DOCSLIB.ORG

Pep-Guidelines-2019-03.Pdf

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pep-Guidelines-2019-03.Pdf Alberta Guidelines for Post-Exposure Management and Prophylaxis: HIV, Hepatitis B, Hepatitis C and Sexually Transmitted Infections Ministry of Health, Government of Alberta March 2019 For more information about this document, contact: Office of the Chief Medical Officer of Health 24th Floor, ATB, 10025 Jasper Avenue Edmonton, Alberta T5J 1S6 Email: [email protected] ISBN 978-1-4601-4336-0 © 2019 Government of Alberta This document is made available under the Open Government License – Alberta https://open.alberta.ca/licence This document is available online at: https://open.alberta.ca/publications/9781460143360 Alberta Guidelines for Post-Exposure Management and Prophylaxis: HIV, HBV, HCV and STIs 2 © 2019 Government of Alberta Table of Contents ACRONYM LIST ………………………………………………………………………………………………….….5 QUICK REFERENCE GUIDE …………………………………………………………………………………..…..7 INTRODUCTION ...……………………………………………..…………………………………..…………..….18 Goal ..………………………………………………...………………………………………..................19 Target Audience ……………………………………………………..………………………………..…19 Roles and Responsibilities ...……………………………………………………………………..…...19 Occupational Health and Safety Act …………………………………………………………..……..19 Mandatory Testing and Disclosure Act ...…………………………...…………………………..…..20 GENERAL CONSIDERATIONS FOR HIV PEP ……………………………………………………………..….21 Rationale for HIV PEP ………………………………………………………………………………..…21 Evidence for the Use of PEP ………………………………………………………………………..…21 Animal Studies ...………………………………………………………………..……...............21 Human Studies ………………………………………………………………….……...............21 Vertical Transmission ...…………………………….……………………………...… 21 Occupational Exposure …………………………………………………………….....22 Sexual Exposure ...…………………………..…………………………..…………....22 Factors Reducing the Efficacy of PEP ………………………………………………..……………..22 Considerations for Providing PEP ………...………………………………………..….................. 23 Safety ...……………………………………………….………………………………...............23 Cost ...…………………………………………………………………………..………………...24 Behavior …...…………………………………………………………………..………………...24 Anxiety …...…………………………………………………………………..…………………..24 Consideration of other HIV Prevention Interventions ………………….…………………... .25 Social and Ethical Considerations ……………………………………………………………..25 Risk of HIV Transmission and Factors Influencing Risk ..…………………………………........25 Suppressed Viral Load ………………………………………………………………………… 26 Consensual Exposure to HIV ….………………………………………………………………..…..…27 Infrequent Consensual Exposure …………………………………………………….………..27 Related Consensual Exposure ..………………………………………………….…………...27 Pre-Exposure Prophylaxis ...……………..…………………………………………………………...28 MANAGEMENT OF HIV PEP…………………………………………………………………………….………..29 Management of the Exposed Site ..………………………………………………………..…………29 Recommendations for Prescribing PEP ..………………………………………………..………....29 Assessment of the Exposed ..………………………………………………………………………...29 Assessment of the Source ………………………………………….………………………...………30 Needlestick Injury in the Community Setting .………………….………………………...…….....31 Alberta Guidelines for Post-Exposure Management and Prophylaxis: HIV, HBV, HCV and STIs 3 © 2019 Government of Alberta Human Bites...……………………………………………………………………………………………31 Timing of PEP ...………………………………………………………………………………………....31 Duration of PEP ………………………………………………………………………………………....32 Choice and Number of Antiretroviral Drugs used for PEP …………………………….………..32 Nucleoside Reverse Transcriptase Inhibitors (NRTI) ………………………………………….…33 Integrase Strand Transfer Inhibitors (INSTI) …………………………………………………….…33 Children ……………………………………………………………………………………………….….34 Pregnancy …………………………………………………………………………………………….….35 Breastfeeding ………………………………………………………………………...…………….…...36 Dispensing of HIV PEP …………………………………………………………………………….