Body Fluid Exposure (Health Care Worker)
Two serious illnesses can be transmitted to a health care worker through body fluid exposure:
Most health care workers exposed to a patient's body fluid don't get infected from it. Exposure to blood is the highest risk. Exposures must be taken very seriously. Both HIV and hepatitis virus infection can lead to lifelong (chronic) illness. Immediately tell your supervisor about any body fluid exposure. Time is of the essence.
Transmission risk depends on the route of exposure. It also depends on the level of infection in the source patient.
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The risk of transmission after a needle stick from an HIV positive source is historically estimated at 0.3%. (That means 3 out of 1,000 exposures.) But this will vary widely based on the type of needle stick, the amount of blood exposure, and level of virus in the source patient.
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The risk of transmission after a mucous membrane exposure to the blood of an HIV positive source is historically estimated at 0.09%. (That means 9 out of 10,000 exposures.) But this will vary widely based on the degree of exposure to infected fluid and the degree of HIV control in the source patient.
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Transmission risk from a source patient with active hepatitis B infection to a nonimmunized worker after a needle-stick injury is 6% to 30%. (That means 6 to 30 out of 100 exposures.)
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Transmission risk from a source patient with active hepatitis C infection after a needle-stick injury is 0% to 7%. (That means 0 to 7 out of 100 exposures.) It's rare with mucous membrane exposure.
If you're in a sexual relationship, talk about your exposure and its risks with your partner. Think about not having sex. Or think about using condoms and preventing pregnancy, until the person who exposed you tests negative. Or wait until your follow-up testing is done. Don't donate blood, tissue, or semen. If you're breastfeeding, talk to your health care provider about the risks to your baby.
Testing
Initial testing for HIV and hepatitis status will be done both on you and the source, if known. This will establish your HIV and hepatitis status today. If the source is positive or unknown, and your initial results are negative, you'll need follow-up blood tests to find out if transmission has occurred. It can take up to 3 to 6 months for blood tests to turn positive for hepatitis. If HIV infection has occurred, the test usually becomes positive within 3 months after exposure. But in rare cases, a positive result could be delayed up to 4 to 6 months after exposure. This delay happens if preventive therapy is taken. So repeat HIV testing may be done in 6 weeks, and again at 3, 4, or 6 months, depending on the test being used. If tests are negative for hepatitis and HIV on final follow-up testing, you can assume that you weren't infected from this exposure.
Postexposure prophylaxis (PEP)
If you haven't already been immunized against hepatitis B, you'll be offered the vaccine. If you have already been immunized, your antibody status will be determined. Treatment advice will be given based on your antibody status and that of the source patient, if known.
There is no preventive treatment or vaccine for hepatitis C or D.
Preventive treatment with antiviral medicine may be offered after an HIV exposure. This will be based on the time since exposure, the type of exposure, the HIV status of the patient, and whether the HIV positive source patient is virally controlled or not, if known. Treatment consists of three oral medicines taken 1 or 2 times a day for 4 weeks. It's advised to start the treatment as soon as possible after the exposure. It's best to start in the first 24 to 72 hours. That's because PEP treatment is likely less effective after that time. Treatment may be started before test results are known. Treatment can be stopped if the source patient test results are negative.
Facts you need to know before making a treatment decision
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There is relatively limited information about how effective medicines used for HIV postexposure prophylaxis are. But if treatment is started early and taken to completion, HIV infection rarely occurs in the exposed person.
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Although the short-term toxicity of antiviral medicines is usually limited, serious complications can occur. But this is rare.
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Make sure you understand the risk of transmission of the disease and the risks of treatment before making your decision. If you're not sure, you can discuss this further with the Employee Health Staff. They can guide you to more resources.
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You may refuse or stop PEP treatment at any time.
When to get medical care
Contact your health care provider right away if any of these occur:
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Unexplained fever over 100.4°F (38°C) or higher, or as advised by your provider
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Chills
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Swollen lymph glands
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Sore throat
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Rash
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Muscle or joint aching
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Prolonged or recurring diarrhea, nausea, or vomiting
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Frequent headaches
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Dark urine or light-colored stools, or jaundice (yellow color to skin or eyes)
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Belly pain
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Abnormal and lasting severe tiredness (fatigue)