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

(Management)
(Hep B)
Line 16: Line 16:
  
 
===Hep B===
 
===Hep B===
# Risk of infc 2- 30% after needle stick
+
*HBIG dose: 0.06mL/kg IM
# Can survive on dried blood for 1 wk
+
*Vaccination serires: Recombivax HB 10mcg IM or Engerix-B 20mcg IM at month 0,1, and 6
# 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
 
  
Patient Unvaccinated, Source Pos
+
===Unvaccinated Patient===
--> HBIG + vaccine
+
*If source is HBsAg+ then give HBIG x 1 and start HBV vaccine series
 +
*If source is HBsAG- then initiate HBV vaccine series
 +
*If source of unknown status then start HBV vaccine series
 +
===Previously Vaccinated Patient===
 +
*No treatment if source is HBsAG+/- or if source is unknown
 +
===Partially Vaccinated (one series) or Non-Responder===
 +
''Non responder defined as anti-HBs<10IU/ml''
 +
*If source HBsAg+ then give HGIG and start HBV vaccine series
 +
**Alternatively patients can have a HBIG vaccine with another dose in one month
 +
*If source is HBsAg- then no treatment is needed
 +
*If source is high risk then give HGIV and start HBV vaccine series
 +
===Partially Vaccinated (two series) or Non Responder
 +
''Non responder defined as anti-HBs<10IU/ml''
 +
*If source HBsAg+ then give two doses of HGIB (now and in 1 month)
 +
*If source is HBsAg- then no treatment needed
 +
*if source is high risk then treat if HBsAg+
  
 
===Hep C===
 
===Hep C===

Revision as of 22:15, 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

  • HBIG dose: 0.06mL/kg IM
  • Vaccination serires: Recombivax HB 10mcg IM or Engerix-B 20mcg IM at month 0,1, and 6

Unvaccinated Patient

  • If source is HBsAg+ then give HBIG x 1 and start HBV vaccine series
  • If source is HBsAG- then initiate HBV vaccine series
  • If source of unknown status then start HBV vaccine series

Previously Vaccinated Patient

  • No treatment if source is HBsAG+/- or if source is unknown

Partially Vaccinated (one series) or Non-Responder

Non responder defined as anti-HBs<10IU/ml

  • If source HBsAg+ then give HGIG and start HBV vaccine series
    • Alternatively patients can have a HBIG vaccine with another dose in one month
  • If source is HBsAg- then no treatment is needed
  • If source is high risk then give HGIV and start HBV vaccine series

===Partially Vaccinated (two series) or Non Responder Non responder defined as anti-HBs<10IU/ml

  • If source HBsAg+ then give two doses of HGIB (now and in 1 month)
  • If source is HBsAg- then no treatment needed
  • if source is high risk then treat if HBsAg+

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