Module 12Module 12Bloodborne Pathogens and the

Dental Health Care WorkerBloodborne Pathogens and the

Dental Health Care Worker

Bloodborne Pathogens and Bloodborne Pathogens and the Dental Health Care Workerthe Dental Health Care Worker

Christine Wisnom, RN, BSNurse Educator

Dental School

University of Maryland Baltimore

Helene Bednarsh, RDH, MPHDirector, HIV Dental Ombudsperson Program

Boston Public Health Commission

Kathy Eklund, RDH, MPHThe Forsyth Institute

Boston, Massachusetts

Christine Wisnom, RN, BSNurse Educator

Dental School

University of Maryland Baltimore

Helene Bednarsh, RDH, MPHDirector, HIV Dental Ombudsperson Program

Boston Public Health Commission

Kathy Eklund, RDH, MPHThe Forsyth Institute

Boston, Massachusetts

Updated Postexposure Protocols for HBV, HCV, HIV & Special Circumstances

MMWR, CDC, 6-01,Vol. 50,RR-11

• HIV • Hepatitis C • Hepatitis B• Pregnancy• Delayed exposure report• Unknown donor exposure• Source patient drug resistant • Human bite protocols

• HIV • Hepatitis C • Hepatitis B• Pregnancy• Delayed exposure report• Unknown donor exposure• Source patient drug resistant • Human bite protocols

Objectives CategoriesObjectives CategoriesObjectives CategoriesObjectives Categories

Prevention

Planning

Identification

Implementation

Evaluation

Prevention

Planning

Identification

Implementation

Evaluation

Objectives-PreventionObjectives-Prevention

Prevention is best strategy to avoid infection

Prevent HBV infection by HBV vaccine Prevent HBV transmission by HBV PEP Prevent HIV infection by timely HIV PEP Prevent injury through utilization of “safe

sharps”, auto-recapping devices

Prevention is best strategy to avoid infection

Prevent HBV infection by HBV vaccine Prevent HBV transmission by HBV PEP Prevent HIV infection by timely HIV PEP Prevent injury through utilization of “safe

sharps”, auto-recapping devices

Safe Sharps ManagementSafe Sharps Management

Objectives- PlanningObjectives- Planning

Planning prior to occupational exposure is the key to efficient implementation of post-exposure protocols

Establish a protocol for occupational exposures

Educate health care workers regarding the implementation of the plan during job orientation and ongoing job training.

CDC, MMWR 6-29-01, Vol.50/No. RR-11, 16.

Planning prior to occupational exposure is the key to efficient implementation of post-exposure protocols

Establish a protocol for occupational exposures

Educate health care workers regarding the implementation of the plan during job orientation and ongoing job training.

CDC, MMWR 6-29-01, Vol.50/No. RR-11, 16.

Objectives- IdentificationObjectives- Identification Identify: Potential risk factors for

transmission of HIV, HBV and HCV Health Care Professional (HCP) for

medical follow-up Various recommendations for PEP

based upon type of exposure for each

Identify: Potential risk factors for

transmission of HIV, HBV and HCV Health Care Professional (HCP) for

medical follow-up Various recommendations for PEP

based upon type of exposure for each

Objectives- ImplementationObjectives- Implementation Implement :Methods of risk reduction

based on Work Practice Controls (WPC) & Exposure Controls (EC)

Emergency first aid for injury Post-exposure counseling Prophylaxis Medical evaluation and follow-up of

exposed individuals

Implement :Methods of risk reduction based on Work Practice Controls (WPC) & Exposure Controls (EC)

Emergency first aid for injury Post-exposure counseling Prophylaxis Medical evaluation and follow-up of

exposed individuals

Objectives- EvaluationObjectives- Evaluation Evaluate: The effectiveness of the Occupational

Exposure Monitoring System Adapt any necessary modifications for

improvement Continue to maintain an evolving system

based upon current scientific findings

Evaluate: The effectiveness of the Occupational

Exposure Monitoring System Adapt any necessary modifications for

improvement Continue to maintain an evolving system

based upon current scientific findings

Exposure DefinitionExposure Definition• “An exposure is a percutaneous

injury (e.g., a needle stick or cut with a sharp object) or contact of mucous membrane or nonintact skin (e.g., exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or other body fluids that are potentially infectious.”

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 3.

