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

(Evaluation)
(Evaluation)
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==Evaluation==
 
==Evaluation==
''Frequently, the only actionable lab on the day of exposure is a rapid [[HIV]] test from the source patient (for consideration of [[PEP]])''
+
''Most commonly, 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===
*Rapid HIV, hepatitis panel, RPR?
+
*Rapid HIV
*Hepatitis B and C infectivity of source patient
+
*Consider [[hepatitis]] panel and possibly RPR
**HBs-Ag (active infection)
+
**Hepatitis B and C infectivity of source patient:
**HBc-Ab IgM (window period)
+
***HBs-Ag (active infection)
**HepC-Ab, plus or minus viral load
+
***HBc-Ab IgM (window period)
 +
***HepC-Ab, plus or minus viral load
  
 
===Exposed-patient labs===
 
===Exposed-patient labs===
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*In many systems, a standardized baseline lab panel is sent in the ED and then followed up at employee health the next day
 
*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]] (to confirm they do not already have HIV)
 
**CBC, C7, LFTs, pregnancy test
 
**CBC, C7, LFTs, pregnancy test
  

Revision as of 20:28, 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

Most commonly, 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
  • Consider hepatitis panel and possibly 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 (to confirm they do not already have 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