Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
Management of occup exposures
1. Management of Occupational
Exposure to BBV
Dr. Faisal Al Hadad
Consultant of Family Medicine & Occupational Health
(ABFM, SBFM, MSc Occupational Health (UK
Incharge of Occupational Health
PSMMC
2. Outline
Primary
Prevention of Blood-borne infections
Management
of exposure to blood or body fluid
Management
of exposure to blood or body fluid
infected with BBV
Employment
infections
Implications of blood-borne
3. Primary Prevention of Bloodborne Infections
Vaccination
Standard
Precautions:
1) Hand hygiene
2) Use of personal protective equipment (e.g., gloves)
3) Safe injection practices
4) Safe handling of potentially contaminated equipment or
surfaces in the patient environment
5) Respiratory hygiene/cough etiquette.
4. Hepatitis B Vaccination
Any
person who performs tasks involving contact with
blood, blood-contaminated body fluids, other body
fluids, or sharps should be vaccinated against hepatitis B.
HCP
who have contact with patients or blood and are
at ongoing risk for percutaneous injuries should be
tested 1–2 months after completion of the 3-dose
vaccination series for anti-HBs
Booster
doses of hepatitis B vaccine are not necessary,
and periodic serologic testing to monitor antibody
concentrations after completion of the vaccine series is
not recommended.
5. Hepatitis B Vaccination
Non-responders
to vaccination who are HBsAg-negative:
- Considered susceptible to HBV infection
- Should be counseled regarding precautions to prevent
HBV infection
- Should obtain HBIG prophylaxis for any known or
probable parenteral exposure to HBsAg-positive blood.
6. Case Study
Nora is a 35 year-old Registered Nurse
experienced a needle-stick injury during
.night shift
What is the risk of HBV, HCV and HIV
?transmission
?What should Nora do in respect to this event
7. Risk of HBV, HCV and HIV Transmission
after Occupational Percutaneous Exposure
• HBV risk varies depending on e-antigen status of source
person
– If e-antigen positive, risk is up to 30%
– If e-antigen negative, risk is 1-6%
• HCV risk is 1.8% (range of 0 - 7%)
• HIV risk is 0.3% (range of 0.2 - 0.5%)
8. Management of Occupational
Exposure to Blood or Body fluid
Treatment
of exposure site : wash exposure site with
water ± soap. No evidence exists that using antiseptics
or squeezing the wound reduces the risk of BBV
transmission.
Inform
supervisor about the incident
Complete
Report
the exposure incident report
the incident to Preventive Medicine during
working hours and the A/E out of working hours.
9. Exposure Incident Report
Date and time of exposure
Details of the procedure being performed including where and how the
exposure occurred.
Details of the exposure including type and amount of fluid and the severity of
exposure (e.g. depth of injury, whether fluid was injected, skin integrity)
Details about the exposure source
- Infectious status
- Stage of the disease, HX of antiretroviral therapy and viral load if the source
is HIV-infected,
Details about the exposed person (Hepatitis B vaccination and vaccine
response status)
Details about counseling, post-exposure management, and follow-up.
10. Management of Exposure in
Preventive Medicine
Reviewing the exposure incident report
Evaluation of the exposure incident
Evaluation of the exposure source
Baseline screening of the exposed person for BBV
Follow up testing of the exposed person
Post-exposure prophylaxis
Counseling
11. Evaluation of the Exposure Incident
Factors to consider in assessing the need for follow up of
occupational exposures:
Type of body substance:
- Blood
- Fluids containing blood
- Potentially infectious fluid or tissue (semen; vaginal secretions; and cerebrospinal, synovial,
pleural, peritoneal, pericardial, and amniotic fluids)
- Direct contact with concentrated virus
Route of exposure:
- Percutaneous injury
- Mucous membrane exposure
- Nonintact skin exposure
- Bites resulting in blood exposure
Amount of exposure
12. Evaluation of the Exposure Source
The
person whose blood or body fluid is the source of an
occupational exposure should be evaluated for BBV
infection.
Information
available in the medical record at the time of
exposure or from the source person, might confirm or
exclude BBV infection.
If
the infectious status of the source is unknown, the source
person should be informed of the incident and tested for
serologic evidence of BBV infection.
Informed
consent must be obtained and confidentiality of the
source person should be maintained at all times.
