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

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BLOOD BODY FLUID EXP
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==HIV==
 +
See "HIV (Occupational)"
  
HIV
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==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
  
- risk is 0.3% xmission rate for needle stick- less for mucous mem
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Patient Unvaccinated, Source Pos
 
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--> HBIG + vaccine
- 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
+
==Hep C==
 
+
# no prophylaxsis
- failed 3 shots/ 1 series- give hep booster and immune globulin x 2 doses over 1 mo
+
# no interferon, no antivirals, no globulin
 
+
# not xmitted efficiently through needle stick- 2% rate
- failed 6 shots/ 2 series- give sequential immune globulin
+
# get basline hcv test and ALT
 
 
 
 
 
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
 
Post Exp Viral Hep Counseling
 
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# can still breast feed
- can still breast feed
+
# no organ/ blood donation
 
+
# no worry about modifiying sex pattern or becoming preg
- no organ/ blood donation
 
 
 
- no worry about modifiying sex pattern or becoming preg
 
  
 
www.needlestick.mednet.ucla.edu
 
www.needlestick.mednet.ucla.edu
  
+
==Source==
 
 
6/06 MISTRY
 
 
 
 
 
 
 
 
 
 
 
 
---------------------------------
 
 
 
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
 
6/06 MISTRY
 
 
HEP B
 
 
Patient Source
 
 
Unvaccinated Pos
 
 
--> HBIG + vaccine
 
 
  
 
==See Also==
 
==See Also==
See ID: HIV (Occupational)
+
See "HIV (Occupational)"
  
 
[[Category:ID]]
 
[[Category:ID]]

Revision as of 05:03, 28 March 2011

HIV

See "HIV (Occupational)"

Hep B

  1. risk of infc 2- 30% after needle stick
  2. can survive on dried blood for 1 wk
  3. found in all fluids but highest conc in blood and therefore highest risk with blood
  4. hep b surface antibodies confers life long immunity
  5. don't need to test pt or source if pt certain fully/ successfully immunized- antibodies > 10 IU at some time
  6. if pt not successfully immunized, give hep b immune globulin
  7. failed 3 shots/ 1 series- give hep booster and immune globulin x 2 doses over 1 mo
  8. failed 6 shots/ 2 series- give sequential immune globulin

Patient Unvaccinated, Source Pos --> HBIG + vaccine

Hep C

  1. no prophylaxsis
  2. no interferon, no antivirals, no globulin
  3. not xmitted efficiently through needle stick- 2% rate
  4. get basline hcv test and ALT

Post Exp Viral Hep Counseling

  1. can still breast feed
  2. no organ/ blood donation
  3. no worry about modifiying sex pattern or becoming preg

www.needlestick.mednet.ucla.edu

Source

6/06 MISTRY

See Also

See "HIV (Occupational)"