• “An exposure is a percutaneous injury (e.g., a needle stick or cut with a sharp object) or contact of mucous membrane or nonintact skin (e.g., exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or other body fluids that are potentially infectious.”

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 3.

Infectious Body FluidsInfectious Body Fluids

• “In addition to blood and body fluids containing visible blood, semen and vaginal secretions are also considered potentially infectious. Although semen and vaginal secretions have been implicated in sexual transmission of HBV, HCV and HIV, they have not caused occupational transmission from patient to health care worker.”

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 3.

• “In addition to blood and body fluids containing visible blood, semen and vaginal secretions are also considered potentially infectious. Although semen and vaginal secretions have been implicated in sexual transmission of HBV, HCV and HIV, they have not caused occupational transmission from patient to health care worker.”

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 3.

Potentially Infectious FluidsPotentially Infectious FluidsPotentially Infectious FluidsPotentially Infectious Fluids

The risk for transmission of HIV, HBV and HCV with the following body fluids is unknown, caution is recommended when handling : cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid. They are considered to pose a potential risk for transmission.

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 3.

The risk for transmission of HIV, HBV and HCV with the following body fluids is unknown, caution is recommended when handling : cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid. They are considered to pose a potential risk for transmission.

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 3.

Low/No Risk Body FluidsLow/No Risk Body Fluids• “Feces, nasal secretions, saliva,

sputum, sweat, tears, urine and vomitus are not considered potentially infectious unless they contain blood. The risk for transmission of HBV. HCV and HIV infection from these fluids and materials is extremely low.” Caution is recommended when handling these fluids.

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 3.

• “Feces, nasal secretions, saliva, sputum, sweat, tears, urine and vomitus are not considered potentially infectious unless they contain blood. The risk for transmission of HBV. HCV and HIV infection from these fluids and materials is extremely low.” Caution is recommended when handling these fluids.

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 3.

Saliva Infectious for HIV?Saliva Infectious for HIV? In the absence of visible blood in the

saliva, exposure to saliva from a person infected with HIV is not considered a potential risk for HIV transmission. However, caution is However, caution is recommended when handling.recommended when handling.

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 3.

In the absence of visible blood in the saliva, exposure to saliva from a person infected with HIV is not considered a potential risk for HIV transmission. However, caution is However, caution is recommended when handling.recommended when handling.

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 3.

Occupational Transmission of HCV

• Transmission from mucous membrane exposure to blood rarely occurs .

• HCV is not transmitted efficiently through occupational exposure to blood.

• Following percutaneous injury from HCV+ source infection rate is 1.8% (range 0%-7%).

• No transmission has been documented from nonintact or intact skin contact with HCV+ blood.

CDC, MMWR, 6-29-01, Vol. 50/ No. RR-11, 5

• Transmission from mucous membrane exposure to blood rarely occurs .

• HCV is not transmitted efficiently through occupational exposure to blood.

• Following percutaneous injury from HCV+ source infection rate is 1.8% (range 0%-7%).

• No transmission has been documented from nonintact or intact skin contact with HCV+ blood.

CDC, MMWR, 6-29-01, Vol. 50/ No. RR-11, 5

Survival of HBV in the Environment

• Only 1/2 of all HBV positive HCW’s recall having an occupational injury. (DIRECT)

• Many infected individuals can recall caring for HBV+ patients. (INDIRECT)

• HBV can survive in dried blood at room temperature on environmental surfaces for at least 1 week. Exposures have occurred via scratches, abrasions, burns or on mucosal surfaces with poor infection control. Evidence of outbreaks have occurred in Hemodialysis Units.

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 4

Occupational Transmission of HBV

• The risk of HBV transmission following needle stick is directly related to the amount of blood and the HBeAg status of the patient.

• Infection from HBeAg+ & HBsAg+ is: 37-62%

• Infection from HBeAg- & HBsAg+ is: 23-37%

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 3.

• The risk of HBV transmission following needle stick is directly related to the amount of blood and the HBeAg status of the patient.

• Infection from HBeAg+ & HBsAg+ is: 37-62%

• Infection from HBeAg- & HBsAg+ is: 23-37%

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 3.

Post-Hepatitis B Vaccine Testing

• “Health Care Professionals who have contact with patients or blood and are at ongoing risk for percutaneous injuries should be tested 1-2 months after completion of the 3-dose vaccination series for anti-HBs.”

• Hepatitis B vaccine may be given during pregnancy, contains no infectious particles.