13. Evaluation of the Exposure Source
Known exposure source
Test known sources for HBsAg, anti-HCV, and HIV antibody
Direct virus assays (e.g. tests for HIV RNA or HCV RNA) for routine screening
of source patients are not recommended
For sources whose infection status remains unknown, consider medical
diagnoses, clinical symptoms, and history of risk behaviors
Do not test discarded needles for bloodborne pathogens
Unknown exposure source
Evaluate the likelihood of exposure to a source at high risk for infection
14. Management of Exposure to HBV
Baseline screening of exposed person for HBV (HBsAg)
and immune status (anti-HBs).
Follow up testing if exposed person is not immune at time
of exposure:
- LFT at 6 weeks and 12 weeks
- HbsAg 12 weeks and 6 months
If exposed person is immune at time of exposure, followup for Hepatitis B is not indicated.
Post-exposure prophylaxis if indicated
16. Management of Exposure to HCV
For the person exposed to an HCV-positive source:
- Perform baseline testing for anti-HCV and ALT activity
- Perform follow-up testing (e.g., at 4–6 months) for anti-HCV and ALT
activity. If earlier diagnosis is desired, testing for HCV RNA may be
performed at 4–6 weeks.
If the source person is not infected with HCV, baseline testing or
further follow-up of the exposed person is not necessary.
Confirm all anti-HCV results reported positive by enzyme immunoassay
using supplemental anti-HCV testing (e.g. RIBA)
IG and antiviral agents are not recommended for PEP after exposure to
HCV-positive blood.
17. Management of Exposure to HIV
HCP
exposed to HIV should be evaluated within hours after
their exposure and should be tested for HIV at baseline.
HIV-antibody
testing should be performed for at least 6
months postexposure.
If
the source person is seronegative for HIV, baseline testing
or further follow-up of the exposed person normally is not
necessary.
HIV
testing should be performed on any exposed person
who has an illness compatible with an acute retroviral
syndrome.
20. HIV Post-exposure Prophylaxis
If
indicated, start PEP as soon as possible after an exposure.
Reevaluation
of the exposed person should be considered
within 72 hours postexposure, especially as additional
information about the exposure or source person becomes
available.
Administer
If
PEP for 4 weeks, if tolerated.
a source person is determined to be HIV-negative, PEP
should be discontinued.
21. Preferred Basic & Expanded Regimen
Basic
2-drugs PEP
- Zidovudine + lamivudine
- Tenofovir DF + emtricitabine
Expanded
3-drugs PEP
Basic regimen plus Lopinavir/ritonavir
22. Counseling for HCP Exposed to HBVor HCV-infected blood
Do not need to take any special precautions to prevent secondary
transmission during the follow-up period.
The exposed person does not need to modify sexual practices or
refrain from becoming pregnant.
If an exposed woman is breast feeding, she does not need to
discontinue.
They should refrain from donating blood, plasma, organs, tissue, or
semen.
23. Counseling for HCP Exposed to HIV
infected blood
Exposed HCP should be advised to use precautions to prevent secondary
transmission during the follow-up period:
- Exercise sexual abstinence or use condoms to prevent sexual transmission
and to avoid pregnancy
- Refrain from donating blood, plasma, organs, tissue, or semen.
- If an exposed woman is breast feeding, discontinuation of breast feeding
should be considered.
For exposures for which PEP is prescribed, HCP should be informed about
possible drug toxicities and the need for monitoring, and possible drug
interactions.
Exposed HCP should be advised to seek medical evaluation for any acute
illness suggestive of HIV infection during the follow-up period.
24. Employment Implications of Bloodborne Infection in RMH
Those
who are anti HCV+ve and PCR+ve should be
transferred to a non-high risk area.
Those
who are anti HCV+ve but PCR-ve can continue
their work since they are not dangerous .
Those
who are PCR-ve for two (2) consecutive tests,
one month apart, are considered free from Hepatitis C
Those
who received treatment for Hepatitis C and
declared cured with PCR-ve for six (6) months from
stopping the treatment are considered free from
Hepatitis C.
25. Employment Implications of Bloodborne Infection in RMH
Employees with positive HBsAg
If PCR is positive and viral load is more than 100,000 copies/ml
the employee should be prohibited from work in high-risk area
and transferred to a non-high risk area.
If PCR is negative or viral load is less than 100,000 copies/ml
twice one (1) month apart, the employee can continue working in
high-risk area, but should be followed up by PCR yearly.
Employees with positive HIV
Staffs who are HIV positive should be dealt with according to the
Government/RMH Policy .
