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

(Exposed-patient labs)
(Evaluation)
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==Evaluation==
 
==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]])''
*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===
 
===Source-patient labs===
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===Exposed-patient labs===
 
===Exposed-patient labs===
*Most require NO <u>immediate</u> laboratory testing
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*In some systems, NO immediate laboratory testing is performed
 +
*In many systems, a standardized baseline lab panel is sent in the ED and then followed up at employee health the next day
 
*If giving HIV [[PEP]]:
 
*If giving HIV [[PEP]]:
 
**Rapid [[HIV]]
 
**Rapid [[HIV]]

Revision as of 20:25, 19 November 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

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

  • In some systems, NO immediate laboratory testing is performed
  • In many systems, a standardized baseline lab panel is sent in the ED and then followed up at employee health the next day
  • If giving HIV PEP:
    • Rapid HIV
    • CBC, C7, LFTs, pregnancy test

Management

HIV

Hepatitis B

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

Hepatitis C

  • No prophylaxis regimen has any benefit

Disposition

  • Outpatient management with employee health follow-up

See Also

References