1. Page Up to Reverse  Employee Health  Page Down to Advance  Employee Health 

2. Page Up to Reverse  Employee Health  Page Down to Advance Blood Borne Pathogen Exposures A HealthCare Worker Guide 4 part series Prevention Education Safety Sharps HELP I’ve been EXPOSED What do I do?

3. Page Up to Reverse  Employee Health  Page Down to Advance Blood Borne Pathogen Exposure - - Healthcare workers are potentially at risk for acquiring certain infections through occupational exposures to blood or certain body fluids & tissues. This may include: needlesticks mucous membrane exposures skin exposures to skin that is open. Education

4. Page Up to Reverse  Employee Health  Page Down to Advance Blood Borne Pathogen Exposure - - Source materials for blood borne pathogens include: blood fluid containing visible blood tissues semen vaginal secretions cerebrospinal fluid synovial fluid pleural fluid peritoneal fluid pericardial fluid amniotic fluid The following are a source of exposure ONLY if visible blood is apparent: urine feces vomitus sputum human bites / scratches Education

5. Page Up to Reverse  Employee Health  Page Down to Advance Blood Borne Pathogen Exposure - - Diseases of concern in Blood Borne Pathogen Exposures include: Human Immunodeficiency Virus (HIV) Hepatitis B Hepatitis C It is vital to seek treatment immediately after such an exposure. PREVENTION is the first line of defense! Education

6. Page Up to Reverse  Employee Health  Page Down to Advance Human Immunodeficiency Virus (HIV) Blood Borne Pathogen Exposure - - Needlestick/sharps injury exposures to HIV positive blood carry a risk of 0.3% (three out of 1,000). Open skin exposures to HIV positive blood carry a risk of less than 0.1% (less than one out of 1,000). Mucous membrane exposures to HIV positive blood carry a risk of 0.09% (about one out of 1,000). RISK Education

7. Page Up to Reverse  Employee Health  Page Down to Advance Human Immunodeficiency Virus (HIV) Blood Borne Pathogen Exposure - - A deep injury to the healthcare worker. A device that comes directly from source patient’s vein or artery Visible blood noted at the time of the incident. A source patient with late stage HIV disease. This is because as HIV progresses there is more virus in any given amount of blood than in the same amount of blood from an asymptomatic early stage HIV positive patient. Factors that increase the risk for HIV transmission In December, 1995, the Center for Disease Control published a study regarding Zidovudine (AZT) use in healthcare workers after a percutaneous exposure to HIV. Education

8. Page Up to Reverse  Employee Health  Page Down to Advance Human Immunodeficiency Virus (HIV) Blood Borne Pathogen Exposure - - Results indicated that the use of AZT was associated with a decrease in the risk for HIV seroconversion. In December, 1995, the Center for Disease Control published a study regarding Zidovudine (AZT) use in healthcare workers after a percutaneous exposure to HIV. In May, 1998, the Center for Disease Control issued Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexposure Prophylaxis. In HIV positive patients multiple anti-HIV drugs are known to be more effective than AZT alone. Education

9. Page Up to Reverse  Employee Health  Page Down to Advance Human Immunodeficiency Virus (HIV) Blood Borne Pathogen Exposure - - A physician should assess risk based on the type of exposure and the source material. Based on that risk assessment, post-exposure prophylaxis will either be recommended, offered, or not offered. The post-exposure prophylaxis regime may include up to three anti- HIV drugs The risks and benefits of taking these drugs need to be explained to the healthcare worker by the physician. Baseline history, physical exam, and lab studies need to done if an exposed employee takes the post-exposure prophylaxis. Education

10. Page Up to Reverse  Employee Health  Page Down to Advance Human Immunodeficiency Virus (HIV) Blood Borne Pathogen Exposure - - Healthcare workers require close follow-up after HIV exposures especially if post-exposure prophylaxis is administered. Results of HIV testing are private and confidential. All positive HIV tests are reported to the Health Department as required by Missouri law. Education

11. Page Up to Reverse  Employee Health  Page Down to Advance Hepatitis B Blood Borne Pathogen Exposure - - Hepatitis B is a virus that affects the liver. Symptoms can include: diminished appetite abnormal liver enzymes abdominal pain enlarged liver jaundice fatigue Long term consequences of Hepatitis B can include: chronic active hepatitis cirrhosis liver cancer Education

12. Page Up to Reverse  Employee Health  Page Down to Advance Blood Borne Pathogen Exposure - - Hepatitis B All healthcare workers should be vaccinated with the three shot series. After the first shot is given, the second shot is given at one month and the third shot is given at six months. The risk of contracting Hepatitis B from a single contaminated needlestick is reported as high as 30% (300 in 1,000). This can be PREVENTED! If an unvaccinated healthcare worker is exposed to Hepatitis B, protective treatments are available. Education

13. Page Up to Reverse  Employee Health  Page Down to Advance Blood Borne Pathogen Exposure - - Hepatitis B At the time of initial evaluation, a test for antibody to Hepatitis B surface antigen will be drawn. indicates that the Hepatitis B vaccine is still protective Hepatitis B antigen screen can also be obtained at baseline to document that the healthcare worker does not have pre- existing Hepatitis B disease. indicates that a Hepatitis B booster needs to be given Education

14. Page Up to Reverse  Employee Health  Page Down to Advance Blood Borne Pathogen Exposure - - Hepatitis C Hepatitis C is a virus that affects the liver. The majority of blood borne hepatitis (non-A, non-B) was identified as Hepatitis C in 1989. Acute infection usually does not produce symptoms or jaundice. Chronic hepatitis C may develop in 70% to 85% of these patients. Long term consequences of Hepatitis C can include: chronic liver disease cirrhosis liver cancer Education

15. Page Up to Reverse  Employee Health  Page Down to Advance Blood Borne Pathogen Exposure - - Hepatitis C The risk of acquiring Hepatitis C after a needlestick from a patient with documented Hepatitis C is 1.8% (about 20 out of 1,000). There is no vaccine! Immunoglobulin is not recommended for post-exposure prophylaxis. Education

16. Page Up to Reverse  Employee Health  Page Down to Advance Blood Borne Pathogen Exposure - - Hepatitis C The exposed healthcare worker is screened for pre-existing Hepatitis C with a test for antibody to Hepatitis C. The antibody to Hepatitis C test is performed on the source patient. If the source is identified as Hepatitis C antibody positive, the healthcare worker needs additional lab tests. At six weeks after the exposure, the healthcare worker needs a liver enzyme test (ALT) and a specialized test called a PCR. This PCR test determines if Hepatitis C virus is present. Additional lab tests may be needed at three months, six months, and twelve months after exposure to a source patient with documented Hepatitis C. Education

17. Page Up to Reverse  Employee Health  Page Down to Advance Blood Borne Pathogen Exposure - - Hepatitis C If the healthcare worker has a positive PCR result, this may indicate early acute infection with Hepatitis C. The exposed healthcare worker is then referred to the Hepatology physicians for consultation and possible treatment. A definitive treatment for acute Hepatitis C has not been established. Research is ongoing in this field. Education

18. Page Up to Reverse  Employee Health  Page Down to Advance Blood Borne Pathogen Exposure - - CDC RESOURCES HIV EXPOSURE ftp://ftp.cdc.gov/pub/Publications/mmwr/rr/rr4707.pdf Hepatitis C EXPOSURE ftp://ftp.cdc.gov/pub/Publications/mmwr/wk/mm4626.pdf Education

19. Page Up to Reverse  Employee Health  Page Down to Advance  Employee Health 