Transcript No Slide Title

Updated U.S. Public Health Service
Guidelines for the
Management of Occupational
Exposures to HBV, HCV, and HIV
and Recommendations for
Postexposure Prophylaxis
CDC. MMWR 2001;50(RR-11)
http://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf
Hepatitis B Virus (HBV), Hepatitis C
Virus (HCV), and Human
Immunodeficiency Virus (HIV)
•
•
•
•
Bloodborne viruses
Can produce chronic infection
Transmissible in healthcare settings
Data from multiple sources (e.g., surveillance,
observational studies, serosurveys) used to
assess risk of occupational transmission
Preventing Transmission
of Bloodborne Viruses
in Healthcare Settings
• Promote hepatitis B vaccination
• Treat all patients as potentially
infectious
• Use barriers to prevent blood/body
fluid contact
• Prevent percutaneous injuries
Factors Influencing Occupational
Risk of Bloodborne Virus Infection
• Prevalence of infection among patients
• Risk of infection transmission after a blood
exposure
• Nature and frequency of blood exposures
Prevalence of Bloodborne Virus
Infection in Patients
• Generally higher in hospitalized patients
than general population
• Varies with geographic area
• Varies with patient group
Risk of Bloodborne Virus
Transmission after
Occupational Percutaneous Exposure
Source
HBV
HBeAg +
HBeAg HCV
Risk
22.0-30.0%
1.0-6.0%
1.8%
HIV
0.3%
Frequency of Percutaneous Injury in
Healthcare Personnel
• Based on CDC estimates, 384,325 (95% CI
311,091-463,922) percutaneous injuries are
sustained by healthcare personnel in US hospitals
annually*
• The number of injuries sustained outside of
hospital settings is unknown
• Frequency of percutaneous injury varies by
occupational group and healthcare setting
* Panlilio, AL, et. al. Estimate of the Annual Number of Percutaneous Injuries
in U.S. Healthcare Workers. 4th Decennial Conference, March 5-9, 2000
National Surveillance
System For Healthcare
Workers
http://www.cdc.gov/ncidod/hip/SURVEILL/nash.HTM
Exposure Types for Blood/Body Fluid
Exposures* Reported to NaSH
June 1995-December 2000
(n=12,678)
Mucous membrane
1817 (14%)
Non-intact skin
352 (3%)
Bite
131 (1%)
Percutaneous
10,378 (82%)
* Excluding intact skin exposures and clean needlesticks. Exposures involving more than one site (4% of all
exposures) are counted as one exposure according to the highest risk route for bloodborne virus transmission.
Device Types for Percutaneous Injuries
Reported to NaSH
June 1995-December 2000
(n=10,378)
Glass (2%) Other/ unknown (6%)
Hollow-bore
needle (60%)
Hypodermic needle
29%
Winged steel needle
12%
Solid sharp (32%)
Suture needle (17%)
Scalpel (7%)
Other (8%)
IV stylet
Phlebotomy needle *
Other hollow-bore needle
6% 3% 10%
* Vacuum tube collection/holder/needle
Reasons for Updating
the PHS Guideline
•
•
•
•
New antiretroviral drugs
Emerging HIV drug resistance
Overuse of PEP for low or no risk exposures
HBV, HCV, and HIV issues best presented in
a single document
Elements of an Effective
Postexposure Management Program
• Clear policies/procedures
• Training of healthcare personnel (HCP)
• Rapid access to
– clinical care
– postexposure prophylaxis (PEP)
– testing of source patients/HCP
• Injury prevention assessment
Elements of Postexposure Management
• Wound management
• Exposure reporting
• Assessment of infection risk
– type and severity of exposure
– bloodborne infection status of source
person
• Appropriate treatment, follow-up, and
counseling
Postexposure Management:
Wound Care
• Clean wounds with soap and water
• Flush mucous membranes with water
• No evidence of benefit for:
– application of antiseptics or disinfectants
– squeezing (“milking”) puncture sites
• Avoid use of bleach and other agents
caustic to skin
Postexposure Management:
The Exposure Report
• Date and time of exposure
• Procedure details…what, where, how, with
what device
• Exposure details...route, body substance
involved, volume/duration of contact
• Information about source person and
exposed person
• Exposure management details
Postexposure Management:
Assessment of Infection Risk
• Type of exposure
–
–
–
–
percutaneous
mucous membrane
non-intact skin
bites resulting in blood
exposure
• Body substance
– blood
– bloody fluid
– potentially infectious
fluid or tissue
• Source person
– presence of HBsAg
– presence of HCV
antibody
– presence of HIV
antibody
– if source unknown,
assess epidemiologic
and clinical evidence
Postexposure Management:
Unknown or Untestable Source
• Consider information about exposure
– where and under what circumstances
– prevalence of HBV, HCV, or HIV in the population
group
• Testing of needles and other sharp instruments
not recommended
– unknown reliability and interpretation of findings
– hazard of handling sharp instrument
Postexposure Management:
Evaluating the Source
• Informed consent should be obtained in
accordance with state and local laws
• Confidentiality of the source person
Postexposure Management:
Evaluating the Source (cont.)
