Healthcare occupational exposure to blood or other body fluids

Background

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

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)
  • Hepatitis B and C infectivity of source patient
    • HBs-Ag (active infection)
    • HBc-Ab IgM (window period)
    • HepC-Ab, plus or minus viral load
  • Source labs
    • Rapid HIV, hepatitis panel, RPR?
  • Exposed labs
    • Rapid HIV (if considering PEP only), hepatitis panel, RPR?
    • If considering PEP
      • CBC, C7, LFTs, pregnancy test

Management

HIV

Hep B

Dosing if indicated

  • 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 HBIG 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 HBIG 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 HBIG (now and in 1 month)
  • If source is HBsAg- then no treatment needed
  • if source is high risk then treat if HBsAg+

Hep C

  • No prophylaxis regimen has any benefit
  • Draw anti-HCV on the source and the exposed patient
  • Draw ALT level on exposed patient and repeat in 6 months or perform HCV RNA PCR in 4 weeks
    • If the patient is anti-HCV positive then confirm the diagnosis with HCV RNA PCR.

See Also

References