Difference between revisions of "Healthcare occupational exposure to blood or other body fluids"

(See Also)
(Management)
Line 27: Line 27:
 
*Consider [[HIV post-exposure prophylaxis]]
 
*Consider [[HIV post-exposure prophylaxis]]
  
===Hep B===
+
{{Hepatitis B post exposure prophylaxis}}
====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===
 
===Hep C===

Revision as of 22:30, 21 January 2017

Background

  • 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

Evaluation

  • 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, 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 labs

  • Rapid HIV (if considering PEP only), hepatitis panel, RPR?
  • If considering PEP
    • CBC, C7, LFTs, pregnancy test

Management

HIV

Hepatitis B Post-Exposure Prophylaxis

Treatment is generally initiated after coordination with occupational health and infectious disease service and based the the exposed patient's vaccination history[2]

Unvaccinated

  • If the source is HBsAg(+) then give HBIG x1 and initiate HBV vaccine in two separate sites
  • If source is HGsAG(-) then start the HBV vaccine series
  • If source blood is unavailable and high risk then give HBIG x1 initiate the HBV series
    • If source blood is low risk and unavailable then begin HBV series

Previously vaccinated non responder (one series)

Non responder status is defined as anti-has <10mIU/mL

  • If the source is HBsAg(+) then give HBIG x 1 and begin revaccination series
    • Can also opt to perform second HBIG administration in one month
  • If source is HBsAg(-) then no treatment is needed
  • If source blood is unavailable and high risk then treat as if HBsAg(+)

Previously vaccinated non responder (two series)

Non responder status is defined as anti-has <10mIU/mL

  • If the source is HBsAg(+) then give HBIG x2 and no HBV series
  • If source is HGsAG(-) then no treatment is needed
  • If source blood is unavailable then initiate the HBV series

Treatment Dosing

No contraindications for pregnancy or breast feeding

  • HBIG 0.06 mL/kg IM
  • Vaccination series: HBV vaccine options:
    • Engerix-B 20mcg IM
    • Recombivax HB 10mcg IM

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.

Disposition

  • Outpatient management with employee health follow-up

See Also

References