…..37 Education …………………………………………………………………………………………….…..37 Follow up of Patients Prescribed HIV PEP ……………………………………………………..….37 HEPATITIS B VIRUS (HBV) ………………………………………………….……………………………….….38 HEPATITIS C VIRUS (HCV) ……………………………………………………………………………………...40 SEXUALLY TRANSMITTED INFECTIONS (STIs) ………………………………………..............................41 REFERENCES ……………………………………………………………………………………………………..42 APPENDIX ………………………………………………………………………………………………………….50 Table 1. Risk of HIV transmission per exposure from a known HIV-positive individual.......50 Table 2. HIV/AIDS Diagnosis Data………………………………………………………….......…….51 Table 3. Risk Assessment ……...……..………………………………………………………………52 ACKNOWLEDGEMENTS ………………………………………………………………………………………...53 Alberta Guidelines for Post-Exposure Management and Prophylaxis: HIV, HBV, HCV and STIs 4 © 2019 Government of Alberta Acronym List AIDS Acquired Immunodeficiency Syndrome Anti-HBs Hepatitis B surface antibody ART Antiretroviral therapy ARV Antiretroviral BBFE Blood and Body Fluid Exposure BBP Blood-borne Pathogen CADTH Canadian Agency for Drugs and Technology in Health Care CDC US Centres for Disease Control and Prevention CDN Canadian CT Chlamydia DNA Deoxyribonucleic acid DRV/r Ritonavir-boosted Darunavir DTG Dolutegravir EFV Efavirenz EIA Syphilis Enzyme immunoassay FDA US Food and Drug Administration FTC Emtricitabine GC Gonorrhea HBeAg Hepatitis B “e” antigen HBIG Hepatitis B Immune Globulin HBsAg Hepatitis B surface antigen HHS US Department of Health and Human Services Anti-HBs Antibody to hepatitis B surface antigen Anti-HBc Antibody to hepatitis B core antigen HBV Hepatitis B Virus HCV Hepatitis C Virus HIVQUAL Human Immunodeficiency Virus- qualitative viral load test HIVQUANT Human Immunodeficiency Virus- quantitative viral load test HCV-RNA Hepatitis C Virus-Ribonucleic acid HIV Human Immunodeficiency Virus IU/L International unit/Litre IDU Injection drug use ICER Incremental cost effectiveness ratio INSTI Integrase Strand Transfer Inhibitor kg kilogram 3TC Lamivudine LMP Last Menstrual Period LPV/r Ritonavir-boosted Lopinavir mg milligram ml/mL milliliter MDR Multi-drug resistance MMWR Morbidity and Mortality Weekly MSM Men Who Have Sex With Men MTDA Mandatory Testing and Disclosure Act NAAT Nucleic Acid Amplification Test NTD Neural Tube Defects NNRTI Non-Nucleoside Reverse Transcriptase Inhibitor NRTI Nucleoside Reverse Transcriptase Inhibitor Alberta Guidelines for Post-Exposure Management and Prophylaxis: HIV, HBV, HCV and STIs 5 © 2019 Government of Alberta OHS Occupational Health and Safety PEP Post-Exposure Prophylaxis PHAC Public Health Agency of Canada PI Protease inhibitor POCT Point-of-Care Test PrEP Pre-Exposure Prophylaxis PWID People Who Inject Drugs QALY Quality Adjusted Life Year RAL Raltegravir RCTs Randomized Control Trials RNA Ribonucleic acid RPR Rapid Plasma Reagin SIV Simian Immunodeficiency Virus STI Sexually Transmitted Infection TDF Tenofovir Disoproxil Fumarate US/USA United States/United States of America VL Viral Load WHO World Health Organization ZDV Zidovudine Alberta Guidelines for Post-Exposure Management and Prophylaxis: HIV, HBV, HCV and STIs 6 © 2019 Government of Alberta Quick Reference Guide: Tables and Figures Figure 1. Algorithm: Detailed HIV Risk Assessment for Post-Exposure following BBFE ……………………8 Table 1. Factors that Increase the Risk of HIV Transmission…………………………………….....................9 Table 2. Testing Recommendations-All…………………………………………………………………………..10 Table 3A. HIV Post-Exposure Prophylaxis Recommendations for Sexual Exposures……………………….11 Table 3B. HIV Post-Exposure Prophylaxis Recommendations for Other Exposures………………………...12 Table 4. HIV PEP Drug Regimen – Adult and Adolescent Regimen…………………………………………...13 Table 5. HIV PEP Drug Regimen – Pediatric Regimen………………………………………………………….14 Table 6. HIV PEP - Pregnancy Regimen……………………………………………………………...................15 Table 7. HBV PEP - High Risk Source...