Occupational Exposures among Healthcare Workers: New Methods for Prevention and Recommended Postexposure Prophylaxis for HIV and Hepatitis B and C

Abstract

Occupational injuries and exposure to blood and body fluids continue to be commonplace in virtually every healthcare setting. Primary prevention of these injuries and exposure is the most important component of preventing occupational infection with any blood-borne pathogen. Should primary prevention fail, secondary prevention consists of post-exposure prophylaxis customized for the specific exposure. The 2013 U.S. Public Health Service recommendations for post-exposure prophylaxis following exposure to HIV include a “preferred” regimen of combined raltegravir, tenofovir, and emtricitabine, although these guidelines are now being continually updated on the CDC website. All healthcare workers started on HIV post-exposure prophylaxis should be re-evaluated within 72 hours, and follow-up HIV testing should occur at 6 weeks, 12 weeks, and from 4 to 6 months after exposure, depending on whether a fourth-generation immunoassay for HIV is used. The three intramuscular doses of hepatitis B vaccine that all healthcare workers should receive at the time of entry into patient care induce a protective antibody response in more than 90 % of healthy recipients. For individuals susceptible to HBV who are exposed to this virus, immunoprophylaxis consists of one dose of hepatitis B immune globulin (HBIG) and reinitiating the vaccine series for nonresponders who have not completed a second three-dose vaccine series. For persons who previously completed a second vaccine series but failed to respond, two doses of HBIG are preferred. The potential for occupational exposure to HCV is increasing, but no vaccine is currently available, and no prophylaxis is recommended. Highly active direct-acting anti-HCV antivirals that inhibit HCV protease, polymerase, and nonstructural protein 5A may eventually play a role in the management of such exposures, but are as yet untested in this setting. In addition, spontaneous clearance of HCV is common, acute HCV infection is highly curable, and early therapy results in high rates of eradication.