• If the HBV, HCV, and/or HIV status of the
source is unknown, perform testing
• Perform testing as soon as possible
• Consult laboratory regarding most
appropriate test to expedite obtaining results
Postexposure Management:
Evaluating the Source for HBV
• Presence of hepatitis B surface antigen
(HBsAg) indicates source is infected with
HBV
Postexposure Management:
Evaluating the Source for HCV
• Repeatedly reactive results by EIA for antiHCV should be confirmed by supplemental
test (RIBA or HCV PCR)
• Direct virus assays not recommended
Postexposure Management:
Evaluating the Source for HIV
• EIA
– Consider rapid test if EIA testing cannot be
completed within 24-48 hours
• Confirmation of reactive result not necessary
for PEP management
• Direct virus assays (e.g., PCR, p24 antigen)
not recommended
Occupational HBV Exposures
Estimated Incidence of HBV infections among
HCP and General Population,
United States, 1985-1999
Incidence per 100,000
350
300
250
Healthcare Personnel
200
150
General U.S. Population
100
50
0
1985
1987
1989
1991
1993
Year
1995
1997
1999
Hepatitis B Vaccination Coverage of
HCP in 113 US Hospitals, 1994-1995*
Occupation
No.
Eligible
Received
3 Doses, %
149
196
1,056
61
645
132
222
69
2,530
*Arch Intern Med 1997;157:2601
Phlebotomist/technician
Radiologist/therapist
Nurse
Physician/resident
Nurse aide
Maintenance/security
Clerical
Food service
Total
81
73
72
71
63
59
44
44
66.5
Concentration of HBV in Body Fluids
High
Blood
Serum
Wound exudates
Moderate
Semen
Vaginal Fluid
Saliva
Low/Not Detectable
Urine
Feces
Sweat
Tears
Breast Milk
Elements of Postexposure Management:
HBV
• Baseline evaluation and testing of exposed
person with unknown HBV immune status
• Consideration of treatment
– when to give
– what to give
• Follow-up testing and counseling
Postexposure Management:
Baseline HBV Testing of Exposed* Person
• Test for anti-HBs if person has been
vaccinated, but vaccine response is unknown
• Baseline testing not necessary if exposed
person has not been vaccinated or vaccine
response is known
* Source HBsAg positive or status unknown
Recommended Postexposure Management:
PEP for Exposure to HBV
Vaccination and antibody
status of exposed person
Treatment when source is HBsAg
positive
Unvaccinated
HBIG x 1 and initiate hepatitis B
vaccine series
Previously vaccinated
Known responder
No treatment
Known nonresponder
HBIG x 1and initiate re-vaccination
or
HBIG x 2
Antibody response
unknown
Test exposed person for anti-HBs
1. If adequate, no treatment
2. If inadequate, HBIG x 1
and vaccine booster
Recommended Postexposure Management:
PEP for Exposure to HBV
Vaccination and antibody
status of exposed person
Treatment when source is not
tested or status unknown
Unvaccinated
Initiate hepatitis B vaccine series
Previously vaccinated
Known responder
No treatment
Known nonresponder
If known high-risk source treat as if
source were HBsAg positive
Antibody response
unknown
Test exposed person for anti-HBs
1. If adequate, no treatment
2. If inadequate, vaccine booster
and recheck titer in 1-2 mos
Side Effects of Hepatitis B Vaccine
• Pain at injection site
• Mild to moderate fever
• Anaphylaxis in an estimated 1 in 600,000
doses given
• No serious adverse events detected through
surveillance
• No risk of adverse effects to fetus
Efficacy of HBV PEP*
Prevention of HBV Infection
Regimen
Multiple doses of HBIG
70-75%
alone when 1st dose
initiated within 1 week
Hepatitis B vaccine series
70-75%
alone
85-95%
Combination of HBIG and
vaccine series
* Estimated for adults, based on perinatal data
Hepatitis B Vaccine:
Long-Term Efficacy
• Anti-HBs titers decline to <10 mIU/mL in 30-50%
of adults within 8-10 years after vaccination
• Exposure to HBV results in anamnestic anti-HBs
response that prevents clinically significant HBV
infection
• Immune memory remains intact for at least 20
years after immunization
• Chronic HBV infection rarely documented
among vaccine responders
• Booster doses currently not recommended
Postexposure Management:
Follow-up HBV Testing of Exposed Person
• Perform follow-up anti-HBs testing in healthcare
personnel who receive hepatitis B vaccine
– test for anti-HBs 1-2 months after last dose
– anti-HBs response to vaccine cannot be
ascertained if HBIG received in the previous
3-4 months
Postexposure Management:
HBV Postexposure Counseling
• Refrain from donating blood, plasma, organs,
tissue, or semen.
