Needle-stick – Housekeeper picks trash that has an improperly disposed insulin needle and her thumb is pierced. She comes to the ED.
Postexposure Prophylaxis after exposure to bloodborne pathogens
-Will obtain baseline testing for HIV, hepatitis B virus, and hepatitis C virus antibodies, and repeat testing in six weeks, three months, and six months.
-CMP, CBC
-Hepatitis Acute Panel HP4
-HIV 1 and 2 Antibody Screen
-HIV Antibody POC
-A single dose of hepatitis B immune globulin, 0.06 mL per kg IM within 24 hours of exposure, followed by hepatitis B vaccine series since the patient was unvaccinated for Hepatitis B.
HIV Prophylaxis for 4 weeks with:
-Raltegravir 400mg PO BID, Disp: 60 tabs.
-Truvada 1 po once daily, Disp: 30 tabs.
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**Review Table 1 in the AFP article below for Hep B prophylaxis.
Modes of Transmission of Communicable Infections
Droplet: Influenza, invasive group A streptococcal disease, invasive meningococcal disease, pertussis, diphtheria, plague, anthrax
Fecal-oral: Hep. A virus.
Contact: Varicella zoster virus (herpes zoster)
Bloodborne: HBV, HCV, HIV
Truvada is Tenofovir 300mg + Emtricitabine 200mg
References
http://www.aafp.org/afp/2013/0701/p25.html
https://www.cdc.gov/niosh/topics/bbp/emergnedl.html