………………………………………………………………………….16 Table 8. HBV PEP - Low Risk Source……..…………………..……….………………………………………...17 Alberta Guidelines for Post-Exposure Management and Prophylaxis: HIV, HBV, HCV and STIs 7 © 2019 Government of Alberta Quick Reference Guide: Figure 1- DETAILED HIV RISK ASSESSMENT for Post-Exposure Following BBFE Step 1: Did a significant EXPOSURE occur? Higher Risk Exposures Lower Risk Exposures Negligible Risk Exposures · Condomless receptive sex (anal and · Condomless oral sex (receptive and vaginal-penile) insertive) · Discarded needles found in · Condomless insertive sex (anal and · Percutaneous injury (solid bore needle, the community vaginal-penile) superficial injury) · Human bites not involving · Needle-Sharing (IDU) · Permucosal exposure (to non-blood blood · Percutaneous needlestick (hollow bore) containing bodily fluids or non-intact · Contact with intact skin; · Occupational Mucous Membrane (splash skin exposure to blood or visible blood- · Superficial scratches that do stained bodily fluid) not bleed to eyes, nose, mouth) Stop · Human bites involving blood YES Step 2: Baseline Testing (Refer to Table 2) NO Step 3: Is the patient presenting within 72 HOURS after exposure? No YES NO PEP Step 4: Is the SOURCE at high risk of being HIV infected? No PEP Consider HIV PEP when source is: Refer to Tables 3A and 3B · Known HIV Positive OR · Known HIV negative but recent high risk activity or symptoms of acute HIV seroconversion (window period) OR · Unknown HIV status but known to be in a major risk group: - MSM - Illicit drug use - Time in endemic country - Hepatitis C positive - History of incarceration - Partners of known or suspected HIV positive If in an Acute Care Setting (Emergency Department): Starter - Initiate a starter pack (3-7 days) and refer to a physician knowledgeable in HIV to continue the risk assessment Pack If Physician Knowledgeable in HIV: - May consider the viral load in an HIV positive source for consensual
Load more

Recommended publications
  • Needlestick Injury Guidelines
    Needlestick Injury Guidelines DEFINITIONS “Exposed person” refers to the pharmacist who was exposed to blood or body fluid. “Source patient” refers to the patient whose blood or body fluid the pharmacist was exposed. 1. PURPOSE 1.1. Providing certain services in a pharmacy, especially injections, carries a risk for the pharmacist and pharmacy personnel of being exposed to the blood and body fluids of patients, particularly via needlestick injury. Exposure to the blood/body fluids of another person can result in the transmission of diseases like HIV, hepatitis B and hepatitis C. This document provides an overview of: • self-protection measures • preventing needle stick injuries in the workplace • procedures to follow in the event of an injury • information on post-exposure management 2. PROCEDURES 2.1. Self-Protection Measures 2.1.1. Pharmacies should have a policy for accepting post-consumer returns that all pharmacy staff members should be familiar with. The policy should include but not limited to: 2.1.1.1. Before touching or accepting any post-consumer returns, ask the patient if there are any sharps; 2.1.1.2. All sharps must be returned to the pharmacy in a designated sharps container; 2.1.1.3. Always wear gloves when handling post-consumer returns; 2.1.1.4. All post-consumer returns must be in a clear plastic bag so all content is visible; 2.1.1.5. Assume that any bag left on the counter could contain hazardous materials; 2.1.2. Pharmacists and pharmacy personnel responsible for handling blood/body fluids or providing injections should be vaccinated for hepatitis B as recommended by the Public Health Agency of Canada (PHAC); Needlestick Injury Guidelines Page 1 of 4 December 17, 2019 2.1.2.1.
