[MCOH-EH] Baseline Testing on Exposed Employee with Negative Source Results

[Kavita Rajasekhar]

The UCSF Clinical Consultation Center (888-448-4911, they are an amazing resource!!!) shared this document with me recently. I am attempting to attach here, but you can always call them and ask for 'latest Hep C testing recs': http://nccc.ucsf.edu/clinician-consultation/pep-post-exposure-prophylaxis/


I found that reviewing the following documents (having a sit down journal club-like discussion where we went through these point by point) with our providers and nurses who handle BFEs regularly helped with our global understanding and, importantly our communication to patients/employees, as this is a 'bread and butter' topic in OccMed, but can often be challenging:​


Hepatitis B/C info
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6210a1.htm

http://www.uptodate.com/contents/prevention-of-hepatitis-b-virus-and-hepatitis-c-virus-infection-among-healthcare-providers?source=search_result&search=HBIG&selectedTitle=5%7E123

HIV info

http://nccc.ucsf.edu/wp-content/uploads/2014/03/Updated_USPHS_Guidelines_Mgmt_Occupational_Exposures_HIV_Recommendations_PEP.pdf​


http://www.uptodate.com/contents/management-of-healthcare-personnel-exposed-to-hiv?source=search_result&search=HIV+PEP&selectedTitle=1%7E150




Kavita Rajasekhar, MD MPH

University of New Mexico

505-272-8442

________________________________
From: MCOH-EH <mcoh-eh-bounces+krajasek=salud.unm.edu at mylist.net> on behalf of Nancy Rodway <nrodway at hotmail.com>
Sent: Monday, January 16, 2017 8:01 PM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] Baseline Testing on Exposed Employee with Negative Source Results


I aggressively use the HCV RNA by PCR on the employee if the source is HCV Ab positive. Some studies have suggested the use of the newer HCV protease inhib antivirals should the employee show early signs of HCV viral exposure.   I have yet to use it on the source blood but thank you for the thought.  I'll add that to my source labs in the future


Nancy


Sent from Outlook<http://aka.ms/weboutlook>


________________________________
From: MCOH-EH <mcoh-eh-bounces at mylist.net> on behalf of Swift, Melanie <melanie.swift at Vanderbilt.Edu>
Sent: Monday, January 16, 2017 4:50 PM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] Baseline Testing on Exposed Employee with Negative Source Results


Nancy, are you testing source patients for HCV with a DNA test? There are some new recommendations coming down the pike about that. Currently we’re testing the source with HCV Ab, and of course there is a long infectious window with that method.



For anyone attending this spring’s AOHC, this is a topic that will be covered in the Medical Center Occupational Health preconference course. (Pardon the shameless promo!)



Melanie Swift, MD

Director, Vanderbilt Occupational Health Clinic

http://occupationalhealth.vanderbilt.edu



From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Nancy Rodway
Sent: Monday, January 16, 2017 2:09 PM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] Baseline Testing on Exposed Employee with Negative Source Results



I do not test further if source is negative as long as the lab is testing also for the p24 antigen.

I am a pathologist as well .... so i see both sides of this issue



Sent from Outlook<http://aka.ms/weboutlook>



________________________________

From: MCOH-EH <mcoh-eh-bounces+nrodway=hotmail.com at mylist.net<mailto:mcoh-eh-bounces+nrodway=hotmail.com at mylist.net>> on behalf of Swift, Melanie <melanie.swift at Vanderbilt.Edu<mailto:melanie.swift at Vanderbilt.Edu>>
Sent: Monday, January 16, 2017 3:04 PM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] Baseline Testing on Exposed Employee with Negative Source Results



We do.

Source patients can test negative in early stages of infection so we offer f/u testing for everyone. It also can forestall against future WC claims if you show they were negative after the exposure.



Melanie Swift, MD

Director, Vanderbilt Occupational Health Clinic

http://occupationalhealth.vanderbilt.edu



From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of April Tainter
Sent: Monday, January 16, 2017 8:15 AM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] Baseline Testing on Exposed Employee with Negative Source Results



Do any of you continue to test beyond baseline if the source is negative?



April Tainter RN

Employee Health Nurse



[Description: Description: cid:image001.png at 01D0D11B.A449DA50]



ThedaCare Medical Centers-Shawano/New London/Waupaca

P 715-701-0168

F 715-524-9983



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From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Swift, Melanie
Sent: Monday, January 16, 2017 7:55 AM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] Baseline Testing on Exposed Employee with Negative Source Results



Ashley, there are several reasons to draw baseline labs on the employee:

•         Source patient testing may be negative in the early stages of infection so a negative source test is not absolute assurance they are not infectious.

•         The employee may have an unrecognized infection; when it later comes to light they are likely to associate it with the exposure. A positive baseline test establishes it as a preexisting infection.

•         The OSHA Bloodborne Pathogen Standard requires the employer offer baseline testing for HIV and hepatitis B regardless of the source’s status:

1910.1030(f)(3)(iii)(A) The exposed employee's blood shall be collected as soon as feasible and tested after consent is obtained.

1910.1030(f)(3)(iii)(B)<https://www.osha.gov/pls/oshaweb/owalink.query_links?src_doc_type=STANDARDS&src_unique_file=1910_1030&src_anchor_name=1910.1030(f)(3)(iii)(B)> If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample shall be preserved for at least 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible.





Melanie Swift, MD

Director, Vanderbilt Occupational Health Clinic

http://occupationalhealth.vanderbilt.edu



From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Hinman, Ashley
Sent: Sunday, January 15, 2017 3:00 PM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
Subject: [MCOH-EH] Baseline Testing on Exposed Employee with Negative Source Results



I was wondering what other facilities are doing when an exposed employee follows up with their designated area (Employee Health) following a blood borne pathogen exposure and the source patient has negative test results.  Do you typically draw baseline testing (Hepatitis C and HIV) on the exposed employee even when the source is negative?  If so, what is your reasoning for doing so?





Thanks,



Ashley Hinman, RN MSN

Nurse Clinician, Employee Health Clinic

University of Iowa Hospitals and Clinics

200 Hawkins Drive, 1097-1 Boyd Tower

Iowa City, IA 52242



[cid:B9D70BDC86E5E21ED886ED0CF268673DF58DCAE1 at mailhost6.uiowa.edu]



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