CDC, MMWR 6-29-2001/Vol. 50/No. RR-11, 16.

• “Health Care Professionals who have contact with patients or blood and are at ongoing risk for percutaneous injuries should be tested 1-2 months after completion of the 3-dose vaccination series for anti-HBs.”

• Hepatitis B vaccine may be given during pregnancy, contains no infectious particles.

CDC, MMWR 6-29-2001/Vol. 50/No. RR-11, 16.

Nonresponders to HBV Vaccine• People who do not respond to the first

three vaccine series <10 mIU/ml should complete a 2nd, 3 vaccine series.

• People who do not respond to the first HBV series only have a 30-50% chance of responding to the 2nd series.

• Testing at completion should be done to determine efficacy/or HbsAg status.

• CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 16.

• People who do not respond to the first three vaccine series <10 mIU/ml should complete a 2nd, 3 vaccine series.

• People who do not respond to the first HBV series only have a 30-50% chance of responding to the 2nd series.

• Testing at completion should be done to determine efficacy/or HbsAg status.

• CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 16.

PEP for HBV Exposures in PEP for HBV Exposures in Non-vaccinated HCW’sNon-vaccinated HCW’s

Health care workers who experience occupational exposure to the blood or body fluids of an HBsAg + individual should receive– 1 dose, 0.06mL/kg., of

Hepatitis B immune globulin (HBIG), and

– The 1st dose of the HBV vaccine series.

Health care workers who experience occupational exposure to the blood or body fluids of an HBsAg + individual should receive– 1 dose, 0.06mL/kg., of

Hepatitis B immune globulin (HBIG), and

– The 1st dose of the HBV vaccine series.

PEP for HBV Non-respondersPEP for HBV Non-responders

When a person has not responded to the 1st HBV vaccine series & is exposed to the blood or body fluids of an HBsAg positive patient, a single dose of HBIG, preferably within 24 hrs. after exposure, and the first dose of the 2nd HBV vaccine series is preferred.

CDC, MMWR. Vol. 50/ No. RR-11, 4.

When a person has not responded to the 1st HBV vaccine series & is exposed to the blood or body fluids of an HBsAg positive patient, a single dose of HBIG, preferably within 24 hrs. after exposure, and the first dose of the 2nd HBV vaccine series is preferred.

CDC, MMWR. Vol. 50/ No. RR-11, 4.

PEP for HBV PEP for HBV for Non-respondersfor Non-responders

HCW’s that experience occupational exposures to the blood or body fluids of HBsAg positive patients who are non-responders to both the 1st and 2nd HBV vaccine series should receive 2 doses of HBIG. – One at the time of injury and the 2nd dose 1 month

later.– HBIG should be given with 24 hrs. if possible. – When given in less than 7 days the effectiveness is

approximately 75%. When given in > 7days after exposure effectiveness is uncertain.

CDC, MMWR 6-29-01, Vol50/No. RR-11, 4

HCW’s that experience occupational exposures to the blood or body fluids of HBsAg positive patients who are non-responders to both the 1st and 2nd HBV vaccine series should receive 2 doses of HBIG. – One at the time of injury and the 2nd dose 1 month

later.– HBIG should be given with 24 hrs. if possible. – When given in less than 7 days the effectiveness is

approximately 75%. When given in > 7days after exposure effectiveness is uncertain.

CDC, MMWR 6-29-01, Vol50/No. RR-11, 4

Expert Consultation Expert Consultation AdvisedAdvised

When drug resistance is evident HCW is pregnant Source is unknown Source is high risk for HIV infection

When drug resistance is evident HCW is pregnant Source is unknown Source is high risk for HIV infection

Use of PEP When Source is Unknown

• Decision made case-by-case PPE worn, removes 50% of inoculum

• Type: puncture, splash, laceration

• Severity : deep wound vs. superficial

• Body fluid and quantity: blood, saliva, large amount vs. minimal amount of body fluid

• Decision made case-by-case PPE worn, removes 50% of inoculum

• Type: puncture, splash, laceration

• Severity : deep wound vs. superficial

• Body fluid and quantity: blood, saliva, large amount vs. minimal amount of body fluid

Use of PEP When Source is Unknown (Cont)

• Environment : IDU clinic, shelter, community prevalence, etc.

• To treat: a 2 drug PEP for 4 weeks, reevaluate if new information is available, if negative discontinue medications. Do not test discarded needles for bloodborne pathogens.

• Environment : IDU clinic, shelter, community prevalence, etc.

• To treat: a 2 drug PEP for 4 weeks, reevaluate if new information is available, if negative discontinue medications. Do not test discarded needles for bloodborne pathogens.

Factors that Increase the Probability of HIV Infection• Exposure to a larger quantity of blood• Injury with a device with visible blood• Deep injury• Injury with device placed in vein/artery• Injury to blood from patient with

advanced AIDS• Host defense, immune response may

prevent infection

• Exposure to a larger quantity of blood• Injury with a device with visible blood• Deep injury• Injury with device placed in vein/artery• Injury to blood from patient with

advanced AIDS• Host defense, immune response may

prevent infection

Management of Occupational Blood Exposure

Management of Occupational Blood Exposure

• When an exposure occurs, you should stop immediately

• Wash wound with soap & water; flush mucous membranes with water.

• Antiseptic use and/or bleeding the wound have not been proven to reduce infections. However, antiseptic use

is not contraindicated. Bleach & other caustic

agents should not be poured directly into the wound.

• When an exposure occurs, you should stop immediately

• Wash wound with soap & water; flush mucous membranes with water.

• Antiseptic use and/or bleeding the wound have not been proven to reduce infections. However, antiseptic use

is not contraindicated. Bleach & other caustic

agents should not be poured directly into the wound.

Evaluation of Occupational Exposure

Evaluation of Occupational Exposure

• Obtain informed consent. • Test source for HBsAg, anti-HCV, and HIV

antibody. Consider using a rapid HIV antibody test if available.

• For patients who refuse testing/or unknown patients, consider medical diagnosis, risk behaviors and S/S.

• Do not test discarded needles for bloodborne pathogens.

• Obtain informed consent. • Test source for HBsAg, anti-HCV, and HIV

antibody. Consider using a rapid HIV antibody test if available.

• For patients who refuse testing/or unknown patients, consider medical diagnosis, risk behaviors and S/S.

• Do not test discarded needles for bloodborne pathogens.

HCV ExposuresHCV Exposures

• Following occupational injury on an HCV+ patient:

• Perform baseline & F/U testing for anti-HCV and alanine aminotransferase (ALT) 4-6 months after exposure.

• Perform HCV RNA 4-6 weeks after exposure, to determine active viral replication.

• Confirm repeatedly positive anti-HCV (EIAs) with additional tests.

• No vaccine or PEP are available for protection against HCV. IG is not recommended for PEP.

• Following occupational injury on an HCV+ patient:

• Perform baseline & F/U testing for anti-HCV and alanine aminotransferase (ALT) 4-6 months after exposure.

• Perform HCV RNA 4-6 weeks after exposure, to determine active viral replication.

• Confirm repeatedly positive anti-HCV (EIAs) with additional tests.

• No vaccine or PEP are available for protection against HCV. IG is not recommended for PEP.

Treating early HCV diseaseTreating early HCV disease While there is currently no vaccine to

prevent HCV infection, or PEP to prevent infection immediately following exposure, recent studies suggest that early treatment of acute HCV may prevent chronic infection.

Therefore HCW’s should be vigilant with recommendations for follow-up and testing.

While there is currently no vaccine to prevent HCV infection, or PEP to prevent infection immediately following exposure, recent studies suggest that early treatment of acute HCV may prevent chronic infection.

Therefore HCW’s should be vigilant with recommendations for follow-up and testing.

Health Care Professional (HCP) Health Care Professional (HCP) Recommendations for PEP in HIV+ SourceRecommendations for PEP in HIV+ Source

When an exposure occurs on an HIV+ patient a HCP will:– Establish patients’stage of infection:

HIV+ or AIDS– Obtain recent blood tests:

CD4 cells, T-cell count, viral load & current medications

– Determine if donor patient has a resistant strain– If information is not available, initiate PEP

PEP should be initiated even if the exposure exceeds 36 hours

When an exposure occurs on an HIV+ patient a HCP will:– Establish patients’stage of infection:

HIV+ or AIDS– Obtain recent blood tests:

CD4 cells, T-cell count, viral load & current medications

– Determine if donor patient has a resistant strain– If information is not available, initiate PEP

PEP should be initiated even if the exposure exceeds 36 hours

Evaluation of HIV Exposure

• Following exposure on an HIV+ patient, assess and treat HCW, ideally within 2 hours.

• Perform HIV antibody testing for at least 6 months postexposure. Baseline 6 weeks 3 months and 6 months.

• Following exposure on an HIV+ patient, assess and treat HCW, ideally within 2 hours.

• Perform HIV antibody testing for at least 6 months postexposure. Baseline 6 weeks 3 months and 6 months.

Evaluation of HIV Exposure

• If symptoms of acute retroviral syndrome appear test HIV antibody immediately. Advise to use precautions to

prevent secondary transmission. • Evaluate for side effects at 72 hours

and every 2 week thereafter. • Treat for 4 weeks.• Consider the use of rapid testing.

• If symptoms of acute retroviral syndrome appear test HIV antibody immediately. Advise to use precautions to

prevent secondary transmission. • Evaluate for side effects at 72 hours

and every 2 week thereafter. • Treat for 4 weeks.• Consider the use of rapid testing.

Basic PEP for HIV Exposures• Basic Regimen (2 drugs):

Zidovudine (AZT) & Lamivudine (3TC) available as COMBIVIR.

• ZDV: 600 mg/day, in 2 or 3 divided doses & 3TC: 150mg twice daily, or give as one COMBIVIR tab twice daily for 4 weeks. Serious toxicity is rare, side effects are manageable, documented to reduce infection by approximately 81%. CDC, MMWR, 6-29-01, Vol. 50/No. RR-11, 9.

• Other basic 2 drug regimens include: 3TC & Stavudine (d4T); or d4T & Didanosine (ddl), and should be considered in areas of the country where COMBIVIR resistance is common. CDC,MMWR, 6-29-01, Vol. 50/No. RR-11, 10.

• Basic Regimen (2 drugs): Zidovudine (AZT) & Lamivudine (3TC) available as COMBIVIR.

• ZDV: 600 mg/day, in 2 or 3 divided doses & 3TC: 150mg twice daily, or give as one COMBIVIR tab twice daily for 4 weeks. Serious toxicity is rare, side effects are manageable, documented to reduce infection by approximately 81%. CDC, MMWR, 6-29-01, Vol. 50/No. RR-11, 9.

• Other basic 2 drug regimens include: 3TC & Stavudine (d4T); or d4T & Didanosine (ddl), and should be considered in areas of the country where COMBIVIR resistance is common. CDC,MMWR, 6-29-01, Vol. 50/No. RR-11, 10.

Expanded PEP for HIV Expanded PEP for HIV ExposuresExposures

An expanded 3 drug regimen should be considered for exposures that pose an increased risk for infection. – A 3 drug regimen includes a basic 2 drug

regime plus the addition of a Protease Inhibitor.

Bartlett J. 2001-2 J. Hopkins Univ. School of Medicine, Medical Management of the HIV Infection, 66.

An expanded 3 drug regimen should be considered for exposures that pose an increased risk for infection. – A 3 drug regimen includes a basic 2 drug

regime plus the addition of a Protease Inhibitor.

Bartlett J. 2001-2 J. Hopkins Univ. School of Medicine, Medical Management of the HIV Infection, 66.

HIV PEP for Percutaneous InjuriesHIV PEP for Percutaneous Injuries

Exposure Low Risk-Asymptomatic

VL

High Risk-AIDS Symptomatic, AIDS or VL

Unknown

Not severe, superficial or injury with solid needle or instrument

2 drug PEP 3 drug PEP Usually none, *consider 2 drug PEP

Severe, blood on device, deep wound

3 drug PEP 3 drug PEP Usually none, *consider 2 drug PEP

Patient StatusPatient Status

VL- Viral load, low <1,500 c/ml, high >1,500c/ml * Consider if source is high HIV risk

HIV PEP for Non-intact Skin & HIV PEP for Non-intact Skin & Mucous Membrane ExposuresMucous Membrane Exposures

Exposure Low Risk- VL, Asymptomatic

High Risk- VL

AIDS, blood on instrument

Unknown

Small volume (drops)

Consider 2 drug PEP

2 drug PEP Usually none, consider 2 drug PEP*

Large volume, major spill

2 drug PEP 3 drug PEP Usually none, consider 2 drug PEP*

Patient Status

VL-Viral load, low <1,500 c/ml., high >1,500 c/ml. * Consider if source has HIV risk

Risk of HIV Infection Following Percutaneous Exposure to HIV+ Blood

• For a mucous membrane exposure

0.09%

• For a percutaneous exposure risk

0.3%.

