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
Management
- 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 prophylaxsis
- no interferon, no antivirals, no globulin
- not xmitted efficiently through needle stick- 2% rate
- get basline hcv test and ALT
Post Exp Viral Hep Counseling
- can still breast feed
- no organ/ blood donation
- no worry about modifiying sex pattern or becoming preg
See Also
- HIV post-exposure prophylaxis
- Harbor: Occupational Exposure
- www.needlestick.mednet.ucla.edu