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
- Risk of infc 2- 30% after needle stick
- Can survive on dried blood for 1 wk
- Found in all fluids but highest conc in blood and therefore highest risk with blood
- Hep b surface antibodies confers life long immunity
- Don't need to test pt or source if pt certain fully/ successfully immunized- antibodies > 10 IU at some time
- If pt not successfully immunized, give hep b immune globulin
- Failed 3 shots/ 1 series- give hep booster and immune globulin x 2 doses over 1 mo
- Failed 6 shots/ 2 series- give sequential immune globulin
Patient Unvaccinated, Source Pos --> HBIG + vaccine
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