Difference between revisions of "Healthcare occupational exposure to blood or other body fluids"
(→Hep C) |
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==Management== | ==Management== | ||
| + | ===HIV=== | ||
*Consider [[HIV post-exposure prophylaxis]] | *Consider [[HIV post-exposure prophylaxis]] | ||
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*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'' | ||
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*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=== | ||
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==See Also== | ==See Also== | ||
*[[HIV post-exposure prophylaxis]] | *[[HIV post-exposure prophylaxis]] | ||
| − | *[ | + | *[www.needlestick.mednet.ucla.edu] |
| − | |||
| − | == | + | ==References== |
| + | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 06:43, 8 September 2015
Contents
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
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
- [www.needlestick.mednet.ucla.edu]