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

(Hep C)
Line 13: Line 13:
  
 
==Management==
 
==Management==
 +
===HIV===
 
*Consider [[HIV post-exposure prophylaxis]]
 
*Consider [[HIV post-exposure prophylaxis]]
  
Line 24: Line 25:
 
*If source is HBsAG- then initiate HBV vaccine series
 
*If source is HBsAG- then initiate HBV vaccine series
 
*If source of unknown status then start HBV vaccine series
 
*If source of unknown status then start HBV vaccine series
 +
 
====Previously Vaccinated Patient====
 
====Previously Vaccinated Patient====
 
*No treatment if source is HBsAG+/- or if source is unknown
 
*No treatment if source is HBsAG+/- or if source is unknown
 +
 
====Partially Vaccinated (one series) or Non-Responder====
 
====Partially Vaccinated (one series) or Non-Responder====
 
''Non responder defined as anti-HBs<10IU/ml''
 
''Non responder defined as anti-HBs<10IU/ml''
Line 32: Line 35:
 
*If source is HBsAg- then no treatment is needed
 
*If source is HBsAg- then no treatment is needed
 
*If source is high risk then give HGIV and start HBV vaccine series
 
*If source is high risk then give HGIV and start HBV vaccine series
===Partially Vaccinated (two series) or Non Responder===
+
 
 +
====Partially Vaccinated (two series) or Non Responder====
 
''Non responder defined as anti-HBs<10IU/ml''
 
''Non responder defined as anti-HBs<10IU/ml''
 
*If source HBsAg+ then give two doses of HGIB (now and in 1 month)
 
*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 HBsAg- then no treatment needed
 
*if source is high risk then treat if HBsAg+
 
*if source is high risk then treat if HBsAg+
 
 
  
 
===Hep C===
 
===Hep C===
Line 48: Line 50:
 
==See Also==
 
==See Also==
 
*[[HIV post-exposure prophylaxis]]
 
*[[HIV post-exposure prophylaxis]]
*[[Harbor: Occupational Exposure]]
+
*[www.needlestick.mednet.ucla.edu]
*www.needlestick.mednet.ucla.edu
 
  
==Source==
+
==References==
 +
<references/>
  
 
[[Category:ID]]
 
[[Category:ID]]

Revision as of 06:43, 8 September 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

HIV

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

  • 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.

See Also

References