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

(Management)
Line 16: Line 16:
  
 
===Hep B===
 
===Hep B===
# risk of infc 2- 30% after needle stick
+
# Risk of infc 2- 30% after needle stick
# can survive on dried blood for 1 wk
+
# Can survive on dried blood for 1 wk
# found in all fluids but highest conc in blood and therefore highest risk with blood
+
# Found in all fluids but highest conc in blood and therefore highest risk with blood
# hep b surface antibodies confers life long immunity
+
# 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
+
# 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
+
# 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 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
+
# Failed 6 shots/ 2 series- give sequential immune globulin
  
 
Patient Unvaccinated, Source Pos
 
Patient Unvaccinated, Source Pos

Revision as of 20:21, 19 May 2015

Background

  • Frequently from needlestick injuries or other occupational exposures to bodily fluids

Workup

  • 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, hep pannel, RPR?
  • Exposed labs
    • Rapid HIV (if considering PEP only), hep pannel, RPR?
    • If considering PEP
      • CBC, C7, LFTs, pregnancy test

Management

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

See Also

Source