Needle-stick Guideline

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How To Develop Your Skill For Great Success And Happiness Including Become CPA? | Additional special tips From Admin

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Needle-stick Guideline

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Concern regarding the management of occupational exposure to human immunodeficiency virus (HIV) was heightened when it was realized that HIV is transmitted through bodily fluids. Despite this concern, the risk of hepatitis is actually a greater occupational threat.

The major pathogens of concern in occupational body fluid exposure are HIV, hepatitis A, hepatitis B, and hepatitis C. [1, 2, 3, 4] These pathogens are viruses that require percutaneous or mucosal introduction for infectivity. The major target organs are the immune system (HIV) and the liver (hepatitis). A lesser theoretical concern is tetanus, which attacks the central nervous system.

The rate of occupational transmission from the blood of an HIV-positive source is believed to be 0.3% for a percutaneous exposure and 0.1% for a mucous membrane (nose, eye, mouth) exposure. [5, 6] For an exposure to intact skin, there is no risk of transmission if removed in timely fashion via washing. The rate of transmission from a hepatitis B–positive source to a nonimmunized host is 6%-24% and 1%-.8% (range, 0%-7%) for exposure to hepatitis C. [2] Hepatitis B infectivity depends on the hepatitis B e antigen (HBeAg) status of the source. If HBeAg-positive, the rate of transmission can be up to 30% but, when negative, is 1%-6%.

Bassett IV, Freedberg KA, Walensky RP. Two drugs or three? Balancing efficacy, toxicity, and resistance in postexposure prophylaxis for occupational exposure to HIV. Clin Infect Dis. 2004 Aug 1. 39(3):395-401. [Medline].

CDC. Recommendations for follow-up of health-care workers after occupational exposure to hepatitis C virus. MMWR Morb Mortal Wkly Rep. 1997 Jul 4. 46(26):603-6. [Medline].

Merchant RC, Keshavarz R. HIV postexposure prophylaxis practices by US ED practitioners. Am J Emerg Med. Jul 2003. 21(4):309-12. [Medline].

Henderson DK. Management of needlestick injuries: a house officer who has a needlestick. JAMA. 2012 Jan 4. 307(1):75-84. [Medline].

Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med. 1997 Nov 20. 337(21):1485-90. [Medline].

CDC. Public Health Service guidelines for the management of health-care worker exposures to HIV and recommendations for postexposure prophylaxis. Centers for Disease Control and Prevention. MMWR Recomm Rep. 1998 May 15. 47(RR-7):1-33. [Medline].

Kuhar DT, Henderson DK, Struble KA, Heneine W, Thomas V, Cheever LW, et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013 Sep. 34 (9):875-92. [Medline].

Sidwell RU, Green JS, Novelli V. Management of occupational exposure to HIV–what actually happens. Commun Dis Public Health. 1999 Dec. 2(4):287-90. [Medline]. [Full Text].

United States Department of Labor. Bloodborne pathogens and needlestick prevention. Occupational Safety and Health Administration. Available at https://www.osha.gov/SLTC/bloodbornepathogens/recognition.html. Accessed: September 5, 2015.

CDC. Recommendations for Postexposure Interventions to Prevent Infections with Hepatitis B Virus, Hepatitis C Virus, or Human Immunodeficiency Virus, and Tetanus in Persons Wounded During Bombings or Similar Mass-Casualty Events – United States, 2008. MMWR. August 2008. 57(RR-6):1-19. [Full Text].

Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, et al. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA. 2014 Jul 23-30. 312 (4):390-409. [Medline].

[Guideline] New York State Department of Health AIDS Institute. HIV Prophylaxis Following Occupational Exposure – What’s New October 2014. New York State Department of Health AIDS Institute. Available at http://www.hivguidelines.org/wp-content/uploads/2016/03/HIV-Prophylaxis-Following-Occupational-Exposure_3-28-16.pdf. October 2014;

[Guideline] Clinical Guidelines: Antiretroviral Drugs for HIV Prevention. World Health Organization. Available at http://www.who.int/hiv/pub/arv/chapter3.pdf?ua=1. Accessed: August 16, 2018.

Information for Healthcare Personnel Potentially Exposed to Hepatitis C Virus (HVC). Center for Disease Control. Available at https://www.cdc.gov/hepatitis/pdfs/testing-followup-exposed-hc-personnel.pdf. Accessed: August 22, 2018.

[Guideline] Kuhar DT, Henderson DK, Struble KA, Heneine W, Thomas V, Cheever LW, et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013 Sep. 34 (9):875-92. [Medline]. [Full Text].

Ford N, Irvine C, Shubber Z, Baggaley R, Beanland R, Vitoria M, et al. Adherence to HIV postexposure prophylaxis: a systematic review and meta-analysis. AIDS. 2014 Nov 28. 28 (18):2721-7. [Medline].

Houston SH, Sinnott JT, Palumbo SJ. Employee health and safety. Reese, ed. Practical Approach to Infectious Diseases. 1996. 706-724, 1406-1409.

[Guideline] Kaplan JE, Dominguez K, Jobarteh K, Spira TJ. Postexposure Prophylaxis Against Human Immunodeficiency Virus (HIV): New Guidelines From the WHO: A Perspective. Clin Infect Dis. 2015 Jun 1. 60 Suppl 3:S196-9. [Medline].

Hsieh WB, Chiu NC, Lee CM, Huang FY. Occupational blood and infectious body fluid exposures in a teaching hospital: a three-year review. J Microbiol Immunol Infect. Aug 2006. (4):321-7. [Medline].

