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Body Fluid Exposure Epidemiology Prevention Greater risk of death from hepatitis than HIV HIV prevalence: 3-15% homosexuals, 1% IVDU’s, 17% homosexual IVDU’s, <0.1% heterosexuals Gloves: inoculum size by 50% 60% related to re-capping of needles; HIV killed by all common sterilisation techniques Transmission Risks Hepatitis B: 5% transmission if e negative, 40% if e positive; most commonly from blood Hepatitis C: 2-10% transmission from needlestick HIV: 0.3% transmission from all exposures Receptive anal intercourse 0.8% Shared IV drug needles 0.6% Needlestick 0.3% Vaginal intercourse 0.1% Insertive anal intercourse 0.1% Mucous membrane exposure <0.1% 1:5,400,000 transfusion risk per unit blood 50% will die from other cause Possibly infectious if visible blood in fluid, if semen or vaginal fluid; extremely low risk = poo, mucus, saliva, sweat, urine, vomit; risk of transmission if acute seroconversion illness / later stages of AIDS Assessment History: contaminated or clean; ?source known infected; exposed immunisation status; pathogen involved and amount in patient’s bloodstream; body fluid and amount involved; RASP = risk assessment stratification protocol: based on HIV status of source, inoculum type, method of transmission, estimated volume of transmission Investigations Community exposure: Test source for: Test exposed for: baseline bloods HbsAg, Hep C, HIV Anti-HbsAg, HbsAg, Hep C, HIV Non-occupational exposure: no evidence to support HIV PEP, but often used Management Staff exposure: Staff Member: Report to senior staff ASAP immediately wash area (with soap and water), treat soft tissue injury as needed Detailed documentation; provide counseling Hepatitis B: If hepatitis B immune – no worries! If not hepatitis B immune (Anti-HbsAg and HbSAg –ive): give hepatitis B immunisation …and if source HbsAg +ive / can’t be identified given HBIg within 72hrs HIV: try to commence within 1 hour of injury (little benefit if started >24-36 hours); risk of seroconversion by at least 80%; full 4/52 course tolerated by 35% due to side effects (pancreatitis, renal calculi) given based on RASP score (give if >1:10,000 chance); not offered with exposure to urine / saliva Use zidovudine + lamivudine for 4/52 if low risk, add in lopinvair and ritonavir if high risk Hepatitis C: no treatment available ADT: if needed Ensure follow up; Repeat blood at 6/52, 3/12, 6/12 (12/12 if high risk / prophylaxis given / positive serology); instruct for next 3/12 – practice safe sex, avoid pregnancy, report febrile illness, do not donate blood Patient Department: Ensure exposure reported; follow up safety policies in hospital