• No need for:
– modification of sexual practices or refraining from
becoming pregnant
– special precautions to prevent secondary transmission.
– modification to patient care responsibilities for exposed
person
• If acute HBV infection, evaluate according to
published recommendations
Occupational HCV Exposures
Occupational Transmission of HCV
• Inefficiently transmitted by occupational exposures
• Average incidence 1.8% (range 0-7%) following
percutaneous exposure from HCV-positive source
• Case reports of transmission from blood splash to
mucous membrane
• Prevalence 1-2% among healthcare personnel
– Lower than among adults in the general population
– 10 times lower than for HBV infection
Elements of Postexposure Management:
HCV
• Baseline evaluation and testing
• Follow-up testing and counseling
Postexposure Management:
Baseline HCV Testing of Exposed Person
• If HCV-positive source, test exposed person for
anti-HCV and ALT
• If source not infected, baseline testing not
necessary
Postexposure Prophylaxis for HCV
• Not recommended after exposure
– immunoglobulin not effective
– no data on use of antivirals (e.g., interferon), and
may be effective only with established infection
– antivirals not FDA approved for this setting
Postexposure Management:
Follow-up of HCV-Exposed HCP
• Test for anti-HCV and ALT 4-6 months after exposure
• Test for HCV-RNA at 4-6 weeks for earlier diagnosis of
HCV infection.
• Confirm anti-HCV EIA-positive results with
supplemental test (e.g., RIBA)
• No guidelines for therapy during acute infection
– when HCV infection identified early, refer worker to
a specialist for proper management
Postexposure Management:
HCV Postexposure Counseling
• Refrain from donating blood, plasma, organs,
tissue, or semen.
• No need for:
– modification of sexual practices or refraining from
becoming pregnant
– special precautions to prevent secondary
transmission.
– modification to patient care responsibilities for
exposed person, even if HCV infected
Occupational HIV Exposures
U.S. Healthcare Personnel with Documented
and Possible Occupationally Acquired
AIDS/HIV Infection, by Occupation, June 2001*
Documented
Transmission (No.)
Occupation
Dental worker, including dentist
Embalmer/morgue technician
Emergency medical technician/paramedic
Health aide/attendant
Housekeeper/maintenance worker
Laboratory technician, clinical
Laboratory technician, nonclinical
Nurse
Physician, nonsurgical
Physician , surgical
Respiratory therapist
Technician, dialysis
Technician, surgical
Technician/therapist, other than above
Other healthcare occupations
Total
Possible
Transmission ( No.)
---1
---1
2
16
3
24
6
---1
1
2
------57
* http://www.cdc.gov/hiv/pubs/facts.htm#Transmission
6
2
12
15
13
17
---34
12
6
2
3
2
9
4
137
Exposures Resulting in Occupational
HIV Transmission*
June 2001
Percutaneous
48
Unknown
Both
2
2
Mucocutaneous
* http://www.cdc.gov/hiv/pubs/facts.htm#Transmission
5
Sharp Objects Associated with 51
Percutaneous Injuries Resulting in HIV
Seroconversion in 50 Healthcare Personnel*
June 2001
Scalpel 2
Hollow-bore
needle 45
Broken vial 2
Unknown 2
* http://www.cdc.gov/hiv/pubs/facts.htm#Transmission
Average Risk of HIV Infection to
Healthcare Personnel by Exposure Route
• Percutaneous
0.3%
• Mucous membrane
0.09%
• Non-intact skin
<0.1%
Risk Factors for HIV Transmission After
Percutaneous Exposure to HIV-Infected Blood:
CDC Case-Control Study*
Risk Factor
Adjusted OR ratio (95% CI)
Deep injury
Visible blood on device
Procedure involving needle
placed in artery or vein
Terminal illness in source patient
Postexposure use of zidovudine
15 (6.0-41)
6.2 (2.2-21)
4.3 (1.7-12)
5.6 (2.0-16)
0.19 (0.06-0.52)
*Cardo et al., New Engl J Med 1997;337:1485-90.
