prophylaxis after needle stick; prophylaxis for blood-borne infection
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Epidemiology
- 1000 accidental needlesticks/day in U.S. hospitals
- 1 in 300 chance of transmitting HIV if the source is positive
Management
- hepatitis B vaccine with hepatitis B immune globulin
- seropositive contact or serostatus unknown
- not needed if hepatitis B immunity after hepatitis B vaccination[1]
- HBsAb in serum in > 10 mIU/mL implies immunity[1]
- consider post-exposure HIV prophylaxis
- 1st antiviral dose should be within 3 hours
- 3-drug regimen for most patients
- use Truvada (emtricitabine/tenofovir) plus dolutegravir or raltegravir (Isentress) for 4 weeks in most cases[1][2]
- HIV antibody to assess victim's prior exposure (why the epipheny now?)[3]
- presumably prior to 1st post-exposure prophlactic antiviral dose within 3 hours
- postexposure management of hepatitis C
- hepatitis C serology & hepatitis C virus RNA at the time of exposure then every 2 months for indefinite period[3]
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 14, 18, 19 American College of Physicians, Philadelphia 2006, 2018, 2022.
- ↑ 2.0 2.1 Prescriber's Letter 20(12): 2013 HIV Occupational Post-Exposure Prophylaxis Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=291209&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 3.0 3.1 3.2 Henderson DK. Management of needlestick injuries: a house officer who has a needlestick. JAMA. 2012;307(1):75-84. Epub 2011 Dec 6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22146902
- ↑ NEJM Knowledge+