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APPENDIX B. Management of Occupational Blood Exposures

Provide immediate care to the exposure site.

  • Wash wounds and skin with soap and water.
  • Flush mucous membranes with water.

Determine risk associated with exposure by

  • type of fluid (e.g., blood, visibly bloody fluid, other potentially infectious fluid or tissue, and concentrated virus) and
  • type of exposure (i.e., percutaneous injury, mucous membrane or nonintact skin exposure, and bites resulting in blood exposure).

Evaluate exposure source.

  • Assess the risk of infection using available information.
  • Test known sources for HBsAg, anti-HCV, and HIV antibody (consider using rapid testing).
  • For unknown sources, assess risk of exposure to HBV, HCV, or HIV infection.
  • Do not test discarded needles or syringes for virus contamination.

Evaluate the exposed person.

  • Assess immune status for HBV infection (i.e., by history of hepatitis B vaccination and vaccine response).

Give PEP for exposures posing risk of infection transmission.

  • HBV: See Table 3.
  • HCV: PEP not recommended.
  • HIV: See Table 4 and Table 5.
  • --- Initiate PEP as soon as possible, preferably within hours of exposure.
  • --- Offer pregnancy testing to all women of childbearing age not known to be pregnant.
  • --- Seek expert consultation if viral resistance is suspected.
  • --- Administer PEP for 4 weeks if tolerated.

Perform follow-up testing and provide counseling.

  • Advise exposed persons to seek medical evaluation for any acute illness occurring during follow-up.

HBV exposures

  • Perform follow-up anti-HBs testing in persons who receive hepatitis B vaccine.
  • --- Test for anti-HBs 1--2 months after last dose of vaccine.
  • --- Anti-HBs response to vaccine cannot be ascertained if HBIG was received in the previous 3--4 months.

HCV exposures

  • Perform baseline and follow-up testing for anti-HCV and alanine amino- transferase (ALT) 4--6 months after exposures.
  • Perform HCV RNA at 4--6 weeks if earlier diagnosis of HCV infection desired.
  • Confirm repeatedly reactive anti-HCV enzyme immunoassays (EIAs) with supplemental tests.

HIV exposures

  • Perform HIV-antibody testing for at least 6 months postexposure (e.g., at baseline, 6 weeks, 3 months, and 6 months).
  • Perform HIV antibody testing if illness compatible with an acute retroviral syndrome occurs.
  • Advise exposed persons to use precautions to prevent secondary transmission during the follow-up period.
  • Evaluate exposed persons taking PEP within 72 hours after exposure and monitor for drug toxicity for at least 2 weeks.

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