    [Show full text]
  • Assessing the Burden of Disease from Sharps Injuries to Health-Care Workers at National and Local Levels
    Environmental Burden of Disease Series, No. 11 Sharps injuries Assessing the burden of disease from sharps injuries to health-care workers at national and local levels Elisabetta Rapiti Annette Prüss-Üstün Yvan Hutin Series Editors Annette Prüss-Üstün, Diarmid Campbell-Lendrum, Carlos Corvalán, Alistair Woodward A Microsoft Excel spreadsheet for calculating the estimates described in this document can be obtained from WHO/PHE. E-mail contact: [email protected] World Health Organization Protection of the Human Environment Geneva 2005 WHO Library Cataloguing-in-Publication Data Rapiti, Elisabetta. Sharps injuries : assessing the burden of disease from sharps injuries to health-care workers at national and local levels / Elisabetta Rapiti, Annette Prüss-Üstün, Yvan Hutin. (Environmental burden of disease series / series editors: Annette Prüss-Üstün ... [et al.] ; no. 11) 1.Needlestick injuries - complications 2.Wounds, Stab - complications 3.Blood- borne pathogens 4.Hepatitis B - etiology 5.Hepatitis C - etiology 6.HIV infections - etiology 7.Accidents, Occupational 8.Health personnel 9.Risk assessment - methods 10.Cost of illness I.Prüss-Üstün, Annette. II.Hutin, Yvan J. F. III.Title IV.Series ISBN 92 4 159232 X (NLM classification: WO 700) ISSN 1728-1652 Suggested citation Rapiti, E, Prüss-Üstün, A, Hutin, Y. Sharps injuries : assessing the burden of disease from sharps injuries to health-care workers at national and local levels. Geneva, World Health Organization, 2005. (WHO Environmental Burden of Disease Series, No. 11). © World Health Organization 2005 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]).
    [Show full text]
  • Management of Needlestick Injuries a House Officer Who Has a Needlestick
    CLINICAL CROSSROADS CLINICIAN’S CORNER CONFERENCES WITH PATIENTS AND DOCTORS Management of Needlestick Injuries A House Officer Who Has a Needlestick David K. Henderson, MD, Discussant Since its identification in 1985, human immunodefi- DR REYNOLDS: Dr J is an intern in internal medicine at a large ciency virus (HIV) has challenged several aspects of health academic residency program. At 2 AM on a call night in the cardiac intensive care unit (CCU), a 70-year-old patient was care delivery. Because HIV is a blood-borne infectious brought to the unit after having experienced an out-of- disease, from the early days of the epidemic, concern was hospital cardiac arrest due to ventricular fibrillation. The raised about risks of occupational exposures and infec- patient’s medical history was not known; he lives with his tions among health care workers. Despite the develop- sister, who reported that he had not seen a physician in ap- ment of highly active antiretroviral therapy, which has proximately 40 years. effectively modulated HIV into a chronic disease in many Dr J was involved in resuscitation efforts in the CCU along settings, risks of occupational infection with 3 blood- with several other clinicians. While attempting to place a borne pathogens remain in the health care workplace. central line and sewing with a curved needle holder, Dr J had a needlestick. The needle was a solid-bore needle; the Using the case of a house officer who has a needlestick stick did not draw blood. After handing over the procedure during a resuscitation attempt, prevention of needle- to another team member, Dr J scrubbed and rinsed the site sticks including universal precautions and postexposure of injury.
    [Show full text]
  • Prophylaxis Decision-Making Following Plasmodium Falciparum Malaria Needlestick Injury: a Case Report F.S
    P2255 Abstract (poster session) Prophylaxis decision-making following Plasmodium falciparum malaria needlestick injury: a case report F.S. Erdinc, S. Yarimoglu, E. Aktepe, G. Tuncer Ertem*, N. Tulek (Ankara, TR) Objectives: Although Turkey is a malaria endemic country, it is non-endemic for falciparum malaria; falciparum malaria is reported only in patients with travel histories. The transmission risk of the pathogen by occupational exposure to blood is reported higher than human immunodeficiency virus or hepatitis C virus. The case presented here, is the first reported postexposure prophylaxis case for falciparum malaria after occupational needlestick injury. Case: A 25-year-old resident doctor had an occupational needlestick injury while taking a blood sample from a falciparum malaria patient. The needlestick pierced the doctors’ glove and caused a bleeding injury on the finger. The 42-year-old male falciparum malaria patient had a history of visit to Sudan. He had fever (38.6°C), tachycardia (113 beats/min), and icteric skin. His peripheral blood smear was positive for P. falciparum with 40% parasitemia. Artemether and lumefantrine (80 mg/480 mg), 2 tablets, four times a day treatment was started to the patient. On the second day of his treatment, while he was afebrile, the needlestick exposure occurred in the night time. Although the source patient was taking therapy, he had still a parasite load around 25%. Type of the injury was deep and caused bleeding. Transmission risk of the disease was taken into account, and on the following day, artemether and lumefantrine provided by Ankara Public Health Directorate and she took the drugs as used in therapy.
