[MCOH-EH] Needlestick/Blood and body fluid exposure Evaluations

[Robinson, Geoffrey]

www.cdc.gov/mmwr/PDF/rr/rr5706.pdf

See attached MMWR recommendation regarding testing of exposed individual.  In brief, and I quote:


1.      Persons for whom neither a reliable history of completed vaccination against HBV nor a known contraindication to vaccination against HBV exist should receive the first dose of the HBV vaccine series as soon as possible (preferably within 24 hours) and not later than 7 days after the event.



2.      Testing should be considered when an HCV-infected source is known or thought to be likely on the basis of the setting in which the injury occurred or exposure to blood or biologic material from a bomber [???] or multiple other injured persons is suspected.



3.      In all health-care settings, [PEP] opt-out screening for HIV (performing HIV screening after notifying the patient that the test will be performed, with assent inferred unless the patient declines or defers testing) is recommended for all patients aged 13-64 years.



It has been our policy to test exposed employees, decision based on CDC definition of exposure, for all antibodies for the above (HBV, HCV, HIV) to ensure that they are positive (HBV) or negative (HCV, HIV) at time of exposure.  We feel that knowing only the immunization status for HBV is inadequate to prove immunity.  We also feel that even without a high risk exposure, it is advisable to know the HCV and HIV status of the exposed on the outside chance that the source individual could unknowingly be positive or incubating.  If the exposed individual is tested only at 4-6 months to check for seroconversion, how can one be sure they were not positive or incubating at time of exposure, especially if no previous testing had ever been performed?  Is self-reported medical history adequate?  But that's another whole discussion.  All exposed individuals are seen face to face.



Our humble opinion, but based on MMWR recommendations.

Geoff Robinson PAC
MedWorks - Bristol Hospital
Bristol CT 06010
(Phone) 860-589-0114
(Fax) 860-589-1936
grobinso at bristolhospital.org<mailto:grobinso at bristolhospital.org>

Connecticut Occupational Medicine Partners
http://compllc.org/





From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Wintermeyer, Stephen F.
Sent: Wednesday, February 11, 2015 10:20 AM
To: mcoh-eh at mylist.net
Subject: [MCOH-EH] Needlestick/Blood and body fluid exposure Evaluations

I am reviewing our policy for the management of a needlestick or blood body fluid evaluation.

My understanding is the standard of practice in 2015 is to test a source patient with a Rapid HIV test, HepBsAg and HepCAb tests.

My question for the group is what is the standard of practice of management of the exposed individual.  Obviously, counseling about risks and proper needle handling should be performed.

Do you require that the exposed individual come into the Employee Health clinic for face to face counseling or do you handle that by phone?
Do you test the exposed individual for HIV, HepBsAb and HepC for any exposure, or only if there is a specific reason to do so (such as the source patient is HIV +)?

Stephen Wintermeyer, MD, MPH
Director
Associate Professor of Clinical Medicine

Campus Health
Indiana University-Purdue University Indianapolis
Coleman Hall, Suite 100
1140 West Michigan Street
Indianapolis, IN  46202
317-274-8214

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