Healthcare occupational exposure to blood or other body fluids
Background
- 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]
Clinical Features
- Frequently from needlestick injuries or other occupational exposures to bodily fluids
Differential Diagnosis
- Laceration
- Retained foreign body
Evaluation
Frequently, the only actionable lab on the day of exposure is a rapid HIV test from the source patient (for consideration of PEP)
Source-patient labs
- Rapid HIV, hepatitis panel, RPR?
- Hepatitis B and C infectivity of source patient
- HBs-Ag (active infection)
- HBc-Ab IgM (window period)
- HepC-Ab, plus or minus viral load
Exposed-patient labs
- In some systems, NO immediate laboratory testing is performed
- In many systems, a standardized baseline lab panel is sent in the ED and then followed up at employee health the next day
- If giving HIV PEP:
- Rapid HIV
- CBC, C7, LFTs, pregnancy test
Management
HIV
- Consider HIV post-exposure prophylaxis
Hepatitis B
- Not normally indicated, assuming patient has had full course of Hepatitis B vaccination (as all healthcare workers should have)
- If exposed-patient NOT already vaccinated, see Hepatitis B Post-Exposure Prophylaxis
Hepatitis C
- No prophylaxis regimen has any benefit
Disposition
- Outpatient management with employee health follow-up