Annual Report 2012 Sharp Injuries and Body Fluid Exposure:- NumberPercentage Physicians2736% Nursing Staff3546.7% Technicians56.6% HK Staff810.7% TOTAL75***

H B V Hapedna Virus double stranded DNA

Risk for Occupational Transmission of HBV ► HBsAg& HBeAg-positive blood :  The risk of developing clinical hepatitis is 22%– 31%;  The risk of developing serologic evidence of HBV infection is 37%–62%. ► HBsAg-positive, HBeAg-negative blood  The risk of developing clinical hepatitis is 1%–6%;  The risk of developing serologic evidence of HBV infection is 23%–37%

H C V Flavi virus. It is a single stranded RNA

Risk for Occupational transmission of HCV  HCV-positive source is 1.8% (range: 0%–7%) rarely occurs from mucous membrane.

H I V Retrovirus with 2 single stranded RNA

Risk for Occupational Transmission of HIV The risks for occupational transmission of HIV vary with the type and severity of exposure: ♦ In percutaneous exposure 0.3% ( 0.2%–0.5%) ♦ In mucous membrane exposure, approximately 0.09% ( 0.006%–0.5%)

A percutaneous injury or contact of mucous membrane or nonintact skin WITH  Blood,tissue and body fluids  Semen and vaginal secretions,  CSF, synovial, pleural, peritoneal, pericardial& amniotic fluid  Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus are not considered potentially infectious unless they contain blood.  Contact without barrier protection to concentrated virus in lab  Human bites: evaluation of HCP + Patient.

Treatment of an Exposure Site  Wash needle stick and cuts with soap and water  Flush splashes to the nose, mouth, or skin with water  Irrigate eyes with clean water, saline THEN  Report the incident to your supervisor  Immediately seek medical treatment

Evaluation of the Source  HEPATITIS B MARKERS  ANTI- HCV  ANTI - HIV

Evaluation of the HCW  HEPATITIS B MARKERS  ANTI- HCV  ANTI – HIV  LFT in HCV Source

A.HBs Ag +ve source. a.Unvaccinated HCW Hepatitis B immunoglobulin (HBIG) IU/Kg(500 IU) + Hepatitis B vaccine series ≈ PEP should be administered as soon as possible after exposure(preferably within 24 hours). The effectiveness of HBIG when administered >7 days after is unknown.

b. In previously vaccinated HCW i. Known responder (HBs Ab > 10 ml U/ml); no treatment. ii. If non-responder HBIG within 24 hours + Hepatitis B vaccination at the same time. OR Second dose of HBIG can be given 1month later.

HCV Positive Source A short course of interferon started early in the course of acute hepatitis C is associated with a higher rate of resolution.

≈Perform baseline testing for anti-HCV and ALT ≈ Earlier diagnosis of HCV infection is desired, testing for HCV RNA (R-T PCR QUALITATIVE AND QUANTITAVE ) ≈ Perform follow-up testing (e.g., at 4 & 6 months) for anti-HCV and ALT. ≈ Confirm all anti-HCV positive results.

HIV Positive Source Several Factors may increase the risk of transmission:- a. If HCW is exposed to a large quantity of blood. b. A procedure that involved a needle is placed directly in a vein or artery or a deep injury. c. If the source patient is in the terminal illness. d. If the injury is deep with hollow-bore needles or penetrating sharps-related event.

PEP in Percutaneous Exposure Class 1 asymptomatic HIV infection or known low viral load (e.g., (<1,500 RNA copies.ml). Class 2 symptomatic HIV infection, AIDS, acute zero conversion, or known high viral load.

PEP in Mucous Membrane Exposure Class 1 asymptomatic HIV infection or known low viral load (e.g., (<1,500 RNA copies.ml). Class 2 symptomatic HIV infection, AIDS, acute sero conversion, or known high viral load.

Antiretroviral Agents for PEP ≈ Nucleoside reverse transcriptase inhibitors (NRTIs). ≈ Nucleotide reverse transcriptase inhibitors (NtRTIs). ≈ Nonnucleoside reverse transcriptase inhibitors (NNRTIs), ≈ Protease inhibitors(PIs), and a single fusion inhibitor. HIV PEP should regimen (zidovudine (AZT) + lamivudine (3TC) complete a full 4-week )

HCP Follow-up ≈ Anti- HIV test at 6 weeks, 3 months, 6 months Extending follow-up to 12 months ≈ EIA standard test ≈ direct virus assays not recommended