Healthcare occupational exposure to blood or other body fluids

(Redirected from Occupational exposure)


  • 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]
  • The CDC has a post exposure prophylaxis hotline at 1-888-448-4911

Clinical Features

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

Differential Diagnosis


Most commonly, the only actionable lab on the day of exposure is a rapid HIV test from the source-patient (for consideration of PEP)

  • Less severe percutaneous exposures are associated with solid and blunt tip needles
  • More severe percutaneous exposures are associated with deep punctures, large bore hollow needles, visible blood on the device, and needles used in patients arteries and veins.
  • Smaller volume (few drops) exposures are considered to be lower risk than higher volume (major blood splash) for mucous membranes and non-intact skin exposures.
  • Most occupational exposures to HIV are not associated with transmission.

Source-patient labs

  • Rapid HIV
  • Consider hepatitis panel and possibly 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 (to confirm they do not already have HIV)
    • CBC, C7, LFTs, pregnancy test



Preferred HIV PEP Regimen[2][3]

PEP should be started as soon as possible after significant exposure and continued for 28 days[4]

  • Raltegravir (Isentress; RAL) 400 mg PO twice daily, plus
  • Truvada, 1 PO once daily (Tenofovir DF [Viread; TDF] 300 mg emtricitabine [Emtriva; FTC] 200 mg)

Other Considerations

  • If known source patient with resistant HIV strain, consult HIV service for source-patient-specific PEP
  • Consider interactions with current medication interactions and contraindications, such as renal impairment with Truvada
    • For patients with creatinine clearance <60mL/min, consider Raltegravir 400mg PO twice daily, plus Zidovudine and Lamivudine with doses adjusted to the degree of renal dysfunction.[5]
  • If the source exposure does report exposure to HIV within the last 6 weeks, HIV RNA PCR (HIV viral load) should be sent along with HIV Ag/Ab screen on the source and nPEP should be initiated for the exposed patient
    • If both tests result not detected and nonreactive, respectively, nPEP should be discontinued.
    • If the source is willing and able to be tested and is found to be HIV-negative with no recent high-risk exposures to HIV, nPEP is not indicated and should not be initiated, or discontinued if already started.
    • The exposed patient still warrants baseline HIV testing and should be offered baseline and follow-up testing for other transmissible infections, e.g. hepatitis A, B, and C, syphilis, chlamydia, and gonorrhea.

Hepatitis B

  • Not normally indicated, assuming patient has had full course of Hepatitis B vaccination (as all healthcare workers should have)

Hepatitis C

  • No prophylaxis regimen has any benefit


  • Outpatient management with employee health follow-up

See Also


  1. Fretz R, Negro F, Bruggmann P et al. Hepatitis B and C in Switzerland - healthcare provider initiated testing for chronic hepatitis B and C infection. Swiss Med Wkly. 2013 May 17;143:w13793.
  2. Kuhar D, et al. Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. September 2013. 34(9):875-892. DOI: 10.1086/672271.
  3. Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV—United States, 2016. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services
  4. Kuhar DT et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):875-92. doi: 10.1086/672271.
  5. Dominguez KL et al. Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV--United States, 2016. Available at: