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Infectious Disease In The Community And Hospital Setting > Needlestick transmission of blood-borne viruses > Flashcards

Needlestick transmission of blood-borne viruses Flashcards

1
Q

How to prevent Hep B infection from needlestick in HCW

A

Vaccination of non-responders or non-vaccinated

PEP - vaccination or HBIg

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2
Q

How to prevent Hep B infection from needlestick in HCW

A

Vaccination of non-responders or non-vaccinated

PEP - vaccination or HBIg

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3
Q

What type of Hep B positive patient is the most infectious?

A

HepB E Ag positive.

Reduced risk if Anti-E positive and low levels of HBV DNA

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4
Q

What does a HBV vaccination consist of?

A

Purified surface Ag

Requires x 3 doses

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5
Q

What is the definition of a non-response to HBV vaccination? What are its implications?

A
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6
Q

How many adults are HBV vaccination non-responders?

A

5-10%

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7
Q

What type of Hep B positive patient is the most infectious?

A

HepB E Ag positive.

Reduced risk if Anti-E positive and low levels of HBV DNA

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8
Q

What does a HBV vaccination consist of?

A

Purified surface Ag

Requires x 3 doses

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9
Q

What should the response be to Hep B vaccination?

A

Generation of anti- HBs

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10
Q

What is the definition of a non-response to HBV vaccination? What are its implications?

A

0-10 iu

No hep b protection

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11
Q

How many adults are HBV vaccination non-responders?

A

5-10%

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12
Q

What is the definition of a hypo-response/sub-optimal responders to HBV vaccination? What are its implications?

A

10-100 iu/l 6-10 weeks after completion of vaccination schedule.
? protected against HBV infection or not
USA and Europe consider protective.
‘Seroconversion’

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13
Q

How many adults are HBV vaccination sub-optimal responders?

A

5-10% adults

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14
Q

What is the definition of an optimal response to HBV vaccination? What are its implications?

A

> 100 iu/l 6-10 weeks after completion of 3-dose vaccination schedule
Protected against HBV infection
‘Seroprotection’

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15
Q

What can be done to increase protection of HBV vaccination non-responders?

A

Repeat course of vaccine and re-test anti-HBs (Complete course of 6)

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16
Q

What can be done to increase protection of HBV vaccination in poor responders

A

Booster dose (x 4 in total)

17
Q

How are HCWs protected against HCV?

A

Treatment of acute infection within 3-6 months - very high clearance rates
Encourage reporting of needle stick exposures/mucosal splash
Monitor for evidence of HCV infection
Treat

18
Q

Why is the policy for HBV vaccination in childhood?

A

Vaccine response linked to age - better response vaccination people at younger age.
Reduce the no. of sub-optimal/non-responders seen.

19
Q

What is looked at to assess significance of exposure to HBV?

A

Route - percutaneous, mucocutaneous, sexual

Source material - blood > other bodily fluids

20
Q

How is an exposure incident managed?

A

Seek advice
Routine testing of needle stick source - need consent from person giving blood
Risk assess source and recipient: - what type of needle? where was the stick?
- HBV consider post exposure management
- HCV monitoring
- HIV consider PEP

21
Q

What intervention is taken for a HCW with exposure to HCV?

A

Monitoring and early diagnosis.

No HCV vaccine

22
Q

What prevention methods can be taken for HCV

A

None, no vaccine = no passive immunisation

23
Q

How are HCWs protected against HCV?

A

Treatment of acute infection within 3-6 months - very high clearance rates
Encourage reporting of needlestick exposures/mucosal splash
Monitor for evidence of HCV infection
Treat

24
Q

What are the stages of HCV monitoring?

A

6 weeks = HCV PCR
12 weeks = HCV PCR + anti HCV serology
6 months = HCV PCR + anti-HCV serology again

25
Q

What treatment is offered to prevent HIV infection post exposure?

A

PEP antiviral triple therapy offered if needle stick known HIV positive or not known but high risk.
NRTI, NNRTI and PI 4 weeks.

26
Q

How is an exposure incident managed?

A

Seek advice
Routine testing of needle stick source - need consent from person giving blood
Risk assess source and recipient: - what type of needle? where was the stick?
- HBV consider post exposure management
HCV monitoring
HIV consider PEP

27
Q

Exposure prone procedures are?

A

those where there is a risk that injury to the worker may result in the exposure of the patients open tissues to the blood of the worker.

28
Q

Latest/current guidelines of HBV and HCWs

A

anti-HBe +ve HCWs measure viral load:
- >10^3 copies/ml = banned from EPPs
-

29
Q

Examples of EPP

A

All surgery
All dentistry
Repair of episiotomy
instrumental delivery

30
Q

Examples of non-EPP

A 
Taking blood
setting up IV lines
Minor surface suturing
Incision of abscesses
Uncomplicated endoscopy
Normal vaginal delivery
31
Q

Can HBV carriers/HBsAg pos be anti-HBs?

A

Yes.

Usually of low tire eg. 10-100 iu/l and non-neutralising

32
Q

What order of testing/vaccination for HCV is carried out on HCWs in order to catch HCV carriers before vaccination?

A

sAg testing
If neg:
Vaccine,
test anti-HBs response (confidence in protection)

33
Q

Why can testing e markers (eAg +ve) be misleading in HCWs?

A

Assumed if HBeAg +ve = highly infectious
But can have virus with pre-core mutants = unable to synthesise e antigen (HBeAg -ve) but highly replicative virus? - misleading as may be highly infectious and at at high risk of chronic liver disease

34
Q

Latest/current guidelines of HBV and HCWs

A

anti-HBe +ve HCWs measure viral load:
- >10^3 copies/ml = banned from EPPs
-

35
Q

Which antivirals are used to reduce infectivity but licensed to reduce liver damage?

A

Tenefovir and Entecavir (dec risk of resistance vs lamivudine)

36
Q

What actions are in place to protect patients from HCV from health care workers?

A

Known HCV RNA +ve workers = out
Current HCWs doing EPPs encouraged to be tested if risk factors i.e. needlestick
For HCWs entering EPP specialities test for HCV infection - doverts HCV pos trainees away from EPP specialities.

37
Q

Standard health checks offered to new employees/HCWs returning to NHS/HCWs performing EPPs for the first time/students

A

HBV vaccine
testing for HCV
Testing for HIV
without affecting employment or training….

38
Q

Additional health checks offered to new NHS HCWs doing EPPs

A

Test for HBsAg, then vaccinate and test for anti-hsb
Test for anti-HCV
Test for anti-HIV

39
Q

Are you allowed to operate if you are HIV pos?

A

No

Infectious Disease In The Community And Hospital Setting (5 decks)

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