Blood Borne Pathogens

 

Workmed Midwest’s Blood Borne Pathogen Exposure Program

 

 This summary serves as a guide to assist the HCP. Refer to the clinical resources link below for further assistance.  

    http://nccc.ucsf.edu/clinical-resources/pep-resources/pep-quick-guide/ for consultation or assistance

         HIV PEP, contact the National Clinicians’ Post-Exposure Prophylaxis hotline at telephone number   888-448-4911 or visit its website: http://www.nccc.ucsf.edu/about_nccc/pepline/.        

********************************************************************************************

High Risk Exposures:  A Percutaneous needlestick. Mucus membranes or non-intact skin (chapping, dermatitis, abrasions, or open wounds) that are exposed to body fluids visibly contaminated with blood. Also, exposures from unfixed tissue, semen, vaginal secretions, Cerebral Spinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids.

Low to No Risk exposures: saliva, vomitus, urine, feces, sweat, tears, or respiratory secretions without visible blood or a blood exposure briefly to intact skin.  

Consider Source:  source known and they have a positive history for HIV, Hep B, Hep C, IV drug use, or positive HIV quick test, unknown source blood status: consider source high risk.

*************************************************************************************

  Is the exposure considered high risk?

NO: Use clinical judgement  

YES: Follow guidelines outlined below and refer individuals to Workmed Midwest within 72 hours for follow-up medical evaluation/counseling with Dr. Bachman 320-227-2595.

Is the source stasis unknown?

YES: Obtain consent for blood draw and for results to be released to Workmed Midwest or to the exposed individual and

Test source’s blood for the following:

 

                         1. HIV quick test                                                          4. Hep B Core Antigen

 

                         2.  Hep B Surface Antibody                                       5. Hep C Antibody

 

                         3.Hep B Surface Antigen                                           6.  HCV RNA (Viral Load) * if known hep C carrier  

 

*If the source refuses to consent for blood draw, treat the exposed individual as though the source is positive for blood borne pathogens.

  If source expires, put a hold on blood vials or notify Medical Examiner that an exposure occurred and blood borne pathogen status needs to be known.

       Draw the following baseline labs on the exposed individual:

 

                 1.  HIV Antibody                           3. Hep B Surface Antibody           

 

                 2.  Hep C Antibody                       4. Liver Profile

   

  Was the source unknown, did the source refuse to have blood drawn for testing, or are they positive for HIV and this was a high-risk HIV exposure:

 YES: Begin or at least offer HIV prophylaxis within two hours or ASAP and draw the following additional labs on the exposed individual:

 

                           1. CBC                                        6. BUN

 

                           2. ALT                                         7. Pregnancy Test: if positive call before PEP                     

 

      3. AST                                         8. Creatinine

 

    4. Total Bilirubin

 

  NO HIV Prophylaxis: Above labs testing not needed at this time. Workmed Midwest will outline future follow-up lab testing as needed, in otherwise high-risk exposure.

  

Was the exposed individual previously vaccinated against Hepatitis B and has knowledge of positive titre results

 >10mlU/ml?

YES: No further testing or treatment for Hepatitis B is needed as they are considered to have lifelong immunity NO: Offer Hepatitis B Immune Globulin if source is known to be positive for Hepatitis B.

The above is a general guide to be used for initial evaluation. The HCP must consider each circumstance indivdually.