Postexposure Treatment

Exposure to potentially infectious blood or body fluids includes needlesticks,
splashing of fluids in the face or eyes, and contact with body
fluids or blood through an open wound on your skin. Although intact
skin is usually a good protective barrier, irritated or chapped skin (for
example, from cold weather) can be penetrated by some viruses. If, despite
following all of the above recommendations, you are exposed to
potentially infectious blood or body fluids, certain steps can be taken
to decrease your risk for becoming ill.
• If you are exposed to HBV and have not been previously vaccinated:
Hepatitis B immunoglobulin (HBIG) should be given (5.0 ml
intramuscularly). HBIG is most effective when administered within
24 hours of a needlestick, but some protection is still afforded if it is
given in the first few days after exposure. You also should begin the
HBV vaccination regimen.
• If you are exposed to HCV: Unfortunately, there is no way to prevent
infection after HCV exposure. However, close observation is warranted,
and at the first sign of hepatitis, interferon therapy should be
instituted. Although early interferon therapy, before any signs or
symptoms of hepatitis have developed, does not prevent illness, once
signs and symptoms become apparent, interferon may prevent serious
illness.
• If you are exposed to HIV: If you have access to drugs used to treat
HIV infection, a short course of medication is often recommended
after a significant exposure. Usually, exposure to infected urine does
not warrant treatment. Recommendations for treatment usually are
related to the patient’s HIV titer and to the healthcare worker’s
degree of exposure. For example, a hollow needlestick from a patient
with a high HIV titer definitely warrants postexposure treatment—
optimally, a combination of zidovudine, 200 mg 3 times/day;
lamivudine, 150 mg 2 times/day, and indinavir, 800 mg 3 times/day.
All are given orally.
Bibliography
1. Gilbert DN, Moellering RC, Sande MA (eds): The Sanford Guide to Antimicrobial
Therapy, 29th ed. Vermont, Antimicrobial Therapy Inc., 1999, pp 112, 128.
2. www.cdc.gov/epo/mmwr (Postexposure prophylaxis).
3. www.osha.gov (Universal precautions).
4. www.who.int (World Health Organization surveillance statistics).

Simple Precautions that Make a Difference

•Wash your hands before and after examining every patient. This is
the single most important way to prevent the spread of infectious
diseases.
•Wear gloves. Gloves should be worn whenever you anticipate contact
with mucous membranes, open wounds, or body substances
(e.g., urine, feces, blood). Also wear gloves when handling items
soiled with blood or body fluids or performing any type of invasive
procedure. Do not go from patient to patient wearing the same pair
of gloves. Gloves are not a substitute for proper hand washing. After
removing your gloves, remember to wash your hands.
• Double-glove whenever possible during procedures involving
sharp instruments. Double gloves may feel uncomfortable at first,
but you will get used to them. Try wearing a glove a half size larger
next to your skin, and wear your regular size over the larger glove.

• Wear goggles. Eye protection is always advisable during procedures.
Get your own pair, and keep them in your pocket. You will be
amazed at how much material accumulates on the lenses, even when
you are not aware that any material has been sprayed. The goggles
used for racket sports are quite comfortable and often very useful.
When you wear a mask over your mouth, the goggles may fog up because
exhaled air escapes from under the mask around the edges of
your nose. To prevent your lenses from fogging, tape the mask to
your cheeks and to the bridge of your nose to prevent air escape.
• Get vaccinated against HBV. All healthcare providers should be immunized
against HBV. The vaccine is 95% effective in preventing infection.
The current vaccine is completely artificial, i.e., no human
products are part of the vaccine. There is no chance of contracting
HBV, HCV, or HIV from the vaccine. The vaccine is administered as a
series of three intramuscular injections. The second dose is given 1
month after the first injection, and the third dose is given 6 months
after the first injection.
• Observe proper use and disposal of all sharp instruments. Needles
for injection should not be recapped by hand. Accidents often occur
during manual recapping. Keep the cap on your tray, and slide the
needle back into the cap when you have finished using it. Do not
attempt to bend needles or other sharp objects. Use your instruments
when placing sutures—not your fingers! Suturing is often difficult
for the novice, but get in the habit of using only instruments
to hold and reposition the needle. With practice, this technique becomes
easier. Do not leave needles or other sharp instruments lying
around. Always place them in a container marked “sharp instruments”
after use.
• Adequately sterilize all reusable materials. This practice is vital to
protect healthcare providers and their patients from serious infectious
diseases. Never reuse needles or syringes without properly sterilizing
them.
• Keep all countertops and other surfaces clean. It is important to regularly
clean all surfaces that may have become contaminated by
blood or other body fluids. HBV can survive for at least 1 week in
dried blood on various surfaces. Adisinfectant made of dilute bleach
should be used for regular cleaning.

Scope of the Problem

These statistics are presented not to scare you, but to emphasize that
the risk is genuine.
Human Immunodeficiency Virus
World Prevalence: Over 47 million people worldwide have been infected
with HIV since the start of the epidemic. In 1998, HIV caused
over 2 million deaths. In some countries in Africa, 1 in 4 people is infected
with HIV. Ninety-five percent of cases occur in the developing
world.
Prevalence in the U.S. Approximately 1 in 200 people carries HIV.

Hepatitis B Virus
World Prevalence. There are over 350 million chronic carriers of HBV
worldwide. In developing nations, 8–15% of the population are chronic
carriers. This percentage drops to less than 5% in developed nations.
Five to ten percent of chronically infected people will develop chronic
liver disease that may lead to death.
Prevalence in the U.S. Approximately 1 million people are chronically
infected with HBV.
Hepatitis C Virus
World Prevalence. Three percent of the world’s population is infected
with HCV. There are more than 170 million chronic carriers of HCV.
About 50–70% of infected people will develop chronic liver disease.
HCV infection is the leading disease necessitating liver transplantation.
Prevalence in the U.S. Approximately 4 million people are chronically
infected with HCV.
Delta Hepatitis Virus
The delta hepatitis virus (HDV) primarily affects patients infected with
HBV. Apatient infected with both HBV and HDV has an increased risk
for the development of fulminant hepatitis compared with a patient infected
with HBV alone (the risk doubles to 20%). About 70–80% of
people infected with HBV and HDV develop chronic hepatitis.
Prevalence in the U.S. Unknown

PROTECTING YOURSELF FROM INFECTIOUS DISEASES

Healthcare providers are at risk for contracting serious infectious diseases.
Although the human immunodeficiency virus (HIV) is often
the most feared, the hepatitis B virus (HBV) and hepatitis C virus
(HCV) are actually much more contagious than HIV, because a
smaller inoculum can cause infection.
Healthcare workers who are inexperienced at technical procedures
and find themselves having to treat open wounds and perform invasive
procedures are especially at risk for two important reasons. First,
treatment of an open wound almost always necessitates exposure to
blood and body fluids. Blood and body fluids represent the primary
mode of transmission of these contagious agents. Second, the treatment
of open wounds and the performance of even simple procedures
(for example, suturing) involves the use of sharp instruments.
Inexperience on the part of the healthcare provider is a major risk
factor contributing to an accidental needlestick or other traumatic
injury during such procedures.