• For nonintact skin

< 0.09%

• For a mucous membrane exposure

0.09%

• For a percutaneous exposure risk

0.3%.

• For nonintact skin

< 0.09%

Management of HIV Negative Management of HIV Negative ExposureExposure

“If source person is HIV seronegative and has no clinical evidence of AIDS or symptoms of HIV infection, no further testing of the person for HIV infection is indicated.

The likelihood of the source person being in the “window period” of HIV, in the absence of acute retroviral syndrome, is extremely small.”

“If source person is HIV seronegative and has no clinical evidence of AIDS or symptoms of HIV infection, no further testing of the person for HIV infection is indicated.

The likelihood of the source person being in the “window period” of HIV, in the absence of acute retroviral syndrome, is extremely small.”

Management of Human BitesManagement of Human Bites

Evaluation of human bites must include both the person who is bitten and the person who inflicted the bite, since both parties were potentially exposed to the other persons blood.

All counseling, testing, PEP and follow-up must be conducted on both parties for HIV, HBV & HCV.

Evaluation of human bites must include both the person who is bitten and the person who inflicted the bite, since both parties were potentially exposed to the other persons blood.

All counseling, testing, PEP and follow-up must be conducted on both parties for HIV, HBV & HCV.

Surveillance of Health Care Workers with Surveillance of Health Care Workers with HIV/AIDS, June 30, 2001HIV/AIDS, June 30, 2001

Ref: CDC Natl. Center for HIV, STD and TB PreventionRef: CDC Natl. Center for HIV, STD and TB Prevention

Through 6/30/01, 23,473 adults with AIDS reported working in health care. This represents 5.1% of the 561,495 reported cases.

Physicians 1,746 Therapists 1,042 Surgeons 117 Health Aids 5,222 Nurses 5,105 Maintenance workers & Dental workers 482 Administrative staff Paramedics 453 Technicians 3,046 http://www.cdc.gov/hiv/pubs/facts/hcwsurv.htm

Through 6/30/01, 23,473 adults with AIDS reported working in health care. This represents 5.1% of the 561,495 reported cases.

Physicians 1,746 Therapists 1,042 Surgeons 117 Health Aids 5,222 Nurses 5,105 Maintenance workers & Dental workers 482 Administrative staff Paramedics 453 Technicians 3,046 http://www.cdc.gov/hiv/pubs/facts/hcwsurv.htm

Surveillance of Health Care Workers Surveillance of Health Care Workers with HIV/AIDS, June 30, 2001with HIV/AIDS, June 30, 2001

Ref: CDC Natl. Center for HIV, STD and TB PreventionRef: CDC Natl. Center for HIV, STD and TB Prevention

Fifty-seven health care workers in the U. S. have seroconverted to HIV following occupational exposures. Twenty-six have AIDS. Laboratory workers 19 (16 clinical labs) Nurses 24 Physicians 6 Surgical technicians 2 Dialysis technicians 1 Respiratory therapist 1 Health aide 1 Embalmer 1 Housekeepers 2

http://www.cdc.gov/hiv/pubs/facts/hcwsurv.htm

Fifty-seven health care workers in the U. S. have seroconverted to HIV following occupational exposures. Twenty-six have AIDS. Laboratory workers 19 (16 clinical labs) Nurses 24 Physicians 6 Surgical technicians 2 Dialysis technicians 1 Respiratory therapist 1 Health aide 1 Embalmer 1 Housekeepers 2

http://www.cdc.gov/hiv/pubs/facts/hcwsurv.htm

Surveillance of Health Care Workers Surveillance of Health Care Workers with HIV/AIDS, June 30, 2001with HIV/AIDS, June 30, 2001

Ref: CDC Natl. Center for HIV, STD and TB PreventionRef: CDC Natl. Center for HIV, STD and TB Prevention

Types of Injuries Percutaneous 48

(puncture or cut) Mucotaneous 5

(mucous membrane and/or skin)

Percutaneous & Mucotaneous 2

Unknown 2

Types of Injuries Percutaneous 48

(puncture or cut) Mucotaneous 5

(mucous membrane and/or skin)

