Sex, Bites, and Needle Sticks

First Aid (ALL)

Exposure to body fluids (esp. bloody) carries some risk however the following confer:

Sharps injury/bite with: Skin penetration/ Contamination of broken skin or mucous membranes
- Needles discovered in the street or the park should be considered as high risk of transmitting Hepatitis B and Hepatitis C but not HIV.
Transfer of blood stained body fluid to the injured site
Blood or body fluid from a person known or suspected of having a blood borne virus

Needle-stick; (Hep C) 1:3, (Hep B) 1:33, (HIV) 1:333
Sharing injecting equipment/ChemSex (HIV); 1:149
Receptive anal intercourse (HIV); general 1:90, ejaculation 1:65, no ejaculation 1:170
Insertive anal intercourse (HIV); general 1:666, non-circumcised 1:161, circumcised 1:909
Receptive vaginal intercourse (HIV); 1:1000
Insertive vaginal intercourse(HIV); 1:1219
Oral intercourse (HIV); <10,000
Human bite (HIV); <1:10,000

Take 10ml Gel (brown) sample – saved sample(EPR in ED contamination injury order set)
Establish status of donor (Ward staff to do if patient)
Complete: Risk assessment form (& Sharps injury form if staff member)

HIV +ve and within 72hr (preferably 1hr) of incident prescribe PEPSE pack (30 days) – available from Pharmacy or in emergency drugs cupboard
- Discuss with On-Call GUM/Microbiology with viral load if possible
- One blue tablet (emtricitabine/tenofovir disoproxil) and 2 yellow (raltegravir) ASAP and then every 24 hours
- Occupational health/GUM Clinic within 7day
- PEP advice leaflet is contained in the pack or Full trust protocol
- Children: Must be referred to Paediatrics Consultant On-Call
Not known but considered high risk with 72hr, discuss with GUM or Microbiology on-call (see source risk questions, at end of post)
Unknown or negative, or beyond 72hrs – treatment not recommended but needs Occupational Health/GP follow-up in 6 weeks

Hep B +ve or Unknown(see risk questions below)
- Recipient immunised & currently >10mIU/ml (check anti-HBS)
  - Booster of Hep B vaccine
- Recipient immunised & currently <10mIU/ml (check anti-HBS)
  - Booster of Hep B vaccine
  - Consider Immunoglobulin (discuss with Microbiology On-Call)
    - If required contact pharmacist in SJUH – contact info on “Rare Antidotes”
- Unimmunised
  - Accelerated course immunisation (0, 1, & 2 months)
  - Consider Immunoglobulin (discuss with Microbiology On-Call)
    - If required contact pharmacist in SJUH – contact info on “Rare Antidotes”
All will need Occupational Health/GP follow-up in 6 weeks (1 month if having accelerated course)

No treatment available, will need follow up with Occupational health/GP at 6 weeks, and if known positive counselling

Have you ever given blood? If yes, when last donated? Continue to ask the following:
Have you ever been told that you are positive for HIV/AIDS, HBV or HCV?
(For men only) have you ever had sex, even safe sex with another man?
Have you ever injected yourself with drugs? (This includes body-building drugs, but excludes prescription drugs, such as insulin).
Have you ever lived in, or visited, any country outside the UK and had sex with men or women living there or received hospital treatment?
Have you ever received a blood transfusion outside the United Kingdom? If yes, where and when?
Have you ever undergone a medical or dental procedure outside of the UK. If so, where and when?
Have you paid or been paid for sex at any time?
Have you ever had sex with a person in the above groups?