TABLE 50.5.

Factors to Consider in Assessing the Need for Follow-Up After Occupational Exposure

Type of Exposure

•Percutaneous injury •Mucous membrane exposure •Nonintact skin exposure •Bites resulting in blood exposure to either person involved

Type and Amount of Fluid/Tissue

•Blood •Fluids containing blood •Potentially infectious fluid or tissue •Direct contact with concentrated virus

Infection Status of Source Patient

•If positive for HBsAg testing for exposed person's vaccination status. •If positive for HCV antibody, consider measuring HCV viral load. •If positive for HIV antibody, consider obtaining HIV viral load testing, and evaluating clinical status of patient.

Susceptibility of Exposed HCP

•Hepatitis B vaccine and vaccine response status •HBV, HCV, and HIV status—baseline testing for HbsAb, anti-HCV, and HIV antibody should be completed as early as possible (preferably within 72 hours)

Accessibility of PEP and Follow-Up

•PEP should be initiated within 2 hours of the exposure. •The eficacy of PEP initiation is thought to diminish after 24 to 36 hours following an exposure.

Laboratory Tests Used for Evaluation

•If the fourth-generation combination HIV Ag/Ab assay is used to test the source patient, HIV follow-up testing can be completed 4 months after exposure.

HBV, hepatitis B virus; HBsAb, hepatitis B surface antigen; HCV, hepatitis C virus; HIV, human immunodeficiency virus; PEP, postexposure prophylaxis.

From Mountain Plains AIDS Education and Training Center. PEP Steps, A Quick Guide to Postexposure Prophylaxis in the Health Care Setting (April 2006); PEP Steps: A Quick Guide to Postexposure Prophylaxis in the Health Care Setting (March 2014).