Percutaneous & Mucotaneous 2

Unknown 2

Body Fluids

Blood 49

Concentrated virus in a laboratory 3

Visibly bloody fluid 1

Unspecified fluids 4

Body Fluids

Blood 49

Concentrated virus in a laboratory 3

Visibly bloody fluid 1

Unspecified fluids 4

http://www.cdc.gov/hiv/pubs/facts/hcwsurv.htm

Occupational Exposure Occupational Exposure Assessment CriteriaAssessment Criteria

Type of exposure Percutaneous Mucous membrane Nonintact skin Bites with blood

contamination to either person

Type of exposure Percutaneous Mucous membrane Nonintact skin Bites with blood

contamination to either person

Type & Amount of fluid Blood Fluids containing blood Potentially infectious

fluid/tissue, i.e. semen, vaginal secretions, etc.

Direct contact with concentrated virus

Type & Amount of fluid Blood Fluids containing blood Potentially infectious

fluid/tissue, i.e. semen, vaginal secretions, etc.

Direct contact with concentrated virus

CDC, MMWR 6-29-01, Vol. 50/ No. RR-11, 17.

Occupational Exposure Occupational Exposure Assessment CriteriaAssessment Criteria

Infectious Status of Source

HIV antibody status HCV antibody status HBsAg status

Infectious Status of Source

HIV antibody status HCV antibody status HBsAg status

Immune Status of Exposed

HCW

HBV, HCV & HIV immune status

Hepatitis B vaccine & vaccine response status

Immune Status of Exposed

HCW

HBV, HCV & HIV immune status

Hepatitis B vaccine & vaccine response status

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 18.

Occupational Exposure ReportOccupational Exposure Report Date & time of injury Procedure being performed,

– If sharp device caused injury, include type, manufacturer & how injury occurred

Type & amount of fluid, severity (deep vs. superficial), condition of skin (chapped, intact)

Source patients HIV, HBV, HCV status & stage (HIV viral load, resistance & antiretroviral meds)

Exposed HCW’s HBV vaccine status & response Counseling, post-exposure treatment & follow-

up

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 17

Date & time of injury Procedure being performed,

– If sharp device caused injury, include type, manufacturer & how injury occurred

Type & amount of fluid, severity (deep vs. superficial), condition of skin (chapped, intact)

Source patients HIV, HBV, HCV status & stage (HIV viral load, resistance & antiretroviral meds)

Exposed HCW’s HBV vaccine status & response Counseling, post-exposure treatment & follow-

up

CDC, MMWR 6-29-01, Vol. 50/No. RR-11, 17

Occupational Exposure ResourcesOccupational Exposure Resources National Clinicians’ Post-exposure Hotline:

PEPline or 1-888-448-4911

CDC, STD, AIDS Hotline: 800-342-AIDS

Hepatitis Hotline: 888-443-7232

CDC reporting for occupationally HIV infected HCW’s & PEP failures: 800-893-0485

HIV antiretroviral pregnancy registry: 800-258-4263

National Clinicians’ Post-exposure Hotline: PEPline or 1-888-448-4911

CDC, STD, AIDS Hotline: 800-342-AIDS

Hepatitis Hotline: 888-443-7232

CDC reporting for occupationally HIV infected HCW’s & PEP failures: 800-893-0485

HIV antiretroviral pregnancy registry: 800-258-4263

SummarySummary

CDC, MMWR 6-29-01, Vol.50 No. RR-11, pp. 3, 6, 7, 9.

Occupational transmission for HIV and HCV is low: – HIV- .09- .3%, HCV- 0- 7%

Occupational transmission for HBsAg+ and HBeAg+ source: – 37-62%.

Occupational transmission for HBsAg+ and HBeAg- source:– 23-37%.

Rapid PEP is effective for HIV and HBV: – HIV PEP-81%, HBV PEP –70-75%.

No PEP available for HCV Standard Precautions, PEP and vaccination are

critical components in reducing cross-transmission of bloodborne pathogens.

Occupational transmission for HIV and HCV is low: – HIV- .09- .3%, HCV- 0- 7%

Occupational transmission for HBsAg+ and HBeAg+ source: – 37-62%.

Occupational transmission for HBsAg+ and HBeAg- source:– 23-37%.

Rapid PEP is effective for HIV and HBV: – HIV PEP-81%, HBV PEP –70-75%.

No PEP available for HCV Standard Precautions, PEP and vaccination are

critical components in reducing cross-transmission of bloodborne pathogens.