eMedicine Specialties > Emergency Medicine > Infectious Diseases

Body Fluid Exposures: Differential Diagnoses & Workup

Author: Darrell G Looney, MD, FAAEM, Attending Physician, Department of Emergency Medicine, Long Island College Hospital
Coauthor(s): Peter B Richman, MD, Consulting Staff, Department of Emergency Medicine, Morristown Memorial Hospital; Richard Dee Shih, MD, Associate Professor, Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey; Program Director, Department of Emergency Medicine, Morristown Memorial Hospital; Attending Physician, New Jersey Poison Center, Newark Beth Israel Medical Center;
Contributor Information and Disclosures

Updated: Nov 11, 2009

Differential Diagnoses

Hepatitis
HIV Infection and AIDS
Sexual Assault
Workers' Compensation

Other Problems to Be Considered

OSHA regulations
Safety issues

Workup

Laboratory Studies

  • Testing for HBV, HCV, and HIV is recommended at the time of injury. This is useful, primarily as baseline evaluation, because patients would not have undergone seroconversion in such a short time frame. Testing to determine the HBV, HCV, and HIV infectious status of the source patient is recommended only if the source individual consents. Under no circumstances should a source patient be tested in the absence of consent because of the obliged consultation and treatment constraints should the result return positive. In many institutions, using surrogate consent is acceptable in cases in which patients cannot consent to the evaluation themselves. This may involve family members, legal guardians, or 2 consenting attending physicians. Regardless, a cogent plan of action and response is necessary should the result be affirmative.
  • Many clinicians obtain routine laboratory evaluations, such as a complete blood cell count and chemistries, which likely are not of much value acutely. However, sending rapid plasma reagent (RPR) and human chorionic gonadotropin (if pregnancy status is unknown) would be prudent because their prognostic value can be reasonably high in these cases.

Imaging Studies

  • Acutely, imaging studies are of little use unless the presence of a foreign body or radiopaque material is suspected.

Procedures

  • The single most pertinent procedure to undertake in the patient after exposure is lavage. Copious amounts of irrigation fluid are appropriate in cases of mucosal exposure (ocular and oral), as well as soap and water washing in cases of needlestick injury. Although no regimen has been shown to affect viral transmission rates, this is an empiric regimen aimed at decreasing the level of exposure to the viral agent and, thereby, decreasing the associated risk of transmission.

More on Body Fluid Exposures

Overview: Body Fluid Exposures
Differential Diagnoses & Workup: Body Fluid Exposures
Treatment & Medication: Body Fluid Exposures
Follow-up: Body Fluid Exposures
Multimedia: Body Fluid Exposures
References
[ CLOSE WINDOW ]

References

  1. 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].

  2. 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].

  3. [Guideline] US Public Health Service. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis. MMRW Recomm Rep. Sept 30 2005;54(RR09):1-17. [Full Text].

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

  5. [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].

  6. [Guideline] CDC. Protection against viral hepatitis. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Recomm Rep. Feb 9 1990;39(RR-2):1-26. [Medline].

  7. [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(RR-7):1-33. [Medline].

  8. 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].

  9. 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].

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

  11. 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].

  12. 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].

  13. 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].

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

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

  16. 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].

  17. 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].

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

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

occupational exposure to disease, postexposure prophylaxis, exposure to HIV, needlestick, needlestick injury, body fluid exposures, splash exposures, mucous membrane exposures, sharps injury, hepatitis B virus, HBV, hepatitis C virus, HCV, human immunodeficiency virus, HIV

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Darrell G Looney, MD, FAAEM, Attending Physician, Department of Emergency Medicine, Long Island College Hospital
Darrell G Looney, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and National Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Peter B Richman, MD, Consulting Staff, Department of Emergency Medicine, Morristown Memorial Hospital
Peter B Richman, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Richard Dee Shih, MD, Associate Professor, Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey; Program Director, Department of Emergency Medicine, Morristown Memorial Hospital; Attending Physician, New Jersey Poison Center, Newark Beth Israel Medical Center;
Richard Dee Shih, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.