Needlestick injuries and post-exposure prophylaxis - Revision history

Aidan at 19:19, 6 August 2024

2024-08-06T19:19:12Z

← Older revision		Revision as of 19:19, 6 August 2024
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	{\| class="wikitable"		{\| class="wikitable"
			! colspan="3" \|Exposed
⚫	!Status ~~(exposed)~~
			!Source
	!HBsAb (exposed)
			! rowspan="2" \|Action
	!HBsAg (source)
	!Action
	\|-		\|-
		⚫	!Status
	\|Unvaccinated
			!No. Doses
			!HBsAb
			!HBsAg
			\|-
			\| colspan="2" rowspan="3" \|unvaccinated or unknown
	\|≥10		\|≥10
	\|any		\|any
	\|no further action		\|no further action
	\|-		\|-
			\| rowspan="2" \|<10
	\|Unvaccinated
⚫	\|~~<~~10
	\|negative		\|negative
			\|start vaccine series
	\|vaccinate
	\|-		\|-
	\|Unvaccinated
⚫	\|~~<~~10
	\|positive or unknown		\|positive or unknown
	\|HBIG x1 and ~~vaccinate~~		\|HBIG and start vaccine series
	\|-		\|-
			\| rowspan="8" \|vaccinated
	\|Vaccinated
			\| rowspan="3" \|3
	\|≥10		\|≥10
	\|any		\|any
	\|no further action		\|no further action
	\|-		\|-
			\|unknown after 48 hours
	\|Vaccinated x1
			\| rowspan="2" \|positive or unknown
	\|<10
			\|vaccinate immediately, HBIG based on titres if within 7 days
	\|negative
	\|vaccinate
	\|-		\|-
		⚫	\|<10
	\|Vaccinated x2+
			\|HBIG and start a second vaccine series
	\|<10
	\|negative
	\|no further action
	\|-		\|-
			\|3 x2 series
	\|Vaccinated x1
	\|~~<~~10		\|<10
	\|positive or unknown		\|positive or unknown
	\|HBIG ~~x1,~~ ~~vaccinate~~		\|HBIG q4wk x2 doses
	\|-		\|-
			\| rowspan="3" \|2
	\|Vaccinated x2+
			\|≥10
	\|<10
	\|positive or unknown		\| rowspan="3" \|positive or unknown
	\|~~HBIG~~ x2 ~~q1mo~~		\|give 3rd dose
	\|-		\|-
			\|unknown after 48 hours
	\|Vaccinated
			\|HBIG and give 3rd dose
	\|unknown
	\|any
	\|measure levels, treat before results
	\|-		\|-
		⚫	\|<10
	\|Undervaccinated
			\|HBIG and give 3rd dose
	\|any
	\|negative
	\|vaccinate
	\|-		\|-
			\|1
	\|Undervaccinated
	\|any		\|any
	\|positive or unknown		\|positive or unknown
	\|HBIG ~~x1,~~ ~~vaccinate~~		\|HBIG and start vaccine series
	\|}		\|}

Aidan: /* Estimated risk of transmission */

2020-09-14T17:58:44Z

Estimated risk of transmission

Show changes

Aidan: /* Non-occupational exposures */

2020-04-02T01:17:42Z

Non-occupational exposures

← Older revision		Revision as of 01:17, 2 April 2020
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	==== Non-occupational exposures ====		==== Non-occupational exposures ====

	[[File:image-20190625174913194.png\|image-20190625174913194]]

	* PEP is '''not''' needed for:		* PEP is '''not''' needed for:

Aidan: /* Presence of sexually transmitted infections (in cases of sexual exposures) */

2019-12-20T17:50:48Z

Presence of sexually transmitted infections (in cases of sexual exposures)

← Older revision		Revision as of 17:50, 20 December 2019
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	** negative with risk factors (e.g. men who have sex with men, multiple sexual partners, people who inject drugs)		** negative with risk factors (e.g. men who have sex with men, multiple sexual partners, people who inject drugs)

	=== Presence of sexually transmitted infections ~~(in cases of sexual exposures)~~ ===		=== Presence of sexually transmitted infections ===

			* in cases of sexual exposure
	* in both the source and exposed patient		* in both the source and exposed patient

Aidan: /* Estimated risk of transmission */

2019-08-16T00:03:53Z

Estimated risk of transmission

← Older revision		Revision as of 00:03, 16 August 2019
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	! Prob. per act (95% CI)		! Prob. per act (95% CI)
	\|-		\|-
	\| '''Parenteral'''		\| colspan="2" \| '''Parenteral'''
	\|
	\|-		\|-
	\| Blood transfusion		\| Blood transfusion
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	\| 0.23% (0-0.46%)		\| 0.23% (0-0.46%)
	\|-		\|-
	\| '''Sexual Exposure'''		\| colspan="2" \| '''Sexual Exposure'''
	\|
	\|-		\|-
	\| Receptive anal intercourse		\| Receptive anal intercourse

Aidan: /* Estimated risk of transmission */

2019-08-16T00:02:00Z

Estimated risk of transmission

← Older revision		Revision as of 00:02, 16 August 2019
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	* HIV: 0.23% (0.1% for mucous membrane exposure)		* HIV: 0.23% (0.1% for mucous membrane exposure)

