The U.S. Public Health Service (PHS) has updated and consolidated all of its previous guidelines and recommendations for the management of health care personnel who have occupational exposure to blood and other body fluids that might contain hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV). The new PHS guidelines were published in the June 29, 2001 issue of the Recommendations and Reports series of Morbidity and Mortality Weekly Report.
The updated PHS guidelines provide recommendations on postexposure management and prophylaxis and for implementation of the guidelines in health care facilities. The guidelines will be covered in the “Practice Guidelines” department in three consecutive issues of American Family Physician. In this issue, recommendations for health care facilities planning to implement the PHS guidelines will be discussed. In the November 15 issue, the PHS recommendations for the management of occupational blood exposures will be outlined, and in the December 1 issue, recommendations for basic and expanded HIV post-exposure prophylaxis regimens will be provided.
Recommendations for Implementation
Establish a Bloodborne Pathogen Policy. According to the PHS, when health care facilities establish a bloodborne pathogen policy, they should develop a written policy for the management of exposures based on the PHS guidelines. The policy should be reviewed periodically to ensure that it is consistent with the PHS recommendations.
Implement Management Policies. When health care facilities implement management policies, all personnel should receive training on the prevention of and response to occupational exposures. These facilities should establish hepatitis B vaccination programs and exposure-reporting systems, have personnel who can manage an exposure readily available at all times, and have ready access to postexposure prophylaxis.
Establish Laboratory Capacity for Bloodborne Pathogen Testing. The PHS recommends that health care facilities provide prompt processing of specimens from the exposed person and the source person to guide the management of occupational exposures. Testing should be performed with appropriate counseling and consent.
Select and Use Appropriate Postexposure Prophylaxis Regimens. According to the PHS guidelines, health care facilities should develop a policy for the selection and use of postexposure prophylaxis antiretroviral regimens for HIV exposures within their institution. These facilities should have hepatitis B vaccine and hepatitis B immune globulin available for timely administration, and should have access to resources with expertise in the selection and use of postexposure prophylaxis.
Provide Access to Counseling for Exposed Health Care Personnel. Health care facilities should provide counseling for their employees who might need help dealing with the emotional effect of an exposure. Health care facilities should also provide medication adherence counseling to assist health care personnel in completing HIV postexposure prophylaxis as necessary.
Monitor for Adverse Effects of Postexposure Prophylaxis. Health care personnel who are taking antiretroviral post-exposure prophylaxis should be monitored periodically for adverse effects through baseline and testing (every two weeks) and clinical evaluation.
Monitor for Seroconversion. Health care facilities should develop a system to encourage exposed personnel to return for follow-up testing. Exposed personnel should be tested for HCV and HIV.
Monitor Exposure Management Programs. Health care facilities should develop a system to monitor reporting and management of occupational exposures to ensure timely and appropriate response. Exposure reports must be evaluated for completeness and accuracy, access to care and laboratory result reporting time. Exposures must be reviewed to ensure that personnel who have been exposed to sources not infected with bloodborne pathogens do not receive postexposure prophylaxis or that postexposure prophylaxis is stopped. Health care facilities also need to monitor completion rates of HBV vaccination, HIV post-exposure prophylaxis and exposure follow-up.