This document summarizes occupational exposures and guidelines for prevention of bloodborne pathogens. It reports that 46.7% of sharp injuries at one hospital were to nursing staff. For HBV, the risk of infection from a sharp exposure to HBsAg-positive blood is 22-31% without vaccination. All healthcare workers should receive the hepatitis B vaccine series. For HCV, the risk of infection from a mucous membrane exposure to an HCV-positive source is 1.8%. For HIV, the risk of infection from a percutaneous exposure to an HIV-positive source is 0.3-0.5%. The document provides post-exposure prophylaxis guidelines for each bloodborne pathogen. It also addresses tuberculosis and varicella

2. Management
of Occupational
Exposures to
HBV, HCV, & HIV

3. Annual Report 2012
Sharp Injuries and Body Fluid Exposure:-
Number Percentage
Physicians 27 36%
Nursing Staff 35 46.7%
Technicians 5 6.6%
HK Staff 8 10.7%
TOTAL 75 ***

4. H B V
Hapedna Virus double stranded DNA

5. Risk for Occupational
Transmission of HBV
►HBsAg& HBeAg-positive blood :
 The risk of developing clinical hepatitis is
22%– 31%;
 The risk of developing serologic evidence of
HBV infection is 37%–62%.
►HBsAg-positive, HBeAg-negative blood
 The risk of developing clinical hepatitis is
1%–6%;
 The risk of developing serologic evidence of
HBV infection is 23%–37%

6. Control of HBV transmission
- All HCW should receive Hepatitis B vaccine
series at 0,1, 6 After 1-2 months check your
immunity .You may be:
 responder (HBs Ab > 10 ml U/ml)
 non-responder (HBs Ab < 10 ml U/ml), receive
Hepatitis B vaccine second series .After 1-2
months check your immunity

7. H C V
Flavi virus.
It is a single stranded RNA

8. Risk for Occupational
transmission of HCV
 HCV-positive source is 1.8% (range: 0%–7%)
rarely occurs from mucous membrane.

9. H I V
Retrovirus with 2 single stranded RNA

10. Risk for Occupational
Transmission of HIV
The risks for occupational transmission of HIV vary
with the type and severity of exposure:
♦ In percutaneous exposure 0.3% ( 0.2%–0.5%)
♦ In mucous membrane exposure,
approximately 0.09% ( 0.006%–0.5%)

11. A percutaneous injury or contact of mucous
membrane or nonintact skin
WITH
 Blood ,tissue and body fluids
 Semen and vaginal secretions ,
 CSF, synovial , pleural , peritoneal , pericardial& amniotic fluid
 Feces, nasal secretions, saliva, sputum, sweat,
tears, urine, and vomitus are not considered
potentially infectious unless they contain blood.
 Contact without barrier protection to concentrated virus in lab
 Human bites: evaluation of HCP + Patient .

12. Treatment of an Exposure
Site
Wash needle stick and cuts with soap and water
 Flush splashes to the nose, mouth, or skin with
water
 Irrigate eyes with clean water, saline
THEN
 Report the incident to your supervisor
 Immediately seek medical treatment

15. Evaluation of the Source
 HEPATITIS B MARKERS
 ANTI- HCV
 ANTI - HIV

16. Evaluation of the HCW
 HEPATITIS B MARKERS
 ANTI- HCV
 ANTI – HIV
 LFT in HCV Source

20. A. HBs Ag +ve source.
a. Unvaccinated HCW
Hepatitis B immunoglobulin (HBIG)
10-12 IU/Kg(500 IU)
+
Hepatitis B vaccine series
≈ PEP should be administered as soon as
possible after exposure(preferably within
24 hours). The effectiveness of HBIG
when administered >7 days after is unknown.

21. b. In previously vaccinated HCW
i. Known responder (HBs Ab > 10 ml U/ml);
no treatment.
ii. If non-responder
HBIG within 24 hours + Hepatitis B
vaccination at the same time.
OR
Second dose of HBIG can be given 1month later.

