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                                        What to Do After an Occupational Exposure

                       When the Source Patient Is Unknown or Refuses to Be Tested


If a source patient cannot be tested or the souce patient is unknown, such as in the case of a needlestick

injury from a sharp in a sharps container, the exposed employee must be presumed to have been exposed

to the most common bloodborne pathogens, Hepatitis B, C and HIV and tested and treated accordingly.


Hepatitis B

Exposed Employee Status
Action to Take When Source Patient is Unknown or Cannot Be Tested
Never vaccinated.

Initiate HBV vaccine series. Test for immunity (anti-HBs) 1-2 months after the last dose of vaccine.


Vaccinated and titer shows immunity (anti-HBs 10mIU/ml or greater).

No treatment or testing needed. Employee is immune to infection with Hepatitis B.
Vaccinated, not immune, and has not completed the second 3-dose series of vaccination.

If known high risk source* treat as if Hepatitis B positive, i.e., give Hepatitis B immune globulin [(HBIG) 0.06 mL/kg intramuscularly] immediately after exposure and reinitiate the vaccine series.

85-95% effective in preventing HBV infection.

Vaccinated, not immune, revaccinated and still not immune.

If known high risk source*, give HBIG immediately after exposure and a second dose one month later. 70-75% effective in preventing HBV infection.
Vaccinated, but never tested for immunity.

Test for Hepatitis B antibody (anti-HBs). If not immune, administer Hepatitis B immune globulin and vaccine booster.


*For known source patients who refuse testing, consider medical diagnoses, clinical symptoms, and history of risk behaviors.

For unknown sources, consider the likelihood of bloodborne pathogen infection among patients in the exposure setting.

Do not test discarded needles for bloodborne pathogens.

Hepatitis C

Treatment When Source Patient is Unknown or Cannot Be Tested
Employee Testing When The Source Patient is Unknown or Cannot Be Tested
Immune globulin and antiviral drugs are not recommended for post exposure prophylaxis.
Perform baseline testing for anti HCV and ALT, then repeat at 4 to 6 months after exposure and again at 12 months after exposure.



Post Exposure Prophylaxis When Source Patient is Unknown or Cannot Be Tested

No treatment necessary, but consider 2-drug PEP in settings where exposure to HIV infected persons is likely. Also consider whether the puncture was less severe (solid needle and superficial injury) or more severe (large bore hollow needle, deep puncture, visible blood on device, or needle used in patient's artery or vein).

PEP is optional. Base on decision between the exposed person and the treating clinician. If PEP is chosen, evaluate the exposed employee with CBC and renal and hepatic function tests for at least 2 weeks.
Post Exposure Testing

Test for HIV antibodies at baseline, 6 weeks, 3 months, 6 months, and 12 months or anytime illness occurs that resembles HIV infection.

Advise employee to take precautions to prevent transmitting disease to others.

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