If giving HIV [[PEP]]:
 +
**Rapid [[HIV]]
 
**CBC, C7, LFTs, pregnancy test
 
**CBC, C7, LFTs, pregnancy test
  

Revision as of 17:05, 19 November 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-patient 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-patient labs

  • Most require NO laboratory testing
  • If giving HIV PEP:
    • Rapid HIV
    • CBC, C7, LFTs, pregnancy test

Management

HIV

Hepatitis B Post-Exposure Prophylaxis

Treatment is generally initiated after coordination with occupational health and infectious disease service and based the the exposed patient's vaccination history[2]

Unvaccinated

  • If the source is HBsAg(+) then give HBIG x1 and initiate HBV vaccine in two separate sites
  • If source is HGsAG(-) then start the HBV vaccine series
  • If source blood is unavailable and high risk then give HBIG x1 initiate the HBV series
    • If source blood is low risk and unavailable then begin HBV series

Previously vaccinated non responder (one series)

Non responder status is defined as anti-has <10mIU/mL

  • If the source is HBsAg(+) then give HBIG x 1 and begin revaccination series
    • Can also opt to perform second HBIG administration in one month
  • If source is HBsAg(-) then no treatment is needed
  • If source blood is unavailable and high risk then treat as if HBsAg(+)

Previously vaccinated non responder (two series)

Non responder status is defined as anti-has <10mIU/mL

  • If the source is HBsAg(+) then give HBIG x2 and no HBV series
  • If source is HGsAG(-) then no treatment is needed
  • If source blood is unavailable then initiate the HBV series

Treatment Dosing

No contraindications for pregnancy or breast feeding

  • HBIG 0.06 mL/kg IM
  • Vaccination series: HBV vaccine options:
    • Engerix-B 20mcg IM
    • Recombivax HB 10mcg IM

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.

Disposition

  • Outpatient management with employee health follow-up

See Also

References