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

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

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

Management

HIV

• Consider HIV post-exposure prophylaxis

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 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

Authors:

Amr Badawy, Jonathan Fletcher, Tom Heston, Jonathan Osgood, Kevin Lu, Michael Holtz, Daniel Ostermayer, robot, Ross Donaldson, Yos Yachivev