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

(Exposed-patient labs)
(Management)
Line 27: Line 27:
  
 
==Management==
 
==Management==
===HIV===
+
===[[HIV]]===
 
*Consider [[HIV post-exposure prophylaxis]]
 
*Consider [[HIV post-exposure prophylaxis]]
  
===Hepatitis B===
+
===[[Hepatitis B]]===
 
*Not normally indicated, assuming patient has had full course of Hepatitis B vaccination (as all healthcare workers should have)
 
*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#Hepatitis_B_Post-Exposure_Prophylaxis|Hepatitis B Post-Exposure Prophylaxis]]
 
**If exposed-patient NOT already vaccinated, see [[Hepatitis_B#Hepatitis_B_Post-Exposure_Prophylaxis|Hepatitis B Post-Exposure Prophylaxis]]
  
===Hepatitis C===
+
===[[Hepatitis C]]===
 
*No prophylaxis regimen has any benefit
 
*No prophylaxis regimen has any benefit
  

Revision as of 22:26, 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

Most commonly, 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
  • Consider hepatitis panel and possibly 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

  • In some systems, NO immediate laboratory testing is performed
  • In many systems, a standardized baseline lab panel is sent in the ED and then followed up at employee health the next day
  • If giving HIV PEP:
    • Rapid HIV (to confirm they do not already have HIV)
    • CBC, C7, LFTs, pregnancy test

Management

HIV

Hepatitis B

  • Not normally indicated, assuming patient has had full course of Hepatitis B vaccination (as all healthcare workers should have)

Hepatitis C

  • No prophylaxis regimen has any benefit

Disposition

  • Outpatient management with employee health follow-up

See Also

References