Managementof Occupational

Exposures

Managementof Occupational Exposures to

HBV, HCV, & HIV

Annual Report 2012Sharp Injuries and Body Fluid

Exposure:-Number Percentage

Physicians 27 36%

Nursing Staff

35 46.7%

Technicians

5 6.6%

HK Staff 8 10.7%

TOTAL 75 ***

H B V

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%

Control of HBV transmission

- All HCW should receive Hepatitis B vaccine series at 0,1, 6 After 1-2 months check your immunity .You may be:

responder (HBs Ab > 10 ml U/ml)

non-responder (HBs Ab < 10 ml U/ml), receive Hepatitis B vaccine second series .After 1-2 months check your immunity

H C V

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.

H I V

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 .

Blood Borne EXPOSURE

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 SourceSeveral 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 asymptomatic HIV infection or known low viral load (e.g., (<1,500 RNA copies.ml). Class 2 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

TUBERCULOSIS

(TB)

Involve face –to-face contact with infectious TB patients :-

a. Entering patient rooms ( patient is present or not).

c. Participating in aerosol-generating procedures.

d. Participating in specimen processing (culture ).

e. Installing, maintaining, or replacing environmental control in areas in which persons with TB are encountered

Tuberculosis Exposure

TB CONTROL PROGRAM

Baseline screening should be done at the time of hire.

A two-step TST should be performed when the initial TST is negative 1--3 weeks after the first.

Screen HCP at risk annually (i.e., symptom screen

& TST for HCWs with baseline negative results). If the HCP is converter recently, preventive

therapy should be considered. Chest radiograph are performed ONLY on those

with recently positive TST and symptomatic.

VARICELLA

Chicken pox

TRANSMISSION¤ AIRBORNE

¤ CONTACT

PERIOD OF OMMUNICABILITY

▀ 1 – 2 days before

the rash

▀ 4-5 days after until all

vesicles are crusted

Varicella Zoster

Transmitted by CONTACT

COMMUNICABLE until all vesicles are crusted

Exposure

A. Varicella:• Patients in the same room . • Face to face contact or (5 minutes or

more).• Visit by a contagious person. 

B. Zoster:

Intimate contact (e.g. touching or hugging) with a contagious person with exposed zoster lesions. 

Vaccine

Given to susceptible contacts within 3 days of exposure may prevent or significantly modify disease.

Immunoglobulins VZIG ( within 4days) Susceptible immunocompromised patients Susceptible pregnant women. (there is no

assurance that VZIG will prevent congenital malformations in the fetus, but it may modify varicella severity ).

Sick leave

Remain off work from days 10-21 post exposure