    [Show full text]
  • Hiv Post-Exposure Prophylaxis (Pep) in the United Nations
    HIV POST-EXPOSURE PROPHYLAXIS (PEP) IN THE UNITED NATIONS GUIDANCE FOR USE OF PEP KITS MARCH 2014 FOR USE BY: HIV PEP KIT CUSTODIANS (PAGE 1) PATIENTS REQUIRING THE USE OF HIV PEP (PAGE 4) HEALTH CARE PROVIDERS ADMINISTERING HIV PEP (PAGE 13) HIV PEP: Custodian Information 1 HIV POST-EXPOSURE PROPHYLAXIS (PEP) KITS: 1 INFORMATION FOR CUSTODIANS 1 WHAT IS PEP? PEP stands for “Post Exposure Prophylaxis”. In the context of HIV, it refers to a set of services that are provided to manage the specific aspects of exposure to HIV and to help prevent HIV infection in an exposed person. These services might comprise first aid, counselling, including the assessment of risk of exposure to HIV, HIV testing, and depending on the outcome of the exposure assessment, a course of anti- HIV medication, with appropriate support and follow-up. PEP should be initiated as soon as possible after exposure, ideally within 2 hours or less, and no later than 72 hours post-exposure. Adherence to a full 28 day course of anti-retroviral (ARV) medicines is critical and the administration of PEP should be provided with comprehensive services in a confidential and trusting environment. Providing assurance and maintaining confidentiality of exposed individuals in all dealings and communications is vital. While PEP is not 100% effective in preventing HIV infection following exposure, the UN Medical Services recommendations for PEP are based on careful review of available studies and constitute the considered opinion of international HIV experts. To access the reference for this leaflet, please see http://www.who.int/hiv/pub/guidelines/PEP/en/index.html and http://www.who.int/hiv/pub/guidelines/arv2013/en/.
    [Show full text]
  • Ebola Virus Disease and Clinical Care Part I: History, Transmission, and Clinical Presentation
    Ebola Virus Disease and Clinical Care Part I: History, Transmission, and Clinical Presentation This lecture is on Ebola virus disease (EVD) and clinical care. This is part one of a three-part lecture on this topic. Preparing Healthcare Workers to Work in Ebola Treatment Units (ETUs) in Africa This lecture will focus on EVD in the West African setting. Ebola Virus Disease and Clinical Care: The training and information you receive in this course will Part I: History, Transmission, and Clinical not cover the use of certain interventions such as intubation Presentation or dialysis which are not available in West African Ebola Treatment Units (ETUs). You will need supplemental training This presentation is current as of December 2014. This presentation contains materials from Centers for Disease Control and to care for patients appropriately in countries where advanced Prevention (CDC), Médecins Sans Frontières (MSF), and World Health Organization (WHO). care is available. U.S. Department of Health and Human Services U.S. Department of Health and Human Services Centers for Disease Control and Prevention Centers for Disease Control and Prevention version 12.03.2014 The learning objectives for this lecture are to: Learning Objectives ▶ Describe the routes of Ebola virus transmission Describe the routes of Ebola virus transmission Explain when and how patients are infectious ▶ Explain when and how patients are infectious Describe the clinical features of patients with Ebola ▶ Describe screening criteria for Ebola virus disease Describe the clinical features of patients with Ebola (EVD) used in West Africa Explain how to identify patients with suspected ▶ Describe screening criteria for EVD used in West Africa EVD who present to the ETU ▶ Explain how to identify patients with suspected EVD who present to the ETU This presentation contains materials from CDC, MSF, and WHO 2 A number of different viruses cause viral hemorrhagic fever.
