Body Fluid Exposures Clinical Presentation

  • Author: Nathalie Mathieu, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Aug 25, 2010
 

History

Patients present with a history of exposure. Typically, this is a splash-type exposure to mucosal or nonintact skin or a needlestick injury to intact skin. Patients may often report exposures to intact keratinized skin out of uninformed concern, or they are aware of some preexisting injury and may be predisposed to infection. Reassurance through awareness of the risks for viral transmission in various scenarios is of significant importance to both the health care provider and the patient.

Health care personnel includes employees, volunteers, attending clinicians, students, contractors, and any public safety workers whose activities involve contact with patients and their environment such that exposure to blood or other body fluids can occur.

Non–health care personnel may be exposed by way of social interaction, sexual encounters, trauma scenarios, or intentional inoculations consistent with contemporary terrorist activity. Note that any postexposure program that does not provide for management and follow-up of nonhospital personnel is woefully inadequate for the needs of a given community.

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Physical

During the physical examination, be sure to assess body area of exposure and depth of any wounds. The neurovascular status in the setting of extremity wounds is an important and often omitted element. The clinician should remain suspicious of occult injury, such as paper cuts or abrasions, which may threaten the integrity of the skin. For mucosal exposures, especially on the face, keep in mind that the exposure may not be limited to only one area, and it may occur simultaneously in nasal, mucosal, and conjunctival mucosae.

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Causes

Most exposures are the result of a departure from universal precautions on some level—whether it is the result of recapping, failure to use personal protective equipment, or the unintentional sharp left in an inappropriate container for disposal. When dealing with blood and body fluid exposures, document whether the exposure represents a departure from universal precautions, Occupational Safety and Health Administration (OSHA) standards, or a true accident (eg, projectile vomiting, precipitous labor with spontaneous rupture of membranes). This information is vital to the institutional safety committee whose function is to monitor the safety of the environment for the entire facility and make recommendations for upgrades and changes in policy.

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Contributor Information and Disclosures
Author

Nathalie Mathieu, MD  Resident Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Joel R Gernsheimer, MD, FACEP  Visiting Associate Professor, Department of Emergency Medicine, Attending Physician and Director of Geriatric Emergency Medicine, State University of New York Downstate Medical Center

Joel R Gernsheimer, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Samuel M Keim, MD  Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Barry J Sheridan, DO  Chief, Department of Emergency Medical Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Simard EP, Miller JT, George PA, et al. Hepatitis B vaccination coverage levels among healthcare workers in the United States, 2002-2003. Infect Control Hosp Epidemiol. Jul 2007;28(7):783-90. [Medline]. [Full Text].

  2. Kamili S, Krawczynski K, McCaustland K, Li X, Alter MJ. Infectivity of hepatitis C virus in plasma after drying and storing at room temperature. Infect Control Hosp Epidemiol. May 2007;28(5):519-24. [Medline].

  3. van Tongeren M, Mee T, Whatmough P, Broad L, Maslanyj M, Allen S. Assessing occupational and domestic ELF magnetic field exposure in the uk adult brain tumour study: results of a feasibility study. Radiat Prot Dosimetry. 2004;108(3):227-36. [Medline]. [Full Text].

  4. New York State Department of Health AIDS Institute. Recommendations for HIV Postexposure Prophylaxis (PEP). 2008. Available at http://www.hivguidelines.org.

  5. Henderson DK, Fahey BJ, Willy M, Schmitt JM, Carey K, Koziol DE. Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures. A prospective evaluation. Ann Intern Med. Nov 15 1990;113(10):740-6. [Medline].

  6. [Guideline] Panlilio AL, Cardo DM, Grohskopf LA, Heneine W, Ross CS. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep. Sep 30 2005;54:1-17. [Medline].

  7. Merchant RC, Nettleton JE, Mayer KH, Becker BM. Blood or body fluid exposures and HIV postexposure prophylaxis utilization among first responders. Prehosp Emerg Care. Jan-Mar 2009;13(1):6-13. [Medline].

