CCMS Medicine Winter 2017 - 27

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Stuck with a Needle
amniotic fluid, semen or vaginal secretions.
Body fluids such as urine, saliva, sputum,
stool, emesis, nasal secretions, tears or
sweat unless visibly contaminated with
blood are not considered at risk for BBP
transmission. HIV and HBV have a
much higher risk of transmission from an
occupational exposure compared to HCV.

When is Post Exposure
Prophylaxis indicated?
Hepatitis B Virus (HBV)
Fortunately, the vast majority of
healthcare workers (HCWs) at risk of
occupational exposure have a first line of
defense against Hepatitis B virus (HBV).
Due to OSHA's Bloodborne Pathogen
Standard mandate, healthcare employers
were required to offer the Hepatitis B
vaccine series to all employees at risk of
exposure beginning in 1991. Although
this offer for the vaccine is a requirement,
the acceptance of the vaccine is not.
There are HCWs who decline the vaccine
and others who receive the vaccine but
mount an inadequate antibody response
to the vaccine. Each of these situations is
treated differently. Even non-occupational
exposures are treated differently than
occupational exposures.
If the HCW is unvaccinated prior to
an exposure and subsequently declines the
vaccination after an exposure, reported rates
of Hepatitis B transmission from a positive
source patient could exceed 50%. In the
case of an unknown antibody response for
a HCW post-Hepatitis B vaccination and

exposure by a positive source, tests should
be done to evaluate Hepatitis B antibodies.
Should the antibody levels be inadequate,
further treatment would include HBIG
and a booster. If a known non-responder
to the vaccine prior to an occupational
exposure incident involves a positive source,
treatment would include HBIG and/or
revaccination.

Human Immunodeficiency
Virus (HIV)
If the exposure source is known to be
seronegative for HIV, no post -exposure
prophylaxis (PEP) treatment for HIV is
indicated. If the exposure source status is
unknown and the individual consents to a
rapid HIV-antibody test, this would also
avoid PEP treatment if a negative result
is obtained. If the source individual is
known to be seropositive for HIV or has an
unknown HIV status (i.e. declines consent
for testing), PEP should not be delayed.
Upon obtaining any additional exposure
source information, the treatment plan can
be altered.

Hepatitis C Virus (HCV)
Fortunately, the risk of transmission
of HCV from an occupational exposure
incident involving a positive exposure
source is very low. No PEP is required.
HCV Antibody testing should be
performed at 4-6 months to determine if
any treatment is necessary.

Don't Wait! Be Prepared
Due to advances in personal protective
equipment and safer needle devices,
exposure incidents have thankfully declined
but there will always be a risk. Be prepared.
Have an exposure incident form ready,
should you ever need one. Know your
state laws regarding consent for the source
individual.
Our 1st Healthcare Compliance clients
have the benefit of following a checklist
to be sure they have covered the necessary
steps when an exposure incident occurs,
including a customizable Exposure Incident
form and form letter for the examining
healthcare provider.
Editor's Note:
About 1st Healthcare Compliance, Inc.
Founded in 2012 in Wilmington, DE
by Julie Sheppard, Esq., 1ST Healthcare
Compliance is a privately-owned woman
business enterprise created to address the void
of healthcare compliance resources available to
help physicians and other healthcare providers
in private practice, hospital networks and
health systems, healthcare billing companies
and skilled nursing facilities comply with
federal rules and regulations. Learn more at
www.1sthcc.com or call 888-54-FIRST.

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Table of Contents for the Digital Edition of CCMS Medicine Winter 2017
