Download Body Fluid Exposure

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