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

(Management)
(Management)
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===Hep B===
 
===Hep B===
 +
====Dosing if indicated====
 
*HBIG dose: 0.06mL/kg IM
 
*HBIG dose: 0.06mL/kg IM
 
*Vaccination serires: Recombivax HB 10mcg IM or Engerix-B 20mcg IM at month 0,1, and 6
 
*Vaccination serires: Recombivax HB 10mcg IM or Engerix-B 20mcg IM at month 0,1, and 6

Revision as of 22:28, 19 May 2015

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

Hep B

Dosing if indicated

  • HBIG dose: 0.06mL/kg IM
  • Vaccination serires: Recombivax HB 10mcg IM or Engerix-B 20mcg IM at month 0,1, and 6

Unvaccinated Patient

  • If source is HBsAg+ then give HBIG x 1 and start HBV vaccine series
  • If source is HBsAG- then initiate HBV vaccine series
  • If source of unknown status then start HBV vaccine series

Previously Vaccinated Patient

  • No treatment if source is HBsAG+/- or if source is unknown

Partially Vaccinated (one series) or Non-Responder

Non responder defined as anti-HBs<10IU/ml

  • If source HBsAg+ then give HGIG and start HBV vaccine series
    • Alternatively patients can have a HBIG vaccine with another dose in one month
  • If source is HBsAg- then no treatment is needed
  • If source is high risk then give HGIV and start HBV vaccine series

Partially Vaccinated (two series) or Non Responder

Non responder defined as anti-HBs<10IU/ml

  • If source HBsAg+ then give two doses of HGIB (now and in 1 month)
  • If source is HBsAg- then no treatment needed
  • if source is high risk then treat if HBsAg+


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

Source