First Aid (ALL)
- Encourage bleeding
- Wash with copious amounts of water or saline
- Don’t Suck
- Don’t use Caustic agents
Link to ALL Trust protocols – HERE
Exposure to body fluids (esp. bloody) carries some risk however the following confer:
Increased Risk
- Deep or penetrating injuries/ wounds
- Wide/hollow bore needles
- Significant amount of blood contamination
- Contamination of large areas of broken skin
- The quality of the blood e.g. freshness and dilution factor
- Lack of barriers to the transfer of body fluid
- High viral load
- Non-immune recipient
- Needle previously in donor’s vein or artery
- Some types of sexual activity
High Risk
- Sharps injury/bite with: Skin penetration/ Contamination of broken skin or mucous membranes
- Needles discovered in the street or the park should be considered as high risk of transmitting Hepatitis B and Hepatitis C but not HIV.
- Transfer of blood stained body fluid to the injured site
- Blood or body fluid from a person known or suspected of having a blood borne virus
- Needle-stick; (Hep C) 1:3, (Hep B) 1:33, (HIV) 1:333
- Sharing injecting equipment/ChemSex (HIV); 1:149
- Receptive anal intercourse (HIV); general 1:90, ejaculation 1:65, no ejaculation 1:170
- Insertive anal intercourse (HIV); general 1:666, non-circumcised 1:161, circumcised 1:909
- Receptive vaginal intercourse (HIV); 1:1000
- Insertive vaginal intercourse(HIV); 1:1219
- Oral intercourse (HIV); <10,000
- Human bite (HIV); <1:10,000
Is PEP recommended?
- SEX
- If exposure >72hrs OR condom used (without accident) – PEP not recommended
- If exposure <72hr AND condom not used/accident – Review Table
- Needle Stick/Bite
- If exposure >72hrs – PEP not recommended
- If exposure <72hr – Review Table
- If in hospital Risk assessment of Source must happen inc. HIV testing – NOT by recipient
- Send baseline: HIV/syphilis (and hep B serology if no history of vaccination). U+Es and LFTs should also be sent
- Prescribe and issue 30 day PEP pack– patient should be advised that they need follow up with sexual health within those 30 days.
- Prescription:
- Emtricitabine/tenofovir disoproxil (200/245mg fixed dose combination) 1 tablet daily
- Raltegravir 1200mg (2 x 600mg tablets) daily
- Prescription:
- PEP packs containing a 30 day supply should be available in A&E. They contain the tablets and patient information leaflets.
Important things to tell patient:
- The PEP pack contains 2 different tablets, the patient should be advised to take:
- 1 blue (emtricitabine/tenofovir disoproxil)
- 2 yellow (raltegravir) tablets as soon as possible.
- They then need to take the same dose every 24 hours until they complete the course or are advised to stop by a specialist.
- They must take the pills at the same time each day. If they are late, take the dose as soon as possible and continue to take the course at the original time.
- If vomiting occurs within 1 hour, repeat the dose. There are 2 extra doses in the PEP pack, no further doses need to be issued.
- Do not take antacids or products containing calcium, aluminium, magnesium or iron whilst on PEP
- If more than 48 hours between PEP doses it should be discontinued.
Refer to Staff to occupational Health and copy to sexualhealthservices.chft@nhs.net, Public to GP and sexual health services
Advise that Incident report should be completed- if occupational
Ideally Treatment within 24hrs
- Recipient Hep B immunity – Blood sample if vaccinated
- Donor risk assessment – NOT to be done by recipient (typically other ward staff) inc. HBV testing
- Significant Exposure?
- Percutaneous exposure (needlestick or other contaminated sharp object injury, a bite which causes bleeding or other visible skin puncture).
- Mucocutaneous exposure to blood (contamination of non-intact skin, conjunctiva or mucous membrane).
- Sexual exposure (unprotected sexual intercourse).
Emergency Departments and Occupational Health Department should have ready access to stocks of Hepatitis B vaccine. Hepatitis B immunoglobulin (HBIG) has to be ordered via the on call Microbiologist.
Trust guidance states further immunisations through GP for public – however many GPs refuse (in this case SDEC would be possible)
There is no immunoglobulin or prophylactic treatment presently available for HCV.
In all cases where there is:
- contamination of the injury with blood or blood stained body fluid; and
- the source blood is known to be positive for, or considered to be “high-risk” for Hepatitis C:
- Donor source from areas with greater prevalence; Eastern Europe or South East Asia
- IVDU
- Received untreated plasma prior to 1985/blood transfusion prior to 1991 (UK)/blood transfusion outside UK
A baseline sample of blood must be taken at the time of the injury for storage from Recipient
Donor risk assessment – NOT to be done by recipient (typically other ward staff) inc. HCV testing
- Refer to Staff to occupational Health and copy to sexualhealthservices.chft@nhs.net
- Public to GP and/or sexual health services for 6 week follow-up
- If at risk should either abstain or use barrier contraception until cleared.