Criteria to Establish HIV PEP as
a Standard of Care
• Biological plausibility
• Indirect scientific evidence of efficacy
– animal models
– human studies
• Safety
• Feasibility
Animal Studies of PEP Efficacy
• Data have been difficult to interpret and
extrapolate to humans, but provide encouraging
evidence of PEP efficacy
• Different virus strains, route of inoculation, dose
of inocula, and drug regimens used
• Delaying time to PEP, shortening the duration, or
decreasing the dose reduced effectiveness of
PEP
Human Studies of HIV PEP Efficacy
• Little information on efficacy of PEP in humans
• Seroconversion infrequent following occupational
exposure to HIV-infected blood
• Use of zidovudine (ZDV) was associated with an
81% decrease in the risk for HIV infection
– limitations include a small number of cases,
and that cases and controls came from different
cohorts (Cardo et al, NEJM 1997;337:1485-90.)
Human Studies of HIV PEP:
Prevention of Perinatal Transmission
• ZDV administered during pregnancy, labor, and
delivery reduced transmission by 67%
(Connor EM, et al. N Engl J Med 1994;331:1173-80.)
• Protective effect only partially explained by
reduction in maternal viral load
• Protective effect observed when ZDV given only
to newborn within the first 48-72 hours of life
(Wade NA, et al. N Engl J Med 1998;339:1409-14.) ( Musoke P, et al.
AIDS 1999;13:479-86.) (Guay LA, et al. Lancet 1999;354:795-802.)
HIV PEP:
Failures in Healthcare Personnel*
World-wide Cases
• 16 cases of ZDV failure
in healthcare personnel
• 5 cases of combination
HIV PEP failure
• no delay in time to
seroconversion
• no adverse effects on
natural history
Potential Explanations
• delay in treatment
• dose too low / low drug
levels
• resistant virus
• high inoculum exposure
• treatment duration too
short
*Beltrami EM. Semin Infect Control 2001;1:2-18
Reported Failures of Combination HIV PEP*
Injury
Regimen
Source on
Antiretroviral?
Biopsy needle
Hollow needle
Large-bore
hollow needle
Hollow needle
ZDV, ddI
ZDV, ddI
yes
no
3 drugs
ZDV, 3TC,
ddI, IDV
ddI, d4T, NVP
yes (not resistant)
yes (resistant)
Unknown sharp
yes (resistant)
All HCP seroconverted within 100 days
*Beltrami EM. Semin Infect Control 2001;1:2-18
Elements of Postexposure Management:
HIV
• Baseline evaluation and testing of exposed
person
• Consideration of treatment
– when to give
– what to give
– pregnancy in exposed
• Follow-up testing and counseling
Postexposure Management:
Baseline HIV Testing of Exposed Person
• EIA standard test
• Direct virus assays not recommended
– p24 antigen
– PCR for HIV RNA
Initiation of HIV PEP
• If indicated, start PEP as soon as possible after
exposure
– regard as an urgent medical concern
– hours rather than days
• Interval after which PEP is no longer likely to be
effective in humans is unknown
– initiating PEP days or weeks after an
exposure might be considered if warranted for
increased risk exposure
Re-evaluation of HIV-Exposed Person
Consider re-evaluation of the exposed person
within 72 hours
– additional information about the source
person may become available
– if the source person has a negative HIV
antibody test, stop PEP
Important Concepts about HIV PEP
• Determining which and how many agents to
use for PEP is largely empiric
• Professional judgement should be used
based on local knowledge and experience in
treating HIV
• Regimens should be tolerable to the exposed
person
Considerations When Using PEP
Risk of Transmission
Risk of Adverse Effects
PEP
Postexposure Management:
HIV PEP Basic Regimen
Basic Regimen
Zidovudine (ZDV):
Lamivudine (3TC):
200 mg tid (300 mg PO bid)
150 mg bid
Alternate Basic Regimens
Didanosine (ddI):
200 mg bid (125 mg bid if <60 kg)
Stavudine (d4T):
40 mg bid (30 mg bid if <60 kg)
Stavudine (d4T):
Lamivudine (3TC):
40 mg bid (30 mg bid if <60 kg)
150 mg bid
Postexposure Management:
