Download Body Fluid Exposure

Body Fluid Exposure
Epidemiology
Prevention
Transmission
risks
Assessment
Investigation
Greater risk of death from hepatitis than HIV
HIV prevalence: 3-15% homos, 1% IVDU, 17% homo IVDU, <0.1% heteros
Gloves: decr inoculum size by 50%
60% related to re-capping of needles; HIV killed by all common sterilisation techniques
Hep B: 5% transmission if e negative, 40% if e positive; most commonly from blood
Hep 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%
MM 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; incr risk of transmission if acute seroconversion illness / later stages of AIDS
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 stratififcation protocol: based on HIV status of source, inoculum type, method of
transmission, estimated vol of transmission
Community exposure: baseline bloods
Test source for:
HbsAg, Hep C, HIV
Test exposed for: Anti-HbsAg, HbsAg, Hep C, HIV
Mng
Non-occupational exposure: no evidence to support HIV PEP, but often used
Staff exposure:
STAFF MEMBER
Report to senior staff ASAP  immediately wash area (with soap and water), trt STI as needed
Detailed documentation; provide counselling
Hep B: If hep B immune – no worries!
If not hep B immune (Anti-HbsAg and HbSAg –ive): give hep B immunisation
if source HbsAg +ive / can’t be identified  given HBIg within 72hrs
HIV: try to commence within 1hr of injury (little benefit if started >24-36hrs); decr risk of seroconversion by at
least 80%; full 4/52 course tolerated by 35% due to SE’s (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
Hep C – no trt available
ADT – if needed
Ensure FU; 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; FU safety policies in hospital
Notes from: Dunn