EMmedonline

• It is defined as a “ reasonably anticipated skin, eye, mucus membrane or parenteral contact with blood or other potentially infectious materials that may result from the performance of employee's duties.

   

Testing of Exposure

• Testing to determine HBV, HCV, HIV infection status of an exposure source should be performed as soon as possible after obtaining the required consent.

Management of potential Hepatitis B Virus Exposure

• If the exposed person has taken Hepatitis B vaccination , Check Anti HBs titre.

• If the Anti HBs titre is below the protection level (anti Hbs <10mIU/ml) or if the patient is nonimmune take HBIG * 1 and initiate revaccination.

• If Hepatitis B Immunoglobulin is indicated it should be given as soon as possible within 24 hrs, After 7 days, the effectiveness is unknown.

* : Dose of HBIG is 0.06 ml/kg IM.

# : Responder is a person with adequate levels of serum antibody to HBsAg (i.e. antiHBs >10mIU/ml).

Management of potential Hepatitis C Virus Exposure

• Source patient should be checked for Anti HCV.

• Exposed patient should be tested for anti HCV and alanine aminotransferase at baseline and follow up at 4 -6 months.

• Immunoglobulins and antivirals are not recommended.

• Medical personnel may not take any precautions to prevent secondary transmission during follow up period, but may not donate blood.

Management of potential Human Immunodeficiency Virus Exposusdre

• The health care workers baseline HIV status should be checked.

• If the source patient is HIV Negative no further follow up is required.

Class 1 : Asymptomatic HIV infection or known low viral load (<1500 RNA copies /ml)

Class II : Symptomatic HIV infection, acquired immunodeficiency syndrome, acute seroconversion or known high viral load.

• In case if the source,is known but HIV status cannot be determined (eg :deceased paerson, inadequate sample) generally no PEP is warranted, however consider basic 2 drug PEP for source with HIV risk factors.

• In case if the source,is unknown, generally no PEP is warranted, however consider basic 2 drug PEP in settings where exposure to HIV infected persons is likely.

PEP Regimen for HIV

• Basic 2 drug regimen

• Zidovudine (300mg BD or 200 mg TID) + Lamivudine (150mg BD)

or

• Zidovudine (300mg BD or 200 mg TID) + Emtricitabine (200 mg OD)

or

• Lamivudine (150mg BD) + Tenofovir (300mg OD)

or

• Tenofovir (300mg OD)+ Emtricitabine ( 200 mg OD)

• Expanded HIV PEP Regimen

• Basic two drug regimen plus one of the following:

   

• Lopinavir/ ritronavir combination 400/100 mg twice daily with food is preferred.

• Alternatively atazanvir/fosamprenavir may be considered along with +/- ritonavir.

Updated on 2/1/2015

Reference

• Tintinalli