22. HCV Positive Source
A short course of interferon started
early in the course of acute hepatitis C
is associated with a higher rate of
resolution.

23. ≈ Perform baseline testing for anti-HCV and ALT
≈ Earlier diagnosis of HCV infection is desired,
testing for HCV RNA
(R-T PCR QUALITATIVE AND QUANTITAVE )
≈ Perform follow-up testing (e.g., at 4 & 6 months)
for anti-HCV and ALT .
≈ Confirm all anti-HCV positive results.

24. HIV Positive Source
Several Factors may increase the risk
of transmission:-
a. If HCW is exposed to a large quantity of blood.
b. A procedure that involved a needle is placed
directly in a vein or artery or a deep injury.
c. If the source patient is in the terminal illness.
d. If the injury is deep with hollow-bore needles
or penetrating sharps-related event.

25. PEP in Percutaneous
Exposure
Class 1 asymptomatic HIV infection or known low viral load
(e.g., (<1,500 RNA copies.ml).
Class 2 symptomatic HIV infection, AIDS, acute zero conversion,
or known high viral load.

26. PEP in Mucous Membrane
Exposure
Class 1 asymptomatic HIV infection or known low viral
load (e.g., (<1,500 RNA copies.ml).
Class 2 symptomatic HIV infection, AIDS, acute sero
conversion, or known high viral load.

27. Antiretroviral Agents for PEP
≈ Nucleoside reverse transcriptase inhibitors
(NRTIs).
≈ Nucleotide reverse transcriptase inhibitors
(NtRTIs).
≈ Nonnucleoside reverse transcriptase inhibitors
(NNRTIs),
≈ Protease inhibitors(PIs), and a single fusion
inhibitor.
HIV PEP should regimen
(zidovudine (AZT) + lamivudine (3TC)
complete a full 4-week )

28. HCP Follow-up
≈ Anti- HIV test at 6 weeks, 3 months,
6 months
Extending follow-up to 12 months
≈ EIA standard test
≈ direct virus assays not recommended

29. TUBERCULOSIS
(TB)

30. Involve face –to-face contact with
infectious TB patients :-
a. Entering patient rooms ( patient is present or not).
c. Participating in aerosol-generating procedures.
d. Participating in specimen processing (culture ).
e. Installing, maintaining, or replacing environmental
control in areas in which persons with TB are
encountered

31. TB CONTROL PROGRAM
 Baseline screening should be done at the
time of hire.
A two-step TST should be performed when the initial
TST is negative 1--3 weeks after the first.
  Screen HCP at risk annually (i.e., symptom screen
& TST for HCWs with baseline negative results).
  If the HCP is converter recently, preventive therapy
should be considered.
  Chest radiograph are performed ONLY on those with
recently positive TST and symptomatic.

33. VARICELLA

34. Chicken pox
TRANSMISSION
¤ AIRBORNE
¤ CONTACT
PERIOD OF OMMUNICABILITY
▀ 1 – 2 days before
the rash
▀ 4-5 days after until all
vesicles are crusted

35. Varicella Zoster
 Transmitted by
CONTACT
 COMMUNICABLE
until all vesicles
are crusted

36. Exposure
 A. Varicella:
• Patients in the same room .
• Face to face contact or (5 minutes or more).
• Visit by a contagious person.
 B. Zoster:
Intimate contact (e.g. touching or hugging)
with a contagious person with exposed
zoster lesions.

37.  Vaccine
Given to susceptible contacts within 3 days of exposure
may prevent or significantly modify disease.
 Immunoglobulins VZIG ( within 4days)
 Susceptible immunocompromised patients
 Susceptible pregnant women. (there is no assurance
that VZIG will prevent congenital malformations in
the fetus, but it may modify varicella severity ).
 Sick leave
Remain off work from days 10-21 post exposure