HIV Expanded Regimen
Expanded Regimen
Basic regimen plus one of the following:
Indinavir (IDV):
Nelfinavir (NFV):
Efavirenz (EFV):
Abacavir (ABC):
800 mg q8h
750 mg tid or 1250 mg bid
600 mg daily
300 mg bid
Recommended HIV PEP for
Percutaneous Injuries
Infection Status of Source
Exposure
Type
HIV positive,
class 1
HIV positive,
class 2
HIV status
unknown
Less Severe
Recommend
basic PEP
Recommend
expanded PEP
Generally,
no PEP
More Severe
Recommend
expanded
PEP
Recommend
expanded PEP
Generally,
no PEP
Class 1: Asymptomatic or known low viral load
Class 2: Symptomatic, AIDS, or known high viral load
Recommended HIV PEP for Mucous
Membrane and Non-Intact Skin Exposures
Infection Status of Source
Exposure
Type
HIV positive,
class 1
Small Volume
Consider
(e.g., few drops) basic PEP
HIV positive,
class 2
HIV status
unknown
Recommend
basic PEP
Generally,
no PEP
Recommend Recommend
Large Volume
basic PEP
expanded PEP
(e.g., major
blood splash) Class 1: Asymptomatic or known low viral load
Generally,
no PEP
Class 2: Symptomatic, AIDS, or known high viral load
Situations Where PEP is Rarely, if
Ever, Warranted
• Intact skin contact with blood and
potentially infectious body fluids
• Exposure to unknown source in
populations where HIV prevalence is low
• Low-risk exposure to unknown source
Situations for Which Expert
Consultation for HIV PEP is Advised
• Resistance of the source virus to
antiretroviral agents
• Known or suspected pregnancy in the
exposed person
• Toxicity of the initial PEP regimen
Resistance to Antiretroviral Agents:
Implications for PEP
• Resistance to antiretroviral drugs reported
• Transmission of resistant virus reported
• Relevance of exposure to resistant virus not
understood
• Patients take many drugs; difficult to know to
which drug virus is resistant
• Cross-resistance within drug classes
Resistance to Antiretroviral Agents:
Implications for PEP (cont.)
• Recommend selection of drugs to which the
source person’s virus is unlikely to be
resistant
• Testing of the source person’s virus for
resistance at the time of exposure is not
recommended
 EXPERT CONSULTATION IS ADVISED
HIV PEP Considerations in
Pregnant Exposed Women
• General principles
– pregnancy is not a contraindication for PEP
– exposed person should make informed decision about
PEP
• Choosing regimen is more complex
– may exacerbate physiologic changes in pregnancy
– short/long-term effects on fetus/newborn unknown
– most data are on zidovudine
– some drugs contraindicated during pregnancy
HIV PEP During Pregnancy
• Efavirenz NOT recommended during
pregnancy because of possible teratogenicity
• Cases of fatal lactic acidosis in pregnant
women treated with d4T and ddI reported
• Indinavir should not be given shortly before
delivery because of hyperbilirubinemia
Primary Toxicities and Side Effects:
Basic Regimens
• Zidovudine (ZDV)
– Neutropenia, anemia
– Nausea, headache, insomnia, muscle pain,
and weakness
• Lamivudine (3TC)
– Abdominal pain, nausea, diarrhea, rash
– Pancreatitis (rare)
• ZDV/3TC
– Toxicity about the same as ZDV alone
Primary Toxicities and Side Effects:
Alternate Basic Regimens
• Didanosine (ddI)
– Pancreatitis, lactic acidosis, neuropathy
– Diarrhea, abdominal pain, nausea
• Stavudine (d4T)
– Peripheral neuropathy, pancreatitis, increased
liver function tests, anemia, neutropenia
– Headache, diarrhea, nausea, insomnia,
anorexia
Toxicities and Side Effects:
Expanded HIV PEP Regimens
• All protease inhibitors
– inhibit metabolism of non sedating antihistamines
and other hepatically metabolized drugs
– increase diabetes-related problems
• Indinavir
– may cause nausea, abdominal pain, nephrolithiasis
• Nelfinavir
– accelerates clearance of certain drugs, including oral
contraceptives
– may cause diarrhea, nausea, abdominal pain,
weakness, rash
Toxicities and Side Effects:
Expanded Regimens (cont.)
