Healthcare occupational exposure to blood or other body fluids

BLOOD BODY FLUID EXP

HIV

- risk is 0.3% xmission rate for needle stick- less for mucous mem

- risk increases with quantity of blood, needle in vein or art, or deep inj, or source pt terminal with high viral titre

- may get PEP failure if resist strain of hiv, high titre, large volume, delayed initiation of PEP or too short course, weak host immune syst, syncytia forming strains of hiv

- rec use rapid hiv test to test source pt to decrease need for unnessasary hiv prophylaxsis. give at least one dose until source pt confirmed as neg

- 3 drug therapy only is skin puntured and source pt hiv+

- HIV PEP consists of:

4 wks of ZDV and 3TC or

3TC and d4t or

d4T and ddI

- side effects- NVD, pancreatittis, dm, kidney stone, skin reactions

- may add third drug for expanded risk of xmission- source pt resistant if dz progressing, viral load still high, cd4 count dropping despite tx

- if source pt resistant, choose drug accordingly

- if source pt hiv neg, and no sxs of aids or acute retroviral syndrome, chance of source pt being in "window" period small and no further testing of stuck pt needed

- no testing of sharps or needles

- if don't know about source pt, start tx for 4 wks. if source pt later known to be neg, can stop

Feces, snot, spit, sweat, tears, vomit, urine not infectious unless contain blood.

Human bite- tx both pt and source. rare route of xmission

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

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

www.needlestick.mednet.ucla.edu

6/06 MISTRY

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hep b core antibody if unvaccinated

hep b surface antibody if vaccinated

tx c

combivir 300/150 1 po bid

indinavir IDV 400mg 2 po tid

6/06 MISTRY

HEP B

Patient Source

Unvaccinated Pos

--> HBIG + vaccine

See Also

See ID: HIV (Occupational)