eMedicine Specialties > Emergency Medicine > Infectious Diseases

Body Fluid Exposures: Follow-up

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

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

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

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.