Healthcare occupational exposure to blood or other body fluids: Difference between revisions
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(Text replacement - " HIV " to " HIV ") |
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==Workup== | ==Workup== | ||
*In many systems, a standardized baseline lab panel is sent in the ED and then followed up at employee health the next day | *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]]) | *Frequently, the only actionable lab on the day of exposure is a rapid [[HIV]] test from the source patient (for consideration of [[PEP]]) | ||
*Hepatitis B and C infectivity of source patient | *Hepatitis B and C infectivity of source patient | ||
**HBs-Ag (active infection) | **HBs-Ag (active infection) | ||
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**Rapid HIV, hep pannel, RPR? | **Rapid HIV, hep pannel, RPR? | ||
*Exposed labs | *Exposed labs | ||
**Rapid HIV (if considering [[PEP]] only), hep pannel, RPR? | **Rapid [[HIV]] (if considering [[PEP]] only), hep pannel, RPR? | ||
**If considering [[PEP]] | **If considering [[PEP]] | ||
***CBC, C7, LFTs, pregnancy test | ***CBC, C7, LFTs, pregnancy test |
Revision as of 10:49, 8 September 2016
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)
- Hepatitis B and C infectivity of source patient
- HBs-Ag (active infection)
- HBc-Ab IgM (window period)
- HepC-Ab, plus or minus viral load
- 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 HBIG 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 HBIG 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 HBIG (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.