Occupational Exposures

The only chief complaint that you are guaranteed to eventually have to manage in a colleague



Respiratory Exposures



* Meningococcus​ (meningococcemia, meningitis, etc)* Give prophylaxis (ceftriaxone) if…* Intubated a pt without a mask* Suctioned a pt without a mask* Performed mouth to mouth resuscitation* Tuberculosis​ * CDC recommends testing if exposed* Treat if positive* CDC recommends prophylaxis in..* Little children, HIV positive, immunosuppressed



Cutaneous Exposures (Broken Skin, Mucous Membranes, Needle Stick)



* Hepatitis B​* Test source patient* If positive, 1-30% risk of transmission with needle stick exposure* (Mucous membrane/broken skin exposures are much lower risk)* Test exposed colleague for anti-HepB surface antibody level* If source patient is positive and coworker is not fully immunized…* Treatment * Hep B Vaccine* Hep B Immunoglobulin* Hepatitis C​* Test source patient* If positive, 2% risk of transmission with needle stick exposure * (Mucous membrane/broken skin exposures are much lower risk)* Get baseline hepatic function labs (LFTs) in coworker* Follow-up on outpatient basis, no prophylaxis available* HIV​* Test source patient with rapid HIV test* If positive, 1/300 risk of transmission with needle stick exposure* Transmission risk increases if: bloody exposure, large needle bore* (Mucous membrane/broken skin exposures are much lower risk)* Generally recommend prophylaxis if source is positive* Prophylaxis is potentially curative if given at exposure* Counsel on safe sex practices* Counsel on common treatment side effects* GI symptoms, headaches, fatigue



Additional Reading HIV Occupational Exposure Guidelines (US Public Health Service)