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

HIV

• Consider HIV post-exposure prophylaxis

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

• HIV post-exposure prophylaxis

Authors:

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