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
- 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
- --- Seek expert consultation if viral resistance is suspected.
- --- Administer PEP for 4 weeks if tolerated.
Perform follow-up testing and provide
- Advise exposed persons to seek medical evaluation for any acute
illness occurring during follow-up.
- Perform follow-up anti-HBs testing in persons who receive hepatitis
- --- 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.
- 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
- 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
- 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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