• Efavirenz
– Rash
– Nervous system problems (e.g., dizziness,
insomnia)
• Abacavir
– Nausea, diarrhea, anorexia, abdominal
pain, fatigue, headache, insomnia
– Hypersensitivity reactions
Reported Cases of Toxicity
Associated with Nevirapine for PEP*
• Fulminant liver failure (one requiring liver
transplantation) and hypersensitivity reaction
have been reported in healthcare personnel
taking nevirapine for PEP
• FDA has received 22 reports of serious adverse
events related to nevirapine taken for PEP
– hepatotoxicity (12 cases)
– skin rash (14 cases)
– rhabdomyolysis (1 case)
*MMWR 2001;49:1153-1155
Postexposure Management:
Follow-up HIV Testing of Exposed Person
• If source HIV positive, test at 6 weeks, 3
months, 6 months
– EIA standard test
– direct virus assays not recommended
• Extending follow-up to 12 months
– recommended for HCP who become infected
with HCV following exposure to co-infected
source
– optional in other situations
Postexposure Management:
Monitoring for PEP Toxicity
• Tests at baseline and 2 weeks after starting PEP
– complete blood count
– renal and hepatic profiles
• Follow-up testing if taking protease inhibitor
– monitor for hypoglycemia
– monitor for crystalluria, hematuria, hemolytic
anemia, and hepatitis if on indinavir
• Modify regimen if toxicity noted
• Expert consultation encouraged
Postexposure Management:
HIV Postexposure Counseling
• Side effects of PEP
drugs
• Signs and symptoms
of acute HIV infection
– fever
– rash
– flu-like illness
• Prevention of secondary
transmission
– sexual abstinence or
condom use
– no blood/tissue
donation
• Transmission and PEP
drug risks if breastfeeding
No work restriction indicated
Summary of Updated
Recommendations for HIV
Exposure Management
• Inclusion of new antiretroviral drugs
• Stronger statements regarding unnecessary
use of PEP
• Use of rapid testing for source patients
• Discourage use of direct virus assays for
follow-up
• Follow-up evaluation within 72 hours
postexposure
Recommendations for Healthcare Facilities
• Establish a bloodborne pathogen management
policy
• Implement management policies (e.g., training,
hepatitis B vaccination, exposure reporting,
PEP access, etc.)
• Establish laboratory capacity for bloodborne
virus testing
• Select and use appropriate PEP regimens
Recommendations for
Healthcare Facilities (cont.)
• Provide access to counseling for exposed
personnel
• Monitor adverse events and seroconversion
• Monitor exposure management programs
(e.g., time between exposure and evaluation,
testing of source persons, completion of
follow-up)
Conclusion
• Occupational exposure management is
complex
• Prevention is best
– hepatitis B immunization
– avoiding occupational blood exposures
• Join the Division of Healthcare Quality
Promotion in challenge of eliminating
needlesticks
Sources of Additional Information
• Division of Healthcare Quality Promotion
Phone: 800-893-0485
Homepage: http://www.cdc.gov/ncidod/hip/
• Hepatitis Hotline
Phone: 888-443-7232
Homepage: http://www.cdc.gov/hepatitis
• Needlestick!
Homepage:http://www.needlestick.mednet.ucla.edu
Sources of Additional Information
• National Institute for Occupational Safety and
Health bloodborne pathogens website
http://www.cdc.gov/niosh/bbppg.html
• Occupational Safety and Health Administration
bloodborne pathogens website
http://www.osha-slc.gov/SLTC/bloodbornepathogens/index.html
PEPline
• National Clinicians’ Post-Exposure
Prophylaxis Hotline (PEPline)
• Free consultation for clinicians treating
occupational exposures to HIV and other
bloodborne pathogens…
• 24 hours a day
• 7 days a week
• 1-888-HIV-4911
• http://www.ucsf.edu/hivcntr/
•
a joint program of UCSF/SFGH CPAT / EPI Center supported by
HRSA and CDC
PREVENTION
IS PRIMARY!
Protect patients…protect healthcare personnel…
promote quality healthcare!