Healthcare occupational exposure to blood or other body fluids

Revision as of 19:58, 19 November 2017 by Rossdonaldson1 (talk | contribs) (Management)


  • The majority of persons (e.g. source patients) chronically infected with hepatitis B and C (65% to 75%) are not aware of their infection [1]

Clinical Features

  • Frequently from needlestick injuries or other occupational exposures to bodily fluids

Differential Diagnosis


  • 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-patient labs

  • Rapid HIV, hepatitis panel, RPR?
  • Hepatitis B and C infectivity of source patient
    • HBs-Ag (active infection)
    • HBc-Ab IgM (window period)
    • HepC-Ab, plus or minus viral load

Exposed-patient labs

  • Most require NO laboratory testing
  • If giving HIV PEP:
    • Rapid HIV
    • CBC, C7, LFTs, pregnancy test


HIV Risk

Hepatitis B

  • Not normally indicated, assuming patient has had full course of Hepatitis B vaccination (as all healthcare workers should have)

Hep C

  • No prophylaxis regimen has any benefit
  • Consider drawing
    • Source-patient
      • Anti-HCV
  • Exposed-patient:
    • ALT level
    • Repeat in 6 months or perform HCV RNA PCR in 4 weeks


  • Outpatient management with employee health follow-up

See Also