Management of significant exposure incidents will include some or all of the following:
For an HIV-exposure incident, blood should be taken at 12 weeks and tested for anti-HIV.
Where appropriate, the individual who is the source of the blood/body fluid should be approached, given an explanation of the incident and asked for informed consent for them to be tested for HIV, HBV and HCV, where the status is not already known. Such information will clearly impact on any decisions taken with regard to the management of the recipient. This universal approach to source testing for BBV normalises the procedure and avoids perceived discrimination (EAGA HIV PEP Guidelines 2008).
For each of the three main blood-borne viruses, there are possible post-exposure interventions and management strategies designed to minimise the chances of the exposed worker acquiring a blood-borne virus, as a result of the exposure. In brief, these possibilities are as follows:
Hepatitis B Virus: consideration of passive immunisation (ie administration of preformed antibodies against HBV, derived from healthy blood donors) in the form of hepatitis B immunoglobulin (HBIg), and of active immunisation with hepatitis B vaccine, usually using an accelerated course (ie doses administered 0, 1, 2, and 12 months post-exposure).
Hepatitis C Virus: monitor the recipient for evidence of acquisition of infection with HCV over the 6 months following exposure (by testing for the presence of HCV RNA and/or antibodies to HCV in samples from the recipient taken at appropriate intervals after the incident). As soon as evidence of infection is detected, the recipient should be referred immediately to an appropriate specialist for consideration of antiviral therapy, as evidence shows that treatment at this stage is very successful.
Human Immunodeficiency Virus: following exposure to HIV administration of post-exposure prophylaxis (ie a regimen of 3 anti-HIV drugs taken for 4 weeks post exposure). The EAGA guidance provides detailed schedules recommended for HIV PEP.
The interventions above can only be instituted after careful risk assessment of the exposure incident by appropriately trained clinical personnel. Exposed individuals should seek immediate specialist post-exposure care at a recognised specialist centre. This phase of treatment or observation is most likely to be administered by a local accident and emergency department, or by other specialist personnel at the local hospital. For those working outside of the NHS, occupational health facilities and expertise may be accessible but will vary in different occupational settings. Whilst the primary responsibility for post exposure medical services lies with the NHS, it is recommended that all occupational health providers ensure that local arrangements are in place for risk assessment, advice and the provision of PEP, in particular to ensure that the correct BBV medical support is immediately available.