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How to Protect Yourself after Body Fluid Exposure By Andine Davenport, RN, COHN-S, and Frank Myers, CIC, MA Nursing2009, May 2009 2.5 ANCC contact hours.

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Presentation on theme: "How to Protect Yourself after Body Fluid Exposure By Andine Davenport, RN, COHN-S, and Frank Myers, CIC, MA Nursing2009, May 2009 2.5 ANCC contact hours."— Presentation transcript:

1 How to Protect Yourself after Body Fluid Exposure By Andine Davenport, RN, COHN-S, and Frank Myers, CIC, MA Nursing2009, May ANCC contact hours Online: © 2009 by Lippincott Williams & Wilkins. All world rights reserved

2 Accidental exposure  To blood or other potentially infectious material (OPIM)  Examples of OPIM - spinal, pleural fluid  Examples of bloodborne and OPIM pathogens - HIV, hepatitis B and C

3 Postexposure prophylaxis (PEP)  Exists for HIV and hepatitis B (HBV)  Not for hepatitis C (HCV)  HCV is the most common chronic bloodborne infection in the U.S. (approx. 3.2 million people)

4 Defining terms  Source - the patient whose blood or OPIM has come in contact with a healthcare worker  Exposed - the healthcare worker  Exposure - contact with OPIM  In some cases, both healthcare worker and patient are considered exposed when blood may “mingle,” such as in sharps injury

5 After an exposure: What’s your risk? HIV transmission  Contracting HIV from accidental occupational exposure is quite rare, as seen by seroconversion rates: - sharps injury, 0.3%, or 1 in mucous membrane exposure, 0.09%, or 1 in 1,000 - exposure to nonintact skin, lower than risk for mucous membrane exposure

6 After an exposure: What’s your risk?  From 1981 to 2006, CDC documented 57 cases of HIV/AIDS among healthcare personnel following occupational HIV exposure and identified additional 140 “possible” cases (included 24 documented and 35 possible cases of occupationally acquired HIV infection among nurses)

7 After an exposure: What’s your risk? HBV transmission  Risk of susceptible person developing clinical HBV following exposure ranges from 1% to 31%, depending on source person’s HBV status  HBV can remain infectious on environmental surfaces for over a week, even in dried blood

8 After an exposure: What’s your risk?  OSHA regulations require offering HBV vaccine to healthcare workers who may be exposed to blood or OPIM on the job  Some healthcare workers don’t accept vaccine or complete vaccine series; others who are properly vaccinated don’t mount an immune response

9 After an exposure: What’s your risk? HCV transmission  Risk of HCV transmission after percutaneous exposure is about 1.8%  Virus can remain viable in environment 16 hours to 4 days; HCV transmission via environment isn’t considered significant risk in healthcare settings (possible exception: hemodialysis units)

10 Classifying potentially infectious body fluids  Blood and any visibly bloody body fluids considered potentially infectious under OSHA guidelines. Other OPIM include: - semen and vaginal secretions - cerebrospinal fluid - synovial fluid - pleural fluid - peritoneal fluid

11 Classifying potentially infectious body fluids - pericardial fluid - amniotic fluid  Materials not considered OPIM include feces, urine, vomitus, nasal secretions, saliva (except during dental procedures), sputum, sweat, tears

12 How to respond  Follow facility policy, based on OSHA, CDC, HIPAA guidelines  Remain calm  If needlestick or puncture injury, or fluids in contact with intact skin, wash area with soap and water

13 How to respond  In case of mucous membrane exposure, rinse area with copious amounts of saline or water  If involves eyes, wash eyes with commercially prepared isotonic solution (eye station) or clean water  Flush splashes to nose, mouth, or skin with water

14 How to respond  Seek further care immediately  Complete an event report  The source must be identified using two patient identifiers

15 Is PEP indicated?  Determine if true exposure to blood or OPIM has occurred  Determine if blood or OPIM has a portal of entry  Evaluate the source

16 Evaluating the source  If source’s HIV, HBV, HCV status is unknown, testing can be initiated  Your facility policy and CDC guidelines address informed consent issue  CDC recommends eliminating second form requirement for HIV testing (California still requires)

17 HIV testing  Rapid HIV test provides results in 20 to 40 minutes  PEP should be administered within 2 hours of exposure  If positive, should be confirmed with more definitive testing

18 HBV and HCV Testing  Never require separate consent form  Blood already drawn from source can be tested  Patient may refuse additional blood drawn  Anyone vaccinated against HBV and developed an immune response is considered to have no risk of contracting

19 HBV and HCV testing  HBV panel for sources varies among facilities  Surface antigen (HBsAg) is standard  HCV testing: anti-HCV has high false- positive rate  Preferred HCV test is recombinant immunoblot assay HCV RNA

20 Assess and test exposed person  Baseline assessment to include history: - current pregnancy or breast feeding - medication reconciliation - HBV vaccination history - liver or kidney problems - depression or insomnia - pancreatitis or anemia - any other information that affects risk of infection

21 Assess and test exposed person  Exposed has right to accept or refuse further testing; refusing could jeopardize worker’s compensation  If immunized with HBV and tested for immunity, no further action required

22 Assess and test exposed person  If not tested for immunity, HBsAb and HbsAg administered; consult occupational health if additional doses needed  Hepatitis C testing should be done with serum liver enzyme levels as soon as possible after exposure

23 Follow-up care for exposed  Anyone exposed to HIV, HCV should have follow-up testing, counseling, and medical evaluation at intervals recommended by CDC  If results negative, no follow-up needed  CDC doesn’t recommend follow-up after PEP for HBV unless exposed develops signs and symptoms of hepatitis

24 PEP for HIV  If rapid HIV test positive, confirming test (remind exposed about false-positives)  Exposed has decision to make regarding receiving PEP for HIV; lasts 30 days and has adverse reactions  Clinicians advised to call National Clinicians’ Postexposure Hotline ( ) for advice before proceeding

25 Teaching about PEP for HIV  Inform of adverse reactions: nausea, diarrhea, abdominal pain, anemia, neutropenia  Help manage adverse reactions  Provide resources to answer questions

26 Teaching about PEP for HIV  Instruct regarding blood tests for toxic drug levels  Instruct testing will include blood cell count, liver and renal functions at 2 weeks  If taking protease inhibitor, teach signs and symptoms of hyperglycemia

27 Teaching about PEP for HIV  Pregnant or breastfeeding women should not take indinavir  Stress importance of completing regimen  Alert patient to contact healthcare provider about adverse reactions

28 PEP for HBV exposure  Exposed persons should be offered hepatitis B immunoglobulin (HBIG) and HBV vaccine  HBIG most effective when given within 24 hours of exposure  Instruct exposed not to donate blood, organs, tissues, semen until 6 month follow-up is complete

29 Testing positive for HCV  CDC guidelines recommend exposed be followed for 4 to 6 months  No PEP regimen available  Immunoglobulin and antiviral drugs not recommended

30 Prevention is best policy  Learn your facility’s infection control standards  Follow them


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