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

[Swift, Melanie]

Looks like both recommendations are saying to test for infection at 6 months. You could detect native HBsAb by 4 months (by then the impact of HBIG would have worn off), but not really efficient to do this when you need to test for infection (HBcAb, HBsAg) at 6 months anyway.

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 Elizabeth.Moline at capellahealth.com
Sent: Tuesday, May 26, 2015 6:51 PM
To: mcoh-eh at mylist.net
Subject: [MCOH-EH] Needlestick/Blood and body fluid exposure Evaluations

See below:

I have found different advice on Hepatits B antigen or core antibody testing in the exposed person if they have not been vaccinated or are a non-responder or insufficiently vaccinated.  What are you protocols?
MMWR Recommendations and Reports / Vol. 62 / No. 10 December 20, 2013
HCP who have anti-HBs <10mIU/mL, or who are unvaccinated or incompletely vaccinated, and sustain an exposure to a source patient who is HBsAg-positive or has unknown HBsAg status, should undergo baseline testing for HBV infection as soon as possible after exposure, and follow-up testing approximately 6 months later. Initial baseline tests consist of total anti-HBc; testing at approximately 6 months consists of HBsAg and total anti-HBc.
** HCP who have anti-HBs <10mIU/mL, or who are unvaccinated or incompletely vaccinated, and sustain an exposure to a source patient who is HBsAg-positive or has unknown HBsAg status, should undergo baseline testing for HBV infection as soon as possible after exposure, and follow-up testing approximately 6 months later. Initial baseline tests consist of total anti-HBc; testing at approximately 6 months consists of HBsAg and total anti-HBc.



Hepatitis B and Healthcare Personnel

CDC answers frequently asked questions about

how to protect healthcare personnel www.immunize.org/catg.d/p2109.pdf<http://www.immunize.org/catg.d/p2109.pdf> * Item #P2109 (4/15)


If an employee receives both HBIG and hepatitis B vaccine after a needlestick from a patient who is HBsAg positive, how long should one wait to check the employee's response to the vaccine?
Anti-HBs testing for HCP who receive both hepatitis B immune globulin (HBIG) and hepatitis B vaccine can be conducted as soon as 4 months after receipt of the HBIG. How-ever, a new recommendation in the 2013 document is to test for hepatitis B core anti-body (anti-HBc) and hepatitis B surface antigen (HBsAg) among certain HCP (those previously unvaccinated, incompletely vacci-nated, or revaccinated) with an exposure from an HBsAg-positive or unknown HBsAg-status patient at the time of the exposure as well as at approximately 6 months after the expo-sure (that is, after the HBV incubation period). The CDC expert panel determined that it would be more efficient to do all the follow-up testing at one time, and recommended test-ing at 6 months after the exposure. Anti-HBs could be measured at a minimum of 4 months after the administration of HBIG, but testing for infection would then follow approximately 2 months later.

Beth


Beth Colbert Moline, MSN, FNP-BC
Nurse Practitioner, Occupational Medicine
National Certified Medical Examiner
WIllamette Valley Medical Center
(503) 435 6586     FAX  (503) 435-6555
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From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Subin, Kenneth MD
Sent: Wednesday, February 11, 2015 9:27 AM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Needlestick/Blood and body fluid exposure Evaluations

Attached are the guidelines we reference.  I believe the PEP line references these as well, unless there is something more updated that I am not aware of.

Ken


Kenneth P. Subin, MD, MPH, CIME, CMRO
Clinical Medical Director
Occupational Medicine
ArnotHealth
Elmira, NY
(607) 737-4539 (p)
(607) 737-7783 (f)



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<mailto: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

[IUPUI_ACR.H]


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