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[Table of Contents]
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Volume: 23S2 • March 1997
AN INTEGRATED PROTOCOL TO MANAGE HEALTH CARE WORKERS EXPOSED
TO BLOODBORNE PATHOGENS
Recommendations for an Integrated Protocol
5. Post-Exposure Prophylaxis for the HCW (Table 4)
Table 4
Post-exposure prophylaxis for the HCW, if the source is positive or status
is
unknown or is negative but has risk factors
|
Bloodborne
Pathogens |
PROPHYLAXIS FOR THE HCW |
| HBV |
- No further action is needed if the HCW is immune +
to HBV (This is presently under review by NACI.)
- Give hepatitis B immune globulin (HBIG), preferably within 48 hours
of exposure (efficacy decreases with time and is unknown after 7 days
(14) ) if the HCW is susceptible
+ to HBV or has an unknown +
status. In addition, start HB vaccine for HCWs who are susceptible
+ to HBV and have not received HB vaccine.
Provide a single dose of vaccine for HCWs who have an unknown
+ status after HB vaccine ++
.
- Give one dose of HBIG, preferably within 48 hours and another in
1 month if the HCW is a known non-responder +
to the HB immunization series.
- Draw blood for testing before HBIG or immunization is given.
|
| HCV |
- Effective post-exposure prophylaxis is not available at this time.
Immunoglobulin is not effective (9)
.
|
| HIV |
- Consider immediate post-exposure chemoprophylaxis (see
Appendix).
|
| + See Section
7. |
| ++ Note: Testing an exposed HCW
(of " unknown + HBV status" at the time
of exposure but who has received a complete series of HB vaccine or who
has a history of unspecified clinical hepatitis) for HBV markers on an
urgent basis may clarify the status of such a HCW regarding HBV and this
may, in some cases, alter the post-exposure prophylaxis used. While not
necessary in this protocol, individual agencies could consider such testing
for these specific HCWs if they are able to know the test results and provide
applicable post-exposure prophylaxis within 48 hours of exposure. Otherwise,
post-exposure prophylaxis will need to be based on information about the
HCW's status available at the time of exposure. |
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