CDC Guidelines for body fluid exposure
Show Updated: June 18, 2021 These NCCC post-exposure prophylaxis (PEP) recommendations will help you with urgent decision-making for occupational exposures to HIV and hepatitis B and C. Consultation can be obtained from Occupational Health or Employee Health Services, local experts, or the NCCC’s PEPline. See the PEPline page for current hours and availability. The CDC’s occupational post-exposure guidelines can be accessed on our PEP Guidelines page. Commonly Asked QuestionsInitial Evaluation: Assessing Exposures and TestingWhat immediate measures should be taken? What is considered to be a potential exposure to HIV, HBV or HCV? • Note that saliva, vomitus, urine, feces, sweat, tears and respiratory secretions do not transmit HIV (unless visibly bloody). The risks of HBV and HCV transmission from non-bloody saliva are considered to be negligible. The PEPline does not recommend routine HIV, HBV or HCV surveillance testing following exposure or possible exposure to non-bloody saliva.* * Federal guidelines consistently emphasize that non-bloody saliva does not carry risk for transmitting HIV, stating that non-bloody saliva is not considered infectious for HIV. The federal guidelines on HBV and HCV are not as clear. They emphasize that certain non-bloody fluids, including saliva, are unlikely to transmit those viruses (various terms are used in the different guidelines), but do not make specific recommendations regarding follow-up testing. In the absence of clear federal guidelines on follow-up HBV and HCV testing following non-bloody saliva exposures, the PEPline recommendation, above, has taken many factors into consideration. Advantages of follow-up testing include: (1) reassurance for exposed persons who need additional confirmation; (2) documentation of the lack of transmission to confer liability protection; and (3) conformity with local regulations (e.g., state, hospital, or practice protocols/guidelines). Disadvantages of follow-up testing include: (1) increasing confusion and stress from the contradictory messages that the exposure does not confer transmission risk yet months of follow-up testing is to be performed; (2) addressing potential false positive test results, which create personal distress and additional healthcare costs; (3) possibly increasing work-related stress and stress-related health conditions; (4) creating a period of modified sexual practices/interactions and family planning in certain instances; and (5) increasing overall healthcare costs and time away from work. Because the transmission risk of HBV and HCV in exposures to non-bloody saliva, if any, is considered to be negligible and the disadvantages listed above are important, the PEPline does not routinely recommend follow-up testing, but does not take the position that such testing should not occur. • A portal of entry (percutaneous, mucous membrane, cutaneous with non-intact skin) What baseline testing should be performed after an exposure? Is a rapid HIV test accurate enough to decide on whether to give PEP? Deciding Whether to Give HIV PEPWhat is the time frame for using PEP? What is the risk of HIV transmission?
* Note: These estimates are from exposures to blood from HIV-positive source persons; risk for transmission from infectious fluids other than blood is probably considerably lower than for blood exposures. Is PEP always recommended if the source person is HIV positive? Is PEP recommended if the source person has an unknown HIV status? Is PEP recommended if the source person is unknown (e.g. sharps box injury)? Should PEP be given if it is uncertain whether the exposure constitutes a significant risk? What if the source person might be in the “window period” for HIV? Is PEP recommended for a patient who was stuck with a sharp device (e.g. needle, razor) from an unknown source outside of a healthcare setting? How should a human bite be managed? HIV PEP: What to GiveHow to choose a PEP regimen? PREFERRED 3-DRUG HIV PEP REGIMEN: Truvada™ 1 tablet by mouth once
daily PLUS Raltegravir (Isentress®; RAL) 400mg by mouth twice daily Duration: 28 days Side effects and drug-drug interactions: See below How long is PEP taken? How to monitor and manage side effects of PEP? The most important concern with the preferred regimen, tenofovir DF/emtricitabine plus raltegravir or dolutegravir, is potential renal toxicity from tenofovir DF. This regimen should be used with caution in persons with impaired renal function or who are at high risk for impaired renal function. Lab monitoring for drug toxicity: Check CBC, renal and hepatic function tests at baseline and two weeks after starting PEP. What are common drug-drug interactions between PEP and the exposed person’s medications? ALTERNATIVE REGIMENS FOR PATIENTS WITH RENAL DYSFUNCTION (creatinine clearance ≤ 59mL/min): Zidovudine plus lamivudine (co-formulated as Combivir®) PLUS raltegravir or dolutegravir. See raltegravir and dolutegravir caution, above. ALTERNATIVE REGIMENS*
* The alternative regimens are listed in order of USPHS preference. Newer antiretroviral medications have become available since the USPHS occupational PEP guidelines were updated in 2013, and other alternatives using these newer medications may be reasonable based upon patient and clinician preference. Note: For additional information on dosing, drug-drug interactions and toxicities, and toxicity monitoring, see the antiretroviral drug tables found in
the Pharmacy section of the NCCC website. ARV drug dosing and toxicity monitoring *
* Note: For additional information on dosing, drug-drug interactions and toxicities, and toxicity monitoring, see the antiretroviral drug tables found in the Pharmacy section of the NCCC website. Pregnancy and BreastfeedingHow should HIV exposures in pregnant people be managed? Special considerations PEP options for persons who are pregnant or breastfeeding
or
Other PEP options can be considered in the event of intolerance, source persons with resistant virus, medication access challenges, or EP preference. In these instances, providers should seek expert consultation. How should HIV exposures in lactating exposed persons be managed? Special considerations: Exposures to HBVHow are exposures to HBV managed? Recommendations for Post-Exposure Prophylaxis After HBV Exposure
How soon do hepatitis B vaccine and HBIG need to be given? Exposures to HCVHow
are exposures to HCV managed? Recommendations for HCV Testing Following Occupational Blood-Borne Pathogen Exposure Source Person Testing 1
Exposed Person Testing 1
Follow-Up Testing of the Exposed PersonHIV Note: The PEPline recommends final follow-up testing at 3 months. Although the original CDC Guidelines (and many hospital and other protocols) recommend testing to 6 months (or 4 months if testing is performed with the 4th generation Ag/Ab test), delaying follow-up testing beyond 3 months is not necessary with the standard HIV test that is widely used at this time, and can add additional months of anxiety for exposed persons and their families. This PEPline recommendation is consistent with the USPHS non-occupational PEP Guidelines. The USPHS occupational guidelines have not yet been updated to reflect this protocol change. • Extended HIV testing to 12 months is indicated only for HCP who actually acquire HCV infection after exposure to an HCV-HIV co-infected source person. HBV (See Exposures to HBV) HCV (See Exposures to HCV) Guidance for Exposed PersonsWhat do I do if I am the exposed individual? What are the rules for handling exposure to blood or body fluids?Always wear gloves for handling items or surfaces soiled with blood or body fluids. Wear gloves if you have scraped, cut, or chapped skin on your hands. Change your gloves after each use. Wash your hands immediately after removing your gloves.
What are three bodily fluids that can be considered infectious?Other potentially infectious materials (OPIM) means: (1) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body ...
What bodily fluid is excluded from the CDC precautions?Universal precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomitus unless they contain visible blood. The risk of transmission of HIV and HBV from these fluids and materials is extremely low or nonexistent.
What is the body fluid not considered infectious?Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus are not considered potentially infectious unless they are visibly bloody.
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