A hospital's occupational health department is reviewing recent healthcare worker exposure incidents. Match each occupational exposure scenario with the most appropriate immediate post-exposure management protocol.
- An unvaccinated healthcare worker sustains a deep needlestick injury from a patient who is HBeAg-positive.Administer specific targeted immune globulin and initiate a three-dose active vaccination series.
- A surgical resident sustains a scalpel laceration while operating on a patient with chronic Hepatitis C.Obtain baseline serologic testing and RNA levels; provide no immediate pharmacologic prophylaxis, with follow-up testing in 4 to 6 weeks.
- A medical student sustains a needlestick from a patient with HIV who has an undetectable viral load on antiretroviral therapy.Initiate immediate post-exposure prophylaxis with a three-drug antiretroviral regimen for 28 days.
- A nurse evaluates a coughing patient without an N95 respirator; the patient is subsequently diagnosed with cavitary pulmonary tuberculosis.Perform baseline symptom screening and immune reactivity testing; repeat testing in 8 to 10 weeks without empiric pharmacologic prophylaxis.
Answer
Hepatitis B exposure requires immune globulin and vaccination; Hepatitis C exposure requires baseline testing and follow-up without immediate prophylaxis; HIV exposure requires a 28-day three-drug antiretroviral regimen; Tuberculosis exposure requires baseline and 8-to-10 week interval testing.
Each occupational exposure requires a specific protocol based on the pathogen: Hepatitis B requires HBIG and vaccination for unvaccinated individuals; Hepatitis C has no available PEP and requires surveillance; HIV requires 3-drug ART regardless of source viral load; Tuberculosis requires serial testing (PPD/IGRA) to monitor for seroconversion before considering treatment.
Step-by-Step Solution
Key Concept
Post-exposure prophylaxis and management protocols for common occupational exposures in healthcare settings.