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Sex, Bites, and Needle Sticks

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September 12, 2019

First Aid (ALL)

  • Encourage bleeding
  • Wash with copious amounts of water or saline
  • Don’t Suck
  • Don’t use Caustic agents

 

Risk of contamination

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

Increased Risk

  • Deep or penetrating injuries/ wounds
  • Wide/hollow bore needles
  • Significant amount of blood contamination
  • Contamination of large areas of broken skin
  • The quality of the blood e.g. freshness and dilution factor
  • Lack of barriers to the transfer of body fluid
  • High viral load
  • Non-immune recipient
  • Needle previously in donor’s vein or artery
  • Some types of sexual activity

High Risk

  • 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

Typical Transmission Rates (from known infective sources)

  • 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

 

Treatment

  • 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

  • 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

  • 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)
    • Unimmunised
      • Accelerated course immunisation (0, 1, & 2 months)
      • Consider Immunoglobulin (discuss with Microbiology On-Call)
  • All will need Occupational Health/GP follow-up in 6 weeks (1 month if having accelerated course)

Hep C

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

 

A list of questions to determine the risk category of the source patient’s blood 

  • 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?

 

Full trust protocol

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