    [Show full text]
  • Hiv & Hepatitis C Exposure Detail Protocol
    ATTACHMENT - HIV & HEPATITIS C EXPOSURE DETAIL PROTOCOL The potentially grave consequences of exposure to body fluids from people infected with HIV and Hepatitis C have prompted development of policies and procedures designed to reduce the risk in healthcare personnel (HCP). The most important practice is the use of available measures to prevent such exposures. Although the incidence of needlestick injuries has been reduced by advances in education, needle disposal, engineering changes (e.g., needleless devices, safety needles) and personnel protection, institutions and healthcare professionals must continue to assume responsibility in further lowering the risk. A. RISK OF TRANSMISSION OF HIV The risk of transmission of HIV infection following inadvertent exposure varies widely depending upon the type of exposure. The risk is increased when the source has a high viral load, the volume is large, and the exposure is deep. The healthcare personnel (HCP) at highest risk are those who have percutaneously been inoculated with blood from an HIV-infected source. All known seroconversions have occurred with exposure to blood, bodily fluids, or viral cultures. Risk by exposure type — The risk of becoming infected with HIV after exposure to body fluids from an HIV-infected patient is low. In the United States, there were 58 confirmed and 150 possible cases of occupationally- acquired HIV reported to the Centers for Disease Control from 1985 to 2013; there was only one confirmed case from 2000 to 2012 A review of prospective studies of seroconversion
    [Show full text]
  • WGO Practice Guideline: Needle Stick Injury and Accidental Exposure to Blood
    WGO Practice Guideline: Needle Stick Injury and Accidental Exposure to Blood Sections: 1. Definitions 2. Risks 3. Avoiding needlestick injury and avoiding infection 4. Immediate action after needlestick injury 5. Treatment approaches 6. Implementation and Registration 7. Literature References 8. Links to Useful Websites 9. Queries and Feedback from You Definitions Needlestick Injury : the accidental puncture of the skin by a needle during a medical intervention Accidental exposure to blood: the unintended contact with blood and or with body fluids mixed with blood during a medical intervention. 2. Risks Accidental exposure to blood caused by needle injuries or injuries following, cutting, biting or splashing incidents carries the risk of infection by blood-borne viruses such as the hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). HBV risk= 5 - 40% HCV risk= 3 - 10% HIV risk = 0.2 - 0.5% HBV prevalence is higher than average in intravenous drug users, homosexual men and in people from developing countries. HCV prevalence is higher in people who have had multiple blood transfusions, in dialysis patients and intravenous drug users. HIV prevalence is also higher in homosexual men, in intravenous drug users and in people from areas where the condition is endemic. Accidental contact with blood occurs especially in the following situations: 1. During re-capping 2. During surgery, especially during wound closure 3. During biopsy 4. When an uncapped needle has ended up in bed linen, surgery clothing etc 5. When taking an unsheathed used needle to the waste container 6. During the cleaning up and transporting of waste material 7.
    [Show full text]
  • Clinical, Economic, and Humanistic Burden of Needlestick Injuries in Healthcare Workers
    Journal name: Medical Devices: Evidence and Research Article Designation: REVIEW Year: 2017 Volume: 10 Medical Devices: Evidence and Research Dovepress Running head verso: Cooke and Stephens Running head recto: Burden of needlestick injuries open access to scientific and medical research DOI: http://dx.doi.org/10.2147/MDER.S140846 Open Access Full Text Article REVIEW Clinical, economic, and humanistic burden of needlestick injuries in healthcare workers Catherine E Cooke1 Introduction: Needlestick injuries (NSIs) from a contaminated needle put healthcare workers Jennifer M Stephens2 (HCWs) at risk of becoming infected with a blood-borne virus and suffering serious short- and long-term medical consequences. Hypodermic injections using disposable syringes and needles 1Department of Pharmacy Practice & Science, University of Maryland are the most frequent cause of NSIs. School of Pharmacy, Baltimore, MD, Objective: To perform a systematic literature review on NSI and active safety-engineered 2Pharmerit International, Bethesda, devices for hypodermic injection. MD, USA Methods: MEDLINE, EMBASE, and COCHRANE databases were searched for studies that evaluated the clinical, economic, or humanistic outcomes of NSI or active safety-engineered devices. For personal use only. Results: NSIs have been reported by 14.9%–69.4% of HCWs with the wide range due to differ- ences in countries, settings, and methodologies used to determine rates. Exposure to contaminated sharps is responsible for 37%–39% of the worldwide cases of hepatitis B and C infections in HCWs. HCWs may experience serious emotional effects and mental health disorders after a NSI, resulting in work loss and post-traumatic stress disorder. In 2015 International US$ (IntUS$), the average cost of a NSI was IntUS$747 (range IntUS$199–1,691).
