Infectious Disease Book

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Bloodborne Pathogen Exposure

Aka: Bloodborne Pathogen Exposure, Needlestick Injury
  1. Background
    1. Needlestick related transmission risks (if source positive)
      1. Hepatitis B: 1-6% (up to 30% if HBeAg positive)
      2. Hepatitis C: 1.8% on average (up to 7% in some studies)
      3. HIV: 0.3% (up to 0.5% in some studies)
  2. Step 1: Initial Management
    1. Wash wounds with copious soap and water
    2. Flush exposed mucous membranes with water
  3. 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
        1. Rapid HIV Testing is available at many centers
        2. Some centers will also test p24 antigen (identifies early HIV Infection)
      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
  4. 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
  5. 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
  6. 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
  7. References
    1. Orman and Moran in Herbert (2016) EM:Rap 16(4):16-7
    2. Moran (2000) Ann Emerg Med 35(1):47-62 [PubMed]
    3. (2001) Am Fam Physician 64(12):2012-14 [PubMed]

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