Healthcare occupational exposure to blood or other body fluids

Background

• Frequently from needlestick injuries or other occupational exposures to bodily fluids

Workup

• 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, hep pannel, RPR?
• Exposed labs
  • Rapid HIV (if considering PEP only), hep pannel, RPR?
  • If considering PEP
    • CBC, C7, LFTs, pregnancy test

Management

• Consider HIV post-exposure prophylaxis

Hep B

1. risk of infc 2- 30% after needle stick
2. can survive on dried blood for 1 wk
3. found in all fluids but highest conc in blood and therefore highest risk with blood
4. hep b surface antibodies confers life long immunity
5. don't need to test pt or source if pt certain fully/ successfully immunized- antibodies > 10 IU at some time
6. if pt not successfully immunized, give hep b immune globulin
7. failed 3 shots/ 1 series- give hep booster and immune globulin x 2 doses over 1 mo
8. failed 6 shots/ 2 series- give sequential immune globulin

Patient Unvaccinated, Source Pos --> HBIG + vaccine

Hep C

1. no prophylaxsis
2. no interferon, no antivirals, no globulin
3. not xmitted efficiently through needle stick- 2% rate
4. get basline hcv test and ALT

Post Exp Viral Hep Counseling

1. can still breast feed
2. no organ/ blood donation
3. no worry about modifiying sex pattern or becoming preg

See Also

• HIV post-exposure prophylaxis
• Harbor: Occupational Exposure
• www.needlestick.mednet.ucla.edu