  8. National Institutes of health consensus development conference statement: management of hepatitis C. June 10-12, 2002. Available at http://consensus.nih.gov/2002/2002hepatitisc2002116html.htm.

  9. Landovitz RJ, Currier JS. Clinical practice. Postexposure prophylaxis for HIV infection. N Engl J Med. Oct 29 2009;361(18):1768-75. [Medline].

  10. [Guideline] Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. Oct 25 2002;51:1-45, quiz CE1-4. [Medline].

  11. Mallin R, Sinclair D. Needlestick injuries and potential body fluid exposure in the emergency department. CJEM. Jan 2003;5(1):36-7. [Medline]. [Full Text].

  12. Nguyen CT, Tran TT. Hepatitis vaccination and prophylaxis. Clin Liver Dis. May 2009;13(2):317-29. [Medline].

  13. Alter MJ. Occupational exposure to hepatitis C virus: a dilemma. Infect Control Hosp Epidemiol. Dec 1994;15(12):742-4. [Medline].

  14. [Guideline] CDC. Guidelines for prevention of transmission of human immunodeficiency virus and hepatitis B virus to health-care and public-safety workers. MMWR Morb Mortal Wkly Rep. Jun 23 1989;38 Suppl 6:1-37. [Medline].

  15. [Guideline] CDC. Protection against viral hepatitis. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Recomm Rep. Feb 9 1990;39:1-26. [Medline].

  16. [Guideline] CDC. Public Health Service guidelines for the management of health-care worker exposures to HIV and recommendations for postexposure prophylaxis. Centers for Disease Control and Prevention. MMWR Recomm Rep. May 15 1998;47:1-33. [Medline].

  17. Gerberding JL, Henderson DK. Management of occupational exposures to bloodborne pathogens: hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. Clin Infect Dis. Jun 1992;14(6):1179-85. [Medline].

  18. Kiyosawa K, Sodeyama T, Tanaka E, et al. Hepatitis C in hospital employees with needlestick injuries. Ann Intern Med. Sep 1 1991;115(5):367-9. [Medline].

  19. Lanphear BP. Trends and patterns in the transmission of bloodborne pathogens to health care workers. Epidemiol Rev. 1994;16(2):437-50. [Medline].

  20. Marcus R. Surveillance of health care workers exposed to blood from patients infected with the human immunodeficiency virus. N Engl J Med. Oct 27 1988;319(17):1118-23. [Medline].

  21. Mast ST, Woolwine JD, Gerberding JL. Efficacy of gloves in reducing blood volumes transferred during simulated needlestick injury. J Infect Dis. Dec 1993;168(6):1589-92. [Medline].

  22. Mauskopf JA, Bradley CJ, French MT. Benefit-cost analysis of hepatitis B vaccine programs for occupationally exposed workers. J Occup Med. Jun 1991;33(6):691-8. [Medline].

  23. Merchant RC, Becker BM, Mayer KH, Fuerch J, Schreck B. Emergency department blood or body fluid exposure evaluations and HIV postexposure prophylaxis usage. Acad Emerg Med. Dec 2003;10(12):1345-53. [Medline].

  24. Jagger J. Risky procedures, risky devices, risky job. Adv in Exposure Prev. 1994;1:4-6.

  25. Robert LM, Bell DM. HIV transmission in the health-care setting. Risks to health-care workers and patients. Infect Dis Clin North Am. Jun 1994;8(2):319-29. [Medline].

  26. Stewardson DA, Burke FJ, Elkhazindar MM, et al. The incidence of occupational exposures among students in four UK dental schools. Int Dent J. Feb 2004;54(1):26-32. [Medline].

  27. Vu T. Standardization of Body Surface Area Calculations. 1999. halls.md. Available at http://www.halls.md/bsa/bsaVuReport.htm.

 
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Flowsheet for management of blood/body fluid exposures.
 
 
 
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