Potential exposure to blood born viruses

---

 

Any patients or healthcare workers exposed to body fluids (blood, CSF, semen, vaginal secretion, amniotic fluid) or blood stained urine, faeces or vomitus should be assessed for risk of acquiring infections.

The commonest viral agents that transmit in this route are

1.      HIV

2.      Hepatitis B

3.      Hepatitis C

Important incidents in the transmission of these viruses

• Sharing the same needle (intravenous drug users)

• Needle stick/ sharp injuries

• Splash (amniotic fluid) during deliver

• Sexual intercourse including rape

• Delivery

• Breast feeding (not for Hepatitis C)

• Blood transfusion

 

Assessment

The source

 Is he/she known to be infected with these viruses?

 Does he/ she have behaviours that increases the likelihood of being infected?

Are there any signs of hepatitis or AID defining illnesses?

Is it possible to test the source?

 

Exposure

Exposure to intact skin- no risk of transmission

Exposure to conjunctivae or mucous membranes- potential risk

Exposure to broken skin – potential risk

 

The recipient

Is there any injury to the skin?

Has she/he been vaccinated for Hepatitis B?

Is she pregnant?

Is she/he taking any medication?

 

Investigations

If the recipient is going to take post-exposure prophylaxis for HIV, test for

• CBC

• LFT

• Urea and electrolytes.

 

Tests

Source

No risk- investigation is not required.

 

Source

Risk- investigate the source for Hepatitis B, Hepatitis C and HIV

If not possible to test the source, the recipient should be managed as if he/ she is exposed to the three viruses.

 

Recipient

Blood should be taken from the recipient and stored.

 

Warning

Do not test without consent.

Do not test body fluid or blood obtained from discarded needle.

 

Management of patients exposed to blood borne viruses (PDF)

 

Management

• Wash with soap and water

• Clean with alcohol

• Wash the mucous membrane or conjunctivae with distilled water or tap water

• Encourage bleeding.

 

If source known to be positive for

1. HIV- start anti-retroviral therapy as post- exposure prophylaxis

2. Hepatitis B- Accelerated course of hepatitis B vaccine ( at 0,1,2 and booster at 6 or 12 months). If the source is known to be HB e Ag positive,  Hepatitis B specific immunoglobulin should be given

3. Hepatitis C- there is no prophylaxis but consider treating it with interferon alpha if seroconvert.

 

If the status of the source is not known manage as if exposed to these virus

 

Follow up

1. Look for

HIV- Seroconversion illness- fever, sore throat, lymphadenopathy, skin rash

Hepatitis B or C- increase in transaminase level or signs and symptoms of hepatitis

 

    2. Investigation

If the source is found to be negative for all these viruses the recipient can be considered to be at low risk of acquiring infection and follow up may not be required. However if the source is found to be positive to any of these viruses the recipient should be tested at 6, 12 or 24 weeks for antibodies or RNAs  by PCR.