Merchant RC, Becker BM, Mayer KH, Fuerch J, Schreck B. Emergency department blood or body fluid exposure evaluations and HIV postexposure prophylaxis usage. Acad Emerg Med. Dec 2003. 10(12):1345-53. [Medline].

Moran GJ. Emergency department management of blood and body fluid exposures. Ann Emerg Med. 2000 Jan. 35(1):47-62. [Medline].

Peate I. Occupational exposure of staff to HIV and prophylaxis therapy. Br J Nurs. 2004 Oct 28-Nov 10. 13(19):1146-50. [Medline].

Rinnert KJ. A review of infection control practices, risk reduction, and legislative regulations for blood-borne disease: applications for emergency medical services. Prehosp Emerg Care. 1998 Jan-Mar. 2(1):70-5. [Medline].

Schriger DL, Mikulich VJ, Centers for Disease Control and Prevention. The management of occupational exposures to blood and body fluids: revised guidelines and new methods of implementation. Ann Emerg Med. 2002 Mar. 39(3):319-21. [Medline].

U.S. Public Health Service. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR Recomm Rep. 2001 Jun 29. 50(RR-11):1-52. [Medline]. [Full Text].

Schillie S, Murphy TV, Sawyer M, Ly K, Hughes E, Jiles R, et al. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Recomm Rep. 2013 Dec 20. 62 (RR-10):1-19. [Medline].

The STOP STICKS campaign: Campaign user’s guide and resources. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/niosh/stopsticks/. Accessed: September 5, 2015.

Centers for Disease Control and Prevention. Workbook for designing, implementing and evaluating sharps injury prevention. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/sharpssafety/resources.html. February 11, 2015; Accessed: September 5, 2015.

Okwundu CI, Uthman OA, Okoromah CA. Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals. Cochrane Database Syst Rev. 2012 Jul 11. CD007189. [Medline].

Raffi F, Rachlis A, Brinson C, Arasteh K, Górgolas M, Brennan C, et al. Dolutegravir efficacy at 48 weeks in key subgroups of treatment-naive HIV-infected individuals in three randomized trials. AIDS. 2015 Jan 14. 29 (2):167-74. [Medline].

Joyce MP, Kuhar D, Brooks JT. Notes from the field: occupationally acquired HIV infection among health care workers – United States, 1985-2013. MMWR Morb Mortal Wkly Rep. 2015 Jan 9. 63 (53):1245-6. [Medline].

[Guideline] World Health Organization.Guidelines on post-exposure prophylaxis for HIV and the use of Co-trimoxazole prophylaxis for HIV-related infections among adults, adolescents and children: recommendations for a public health approach. http://apps.who.int/iris/bitstream/10665/145719/1/9789241508193_eng.pdf?ua=1. Accessed: March 19, 2017.

Sax PE, Wohl D, Yin MT, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate, coformulated with elvitegravir, cobicistat, and emtricitabine, for initial treatment of HIV-1 infection: two randomised, double-blind, phase 3, non-inferiority trials. Lancet. 2015 Jun 27. 385 (9987):2606-15. [Medline].

HIV Surveillance Report, 2013; vol 25. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hiv/pdf/g-l/hiv_surveillance_report_vol_25.pdf. Published February 2015.; Accessed: March 19, 2017.

Rodger AJ, Cambiano V, Bruun T, et al. Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. JAMA. 2016 Jul 12. 316 (2):171-81. [Medline].

Günthard HF, Saag MS, Benson CA, del Rio C, Eron JJ, Gallant JE, et al. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2016 Jul 12. 316 (2):191-210. [Medline].

Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral Therapy for the Prevention of HIV-1 Transmission. N Engl J Med. 2016 Sep 1. 375 (9):830-9. [Medline].

[Guideline] Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV—United States, 2016. United States Centers for Disease Control and Prevention. Available at http://stacks.cdc.gov/view/cdc/38856 . 2016; Accessed: March 21, 2017.

Bloodborne pathogens and needlestick prevention. Occupational Safety and Health Administration. Available at https://www.osha.gov/SLTC/bloodbornepathogens/recognition.html . Accessed: March 21, 2017.

Tomkins SE, Elford J, Nichols T, Aston J, Cliffe SJ, Roy K, et al. Occupational transmission of hepatitis C in healthcare workers and factors associated with seroconversion: UK surveillance data. J Viral Hepat. 2012 Mar. 19 (3):199-204. [Medline].

Megan A Stobart-Gallagher, DO Clinical Instructor of Emergency Medicine, Sidney Kimmel Medical College of Thomas Jefferson University; Assistant Program Director, Emergency Medicine Residency, Undergraduate Medical Director, Department of Emergency Medicine, Einstein Healthcare Network; Attending Physician, Department of Emergency Medicine, Albert Einstein Medical Center

Megan A Stobart-Gallagher, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Weiss, MD, DTM&H Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Professor, Department of Surgery (Emergency Medicine), Stanford University Medical Center

Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Oncology Association of Practices, Southern Clinical Neurological Society, Wilderness Medical Society

Disclosure: Nothing to disclose.

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician, Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Palmetto Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor – Chief Editor for Medscape.

Robert E Suter, DO, MHA Professor, Division of Emergency Medicine, University of Texas at Southwestern Medical School

Robert E Suter, DO, MHA is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

William G Gossman, MD, FAAEM Associate Clinical Professor of Emergency Medicine, Creighton University School of Medicine; Chairman, Department of Emergency Medicine, Creighton University Medical Center

William G Gossman, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Brenda Cosens, RN Branch Director, Encompass Home Health

Disclosure: Nothing to disclose.

Mariclaire Cloutier Freelance editor, Medscape Drugs & Diseases

Disclosure: Nothing to disclose.

Needle-stick Guideline

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