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APPENDIX B. Management of Occupational Blood Exposures
Provide immediate care to the exposure site.
Wash wounds and skin with soap and water.
Flush mucous membranes with water.
Determine risk associated with exposure by
type of fluid (e.g., blood, visibly bloody fluid, other potentially infectious fluid or
tissue, and concentrated virus) and
type of exposure (i.e., percutaneous injury, mucous membrane or nonintact skin
exposure, and bites resulting in blood exposure).
Evaluate exposure source.
Assess the risk of infection using available information.
Test known sources for HBsAg, anti-HCV, and HIV antibody (consider using
rapid testing).
For unknown sources, assess risk of exposure to HBV, HCV, or HIV infection.
Do not test discarded needles or syringes for virus contamination.
Evaluate the exposed person.
Assess immune status for HBV infection (i.e., by history of hepatitis B vaccination
and vaccine response).
Give PEP for exposures posing risk of infection transmission.
HBV: See Table 3.
HCV: PEP not recommended.
HIV: See Table 4 and Table 5.
--- Initiate PEP as soon as possible, preferably within hours of exposure.
--- Offer pregnancy testing to all women of childbearing age not known to be
pregnant.
--- Seek expert consultation if viral resistance is suspected.
--- Administer PEP for 4 weeks if tolerated.
Perform follow-up testing and provide
counseling.
Advise exposed persons to seek medical evaluation for any acute
illness occurring during follow-up.
HBV exposures
Perform follow-up anti-HBs testing in persons who receive hepatitis
B vaccine.
--- Test for anti-HBs 1--2 months after last dose of vaccine.
--- Anti-HBs response to vaccine cannot be ascertained if HBIG was
received in the previous 3--4 months.
HCV exposures
Perform baseline and follow-up testing for anti-HCV and alanine
amino- transferase (ALT) 4--6 months after exposures.
Perform HCV RNA at 4--6 weeks if earlier diagnosis of HCV infection desired.
Confirm repeatedly reactive anti-HCV enzyme immunoassays (EIAs) with
supplemental tests.
HIV exposures
Perform HIV-antibody testing for at least 6 months postexposure (e.g., at
baseline, 6 weeks, 3 months, and 6 months).
Perform HIV antibody testing if illness compatible with an acute retroviral
syndrome occurs.
Advise exposed persons to use precautions to prevent secondary
transmission during the follow-up period.
Evaluate exposed persons taking PEP within 72 hours after exposure and
monitor for drug toxicity for at least 2 weeks.
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