eMedicine Specialties > Emergency Medicine > Infectious Diseases
Body Fluid Exposures: Follow-up
Updated: Nov 11, 2009
Follow-up
Further Inpatient Care
- If the source patient is positive for HBV, HCV, and/or HIV, repeatedly test the exposed caregiver at timed intervals of 0, 3 months, and 6 months. This requires close and reliable follow-up mechanisms, such as Occupational Health Services or primary care physicians.
Deterrence/Prevention
- OSHA standards are to be encouraged and reinforced by all hospital employees consistently because prevention is the single best weapon against blood/body fluid exposures.
- The following universal precautions should be followed in all patient contact situations:
- Wash hands between care of each patient.
- Use gloves when handling body fluids or performing procedures where exposure is possible, including contact with mucous membranes.
- Use protective gowns, eyewear, and masks during procedures when risk of splash or spray of body fluids exists.
- Never recap needles. If recapping is necessary, the cap should not be held by hand, rather lay the cap on a firm surface and insert the needle. Then, the entire system is lifted, and the cap is secured in place.
- OSHA requirements are now moving toward needleless and needlestick prevention systems as basic requirements in health care facilities. Institutions must evaluate these systems and employ those that function best within their departments.
- Wearing gloves may reduce (>50%) the volume of blood introduced through the injury.
Complications
- Infection is still a significant concern at any given exposure, especially those involving disruption of the normal integumentary barrier. Antibiotic prophylaxis should be considered.
Prognosis
- Prognosis is associated with risk of infection and its sequelae. This is difficult to specify in any given patient. However, given the risk of HIV transmission of less than 1%, the prognosis of any given exposed patient may be listed as good but may only remain so with vigilant follow-up and consistent use of prophylaxis against infection.
Patient Education
- For excellent patient education resources, visit eMedicine's Public Health Center and Sexually Transmitted Diseases Center. Also, see eMedicine's patient education articles Hepatitis B, Hepatitis C, and HIV/AIDS.
Miscellaneous
Medicolegal Pitfalls
- Failure to provide appropriate counseling and HBV/HIV prophylaxis when indicated could leave the ED physician vulnerable to adverse liability if the injured patient seroconverts. This is of paramount importance, not just medicolegally, but also in terms of the overall management of the blood/body fluid exposed individual. These efforts serve to "close the loop" in the quest to eliminate preventable occurrences. Still, one of the greatest difficulties remains in "making the call" as to whether an exposure warrants prophylaxis or not. While leaving the decision up to the patient will result in a higher than necessary rate of medication dispensing, until methods of HIV detection and management can provide both more timely and greater levels of reassurance, this will likely remain the course most practitioners will take.
More on Body Fluid Exposures |
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| Differential Diagnoses & Workup: Body Fluid Exposures |
| Treatment & Medication: Body Fluid Exposures |
Follow-up: Body Fluid Exposures |
| Multimedia: Body Fluid Exposures |
| References |
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References
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Risky procedures, risky devices, risky job. Adv in Exposure Prev. 1994;1:4-6.
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Vu T. Standardization of Body Surface Area Calculations. halls.md. Available at http://www.halls.md/bsa/bsaVuReport.htm.
Further Reading
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
Follow-up: Body Fluid Exposures