Approach
• Institutional guidelines vary regarding occupational exposures of HC workers to bodily fluids
• Refer to CDC/local experts for recs on postexposure prophylaxis
• National Clinicians’ Postexposure Prophylaxis Hotline (PEPline): (888) 448-4911
History
• Any percutaneous injury, mucous membrane exposure, or exposure of nonintact skin to any blood & other bodily fluids considered potentially infectious
• RFs: High-risk procedures, use of equipment w/o newer safety designs, failure to follow universal precautions
Findings
• Physical examination nl; should be documented for future reference
Evaluation
• Consent & test source pt for HIV, HBsAg, Hep C Ab (direct viral assays not rec)
• Test HC worker for HIV & Hep C Ab, draw HBsAb titers if unknown immune status
• Check serum hCG, CBC, Chem 7, LFTs, & UA before starting prophylaxis
• If source pt is HIV+, ID consult for appropriate regimen based on source pt’s regimen
Treatment
• HIV: 2 drug regimen (Combivir) × 4 wk; 3 drug regimen (Nelfinavir) for high-risk exposures
• Hep B: Start vaccination series if unvaccinated, Hep B immune globulin (HBIG) if HBeAg+
• Multiple doses HBIG w/i 1 wk of exposure provides 75% protection from infection
• Hep C: CDC does not recommend use of interferon or ribavirin for HCV exposure
• Consider interferon & ribavirin tx as soon as HCV seroconversion is documented
Disposition
• F/u w/ ID specialist; fully inform risks & benefits of tx & nontx
Pearls
• ∼80% ↓ rate of transmission w/ immediate initiation (w/i 2 h) of HIV PEP
• Rates of occupational transmission after percutaneous exposure
• HIV + source pt: 0.3%; Hep B + source pt; 5–20%, Hep C + source pt: 1–10%