			{\| class="wikitable"
	{\|
	! Exposure		! Exposure
	! Prob. per act (95% CI)		! Prob. per act (95% CI)

Aidan: /* Hepatitis C exposure */

2019-08-16T00:01:48Z

Hepatitis C exposure

← Older revision		Revision as of 00:01, 16 August 2019
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	** HBsAb 1-2 months after completing the vaccine series (or 6 months after, if they received HBIg)		** HBsAb 1-2 months after completing the vaccine series (or 6 months after, if they received HBIg)

	== Hepatitis C ~~exposure~~ ==		== Hepatitis C Exposure ==

	* No prophylaxis		* No prophylaxis

Aidan: /* Management */

2019-08-16T00:01:39Z

Management

← Older revision		Revision as of 00:01, 16 August 2019
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	* May include HBIG and vaccination for those who are not immune or are of unknown status		* May include HBIG and vaccination for those who are not immune or are of unknown status

			{\| class="wikitable"
	{\|
	! Status (exposed)		! Status (exposed)
	! HBsAb (exposed)		! HBsAb (exposed)

Aidan: /* Hepatitis B exposure */

2019-08-16T00:01:27Z

Hepatitis B exposure

← Older revision		Revision as of 00:01, 16 August 2019
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	*** Gonorrhea and chlamydia cultures/NAAT from throat, vagina, rectum, and urine, as indicated		*** Gonorrhea and chlamydia cultures/NAAT from throat, vagina, rectum, and urine, as indicated

	== Hepatitis B ~~exposure~~ ==		== Hepatitis B Exposure ==

	* Depends on the vaccination and antibody status of the exposed individual as well as the serologic status of the source		* Depends on the vaccination and antibody status of the exposed individual as well as the serologic status of the source

Aidan: /* Procedure */

2019-08-16T00:01:13Z

Procedure

← Older revision		Revision as of 00:01, 16 August 2019
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	== ~~Procedure~~ ==		== Assess Exposure Risk ==

	=== Assess exposure risk ===

	Many factors contribute to the risk of transmission of a blood borne pathogen, including the type of body fluid involved, the type of injury that occurred, the size of the inoculum, and the attributes of the source and exposed patient. All of the following information should be obtained and recorded.		Many factors contribute to the risk of transmission of a blood borne pathogen, including the type of body fluid involved, the type of injury that occurred, the size of the inoculum, and the attributes of the source and exposed patient. All of the following information should be obtained and recorded.
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	The risk of transmission to receptive partner increases with ejaculation, presence of ulcers and sexually transmitted infections in the mucous membrane (oral, genital, rectal), and high viral load in the source (e.g. acute or late-stage disease).		The risk of transmission to receptive partner increases with ejaculation, presence of ulcers and sexually transmitted infections in the mucous membrane (oral, genital, rectal), and high viral load in the source (e.g. acute or late-stage disease).

	=== Perform ~~baseline~~ ~~testing~~ ===		== Perform Baseline Testing ==

	Since serologic testing of the source patient is the most reliable method to assess the risk of exposure, this is strongly recommended. Ascertain if the exposed individual is willing to be tested for antibody to hepatitis B, hepatitis C, and HIV. If the exposed individual is not willing to be tested, do not test the source patient unless they have a separate indication for testing.		Since serologic testing of the source patient is the most reliable method to assess the risk of exposure, this is strongly recommended. Ascertain if the exposed individual is willing to be tested for antibody to hepatitis B, hepatitis C, and HIV. If the exposed individual is not willing to be tested, do not test the source patient unless they have a separate indication for testing.
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	*** Gonorrhea and chlamydia cultures/NAAT from throat, vagina, rectum, and urine, as indicated		*** Gonorrhea and chlamydia cultures/NAAT from throat, vagina, rectum, and urine, as indicated

	=== Hepatitis B exposure ===		== Hepatitis B exposure ==

	* Depends on the vaccination and antibody status of the exposed individual as well as the serologic status of the source		* Depends on the vaccination and antibody status of the exposed individual as well as the serologic status of the source
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	* Can give a second 3-dose series if they are a non-responder after the first course		* Can give a second 3-dose series if they are a non-responder after the first course

	==== Counselling and follow-up ====		=== Counselling and follow-up ===

	* Counselled on signs and symptoms of hepatitis within the next 6 weeks to 6 months		* Counselled on signs and symptoms of hepatitis within the next 6 weeks to 6 months
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	** HBsAb 1-2 months after completing the vaccine series (or 6 months after, if they received HBIg)		** HBsAb 1-2 months after completing the vaccine series (or 6 months after, if they received HBIg)

	=== ~~HCV~~ exposure ===		== Hepatitis C exposure ==

	* No prophylaxis		* No prophylaxis
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	* Follow HCV antibody at 3 and 6 months if source is HCV positive or unknown		* Follow HCV antibody at 3 and 6 months if source is HCV positive or unknown

	=== HIV exposure ===		== HIV exposure ==

	=== Indications for PEP ===		=== Indications for PEP ===