Infectious Disease Book

Miscellaneous

  • Bloodborne Pathogen Exposure

Vector-Borne Disease

http://www.fpnotebook.com/

Bloodborne Pathogen ExposureAka: Needlestick Injury

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  1. Step 1: Initial Management
    1. Wash wounds with copious soap and water
    2. Flush exposed mucous membranes with water
  2. Step 2: Evaluate Source of Exposure
    1. Avoid testing discarded needles or syringes
    2. Test known source
      1. Hepatitis B Surface Antigen
      2. Hepatitis C Virus Antibody
      3. HIV Test
      4. Liver Function Tests
        1. Aspartate Aminotransferase
        2. Alanine Aminotransferase
        3. Alkaline Phosphatase
    3. Assess risk of exposure if source unknown
      1. Hepatitis B Risk
  3. Step 3: Evaluate Exposed Patient
    1. Assess Hepatitis B Immune Status
      1. Prior vaccination
      2. Vaccine response
    2. Initial labs
      1. Anti-HCV RNA
      2. Hepatitis B Surface Antibody
      3. Hepatitis B Surface Antigen
      4. HIV Test
      5. See labs specific to HIV Postexposure Prophylaxis
    3. Follow-up labs
      1. Anti-HCV RNA
        1. Consider testing at 2, 4 and 8 weeks after exposure
        2. Repeat at 4-6 months after exposure
      2. HIV Test
        1. Repeat at 6 months after exposure
  4. Step 4: Management of the exposed patient
    1. Postexposure Prophylaxis
      1. See HIV Postexposure Prophylaxis
      2. See Hepatitis B Postexposure Prophylaxis
    2. Prevent transmission of possible infections
      1. Use protection from Sexually Transmitted Disease
      2. Consider Immunization of close contacts
  5. Prevention: Pre-exposure
    1. Healthcare workers should be immunized with Hepatitis B Vaccine
    2. Use retractable syringe needles and have readily available sharps containers
    3. Avoid re-capping needles
  6. References
    1. Moran (2000) Ann Emerg Med 35(1):47
    2. (2001) Am Fam Physician 64(12):2012

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