    [Show full text]
  • Community Acquired Needlestick Injuries (Reviewed May 2016) Injuries Communityacquiredneedlestick 4
    EMI Guidelines - Appendix 19 Community acquired needlestick injuries (reviewed May 2016) TOOLKIT COMMUNITY ACQUIRED NEEDLESTICK INJURIES Community acquired needlestick injuries (CANSIs) have not been well described, and the evidence base on which to recommend management strategies is poor.1 CANSIs cover a wide spectrum from criminal assault with blood filled syringes to children playing with discarded syringes in public parks.1 Although community needlestick injuries are a common source of anxiety for the public and for the health care providers who treat them, transmission of BBVs in a non-clinical setting is exceedingly rare.2 CANSI due to deliberate assault with a blood filled syringe represents a higher risk than average.1 In contrast to the situation with needlestick injuries in health care workers, the source of blood in discarded needles is usually unknown, injury does not occur immediately after needle use, the needle rarely contains fresh blood, any virus present has been exposed to drying and environmental temperatures, and injuries are usually superficial.3 The risk of BBV transmission through a needlestick injury from a discarded needle/syringe is likely to depend on several factors. These factors include the prevalence of BBVs among PWID in the particular setting, the type of injury sustained, the viability of the particular virus outside the body, how recently the needle/syringe has been used, the level of immunity (in the case of HBV) and the availability and use of PEP (in the case of HBV and HIV).4 Reported cases of BBV transmission following a CANSI There are currently few reported incidents of BBV infections thought to be secondary to a CANSI.
    [Show full text]
  • Health Hazard Evaluation Report 2018-0015B
    Interim Report: Evaluation of Occupational Exposures to Opioids, Mental Health Symptoms, Exposure to Traumatic Events, and Job Stress in a City Fire Department HHE Report No. 2018-0015b February 2019 Authors: Sophia Chiu, MD, MPH Douglas M. Wiegand, PhD Kendra Broadwater, MPH, CIH Jessica F. Li, MSPH Desktop Publisher: Jennifer Tyrawski Editor: Cheryl Hamilton Medical Field Assistance: Marie de Perio, Guadalupe (Pita) Gomez, Reed Grimes, Laurel Harduar Morano, Sean Lawson, Sara Luckhaupt, Miriam Siegel, Loren Tapp, Shawna Watts Data Support: Denise Giglio Keywords: North American Industry Classification System (NAICS) 922160 (Fire Protection), Ohio, Fire Fighter, Emergency Medical Services, Illicit Drug, Opioid, Fentanyl, Job Stress, Mental Health, Trauma Disclaimer The Health Hazard Evaluation Program investigates possible health hazards in the workplace under the authority of the Occupational Safety and Health Act of 1970 (29 U.S.C. § 669(a)(6)). The Health Hazard Evaluation Program also provides, upon request, technical assistance to federal, state, and local agencies to investigate occupational health hazards and to prevent occupational disease or injury. Regulations guiding the Program can be found in Title 42, Code of Federal Regulations, Part 85; Requests for Health Hazard Evaluations (42 CFR Part 85). Availability of Interim Report Copies of this interim report have been sent to the employer (city and fire department) and fire department union. This report is not copyrighted and may be freely reproduced. Recommended Citation NIOSH [2019]. Interim report: evaluation of occupational exposures to opioids, mental health symptoms, exposure to traumatic events, and job stress in a city fire department. By Chiu S, Wiegand DM, Broadwater K, Li JF.
    [Show full text]
  • Needlestick Injury Information Leaflet
    Heales Medical Health Promotion NEEDLESTICK INJURY INFORMATION LEAFLET What it is Who is at risk What are the risks Immunisation What actions to take Reduce & prevent injuries changing the shape of Occupational Health Heales Medical Health Promotion NEEDLESTICK INJURY INFORMATION LEAFLET This leaflet is intended for workers in a health care setting who have the potential of sustaining an inoculation injury. It is produced to help individuals take the appropriate actions when an injury has occurred, in­addition to the preventative measures that the individual or an organisation should take to minimise inoculation injuries. Accidental innoculation with infected blood and or body fluids presents a real risk to health care workers. It constitutes a means of contracting occupationally acquired infections with Hepatitis B, C and HIV. Percutaneous injuries involving hollowbore needles remain the most commonly reported occupational exposures in the healthcare setting. The Health Protection Agency reported in 2014 that doctors and dentists are known to report a higher number of occupational exposures than nursing professionals. What is it? An inoculation injury is: • A needle or sharps injury: where an accidental puncture of the skin has taken place by a contaminated needle or sharps instrument (blades, dental probes, scalpels). • Human bite: blood borne virus (BBVs) are also potentially transmissible by a human bite if the bite breaks the skin of the person bitten. • Mucocuutaneous injury: is where blood, or body fluids mixed with blood comes in contact with a mucous membrane (eyes, nose, mouth, cuts). Who is at risk? The main group of workers at risk from innoculation injuries are those within the healthcare sector.
    [Show full text]