Download Management of Occupational Exposures to HBV, HCV, and HIV

Management
of Occupational
Exposures to
HBV, HCV, & HIV
Annual Report 2012
Sharp Injuries and Body Fluid Exposure:Number
Percentage
Physicians
27
36%
Nursing Staff
35
46.7%
Technicians
5
6.6%
HK Staff
8
10.7%
75
***
TOTAL
HBV
Hapedna Virus double stranded DNA
Risk for Occupational
Transmission of HBV
►
HBsAg& HBeAg-positive blood :
 The risk of developing clinical hepatitis is
22%– 31%;
 The risk of developing serologic evidence of
HBV infection is 37%–62%.
►HBsAg-positive, HBeAg-negative blood
 The risk of developing clinical hepatitis is
1%–6%;
 The risk of developing serologic evidence of
HBV infection is 23%–37%
HCV
Flavi virus.
It is a single stranded RNA
Risk for Occupational
transmission of HCV

HCV-positive source is 1.8% (range: 0%–7%)
rarely occurs from mucous membrane.
HIV
Retrovirus with 2 single stranded RNA
Risk for Occupational
Transmission of HIV
The risks for occupational transmission of HIV vary
with the type and severity of exposure:
♦ In percutaneous exposure 0.3% ( 0.2%–0.5%)
♦ In mucous membrane exposure,
approximately 0.09% ( 0.006%–0.5%)
A percutaneous injury or contact of mucous
membrane or nonintact skin
WITH

Blood ,tissue and body fluids

Semen and vaginal secretions ,

CSF, synovial , pleural , peritoneal , pericardial& amniotic fluid

Feces, nasal secretions, saliva, sputum, sweat,
tears, urine, and vomitus are not considered
potentially infectious unless they contain blood.

Contact without barrier protection to concentrated virus in lab

Human bites: evaluation of HCP + Patient .
Treatment of an Exposure
Site
Wash needle stick and cuts with soap and water
 Flush splashes to the nose, mouth, or skin with
water
 Irrigate eyes with clean water, saline
THEN

Report the incident to your supervisor

Immediately seek medical treatment
Evaluation of the Source

HEPATITIS B MARKERS
 ANTI- HCV
 ANTI - HIV
Evaluation of the HCW

HEPATITIS B MARKERS
 ANTI- HCV
 ANTI – HIV
 LFT in HCV Source
A. HBs Ag +ve source.
a.
Unvaccinated HCW
Hepatitis B immunoglobulin (HBIG)
10-12 IU/Kg(500 IU)
+
Hepatitis B vaccine series
PEP should be administered as soon as
possible after exposure(preferably within
24 hours). The effectiveness of HBIG
when administered >7 days after is unknown.
≈
b. In previously vaccinated HCW
i.
Known responder (HBs Ab > 10 ml U/ml);
no treatment.
ii. If non-responder
HBIG within 24 hours + Hepatitis B
vaccination at the same time.
OR
Second dose of HBIG can be given 1month later.
HCV Positive Source
A short course of interferon started
early in the course of acute hepatitis C
is associated with a higher rate of
resolution.
≈ Perform baseline testing for anti-HCV and ALT
≈ Earlier diagnosis of HCV infection is desired,
testing for HCV RNA
(R-T PCR QUALITATIVE AND QUANTITAVE )
≈ Perform follow-up testing (e.g., at 4 & 6 months)
for anti-HCV and ALT .
≈ Confirm all anti-HCV positive results.
HIV Positive Source
Several Factors may increase the risk
of transmission:a. If HCW is exposed to a large quantity of blood.
b. A procedure that involved a needle is placed
directly in a vein or artery or a deep injury.
c. If the source patient is in the terminal illness.
d. If the injury is deep with hollow-bore needles
or penetrating sharps-related event.
PEP in Percutaneous
Exposure
Class 1 asymptomatic HIV infection or known low viral load
(e.g., (<1,500 RNA copies.ml).
Class 2 symptomatic HIV infection, AIDS, acute zero conversion,
or known high viral load.
PEP in Mucous Membrane
Exposure
Class 1
Class 2
asymptomatic HIV infection or known low viral
load (e.g., (<1,500 RNA copies.ml).
symptomatic HIV infection, AIDS, acute sero
conversion, or known high viral load.
Antiretroviral Agents for PEP
≈ Nucleoside reverse transcriptase inhibitors
(NRTIs).
≈ Nucleotide reverse transcriptase inhibitors
(NtRTIs).
≈ Nonnucleoside reverse transcriptase inhibitors
(NNRTIs),
≈ Protease inhibitors(PIs), and a single fusion
inhibitor.
HIV PEP should regimen
(zidovudine (AZT) + lamivudine (3TC)
complete a full 4-week )
HCP Follow-up
≈
Anti- HIV test at 6 weeks, 3 months,
6 months
Extending follow-up to 12 months
≈
EIA standard test
≈
direct virus assays not recommended