Difference between revisions of "Healthcare occupational exposure to blood or other body fluids"
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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=== |
− | * | + | *Most require NO laboratory testing |
− | * | + | *If giving HIV [[PEP]]: |
+ | **Rapid [[HIV]] | ||
**CBC, C7, LFTs, pregnancy test | **CBC, C7, LFTs, pregnancy test | ||
Revision as of 17:05, 19 November 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
- Laceration
- Retained foreign body
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
Management
HIV
- Consider HIV post-exposure prophylaxis
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
- Give in opposite arm from hepatitis B vaccine if patient also receiving vaccine
- 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
- ↑ 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.
- ↑ Postexposure prophylaxis to prevent hepatitis b virus infection. CDC MMWR http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a3.htm?s_cid=rr5516a3_e