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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)