From the Guidelines
For a police officer exposed to blood and saliva from a person with unknown infection status but without open wounds or sores, the risk of HIV, hepatitis B, and hepatitis C transmission is extremely low, and therefore, no post-exposure prophylaxis (PEP) is generally needed in this scenario. The officer should immediately wash the exposed area thoroughly with soap and water, as recommended by 1. Blood testing is recommended to establish baseline status, with follow-up testing at appropriate intervals (typically at 6 weeks, 3 months, and 6 months post-exposure) 1. If the officer is not already vaccinated against hepatitis B, vaccination should be initiated, as suggested by 1. The officer should report the incident through proper occupational health channels and document the exposure details. This conservative approach is recommended because HIV and hepatitis viruses require direct access to the bloodstream for transmission, and intact skin prevents this access. If any additional information becomes available about the source individual's infection status, or if there were unrecognized breaks in the skin, the management plan should be reassessed promptly. Key considerations in managing such exposures include:
- Immediate washing of the exposed area
- Baseline and follow-up blood testing
- Hepatitis B vaccination if not already immunized
- Reporting and documentation of the incident
- Reassessment of the management plan if new information becomes available or if there were unrecognized skin breaks. Given the low risk of transmission and the effectiveness of intact skin as a barrier, the approach outlined prioritizes the officer's safety while minimizing unnecessary interventions, as supported by the guidelines outlined in 1.
From the Research
Management of Blood and Saliva Exposure
The patient, a police officer, was exposed to blood and saliva from a person with unknown HIV, hepatitis B, and hepatitis C status. The management of such exposure involves several steps:
- Immediate reporting of the incident to the relevant authorities and seeking medical attention
- Assessment of the exposure, including the type and amount of bodily fluid exposed, and the presence of any open wounds or sores on the officer
- Post-exposure prophylaxis (PEP) may be considered, depending on the risk of transmission and the officer's vaccination status
Post-Exposure Prophylaxis (PEP)
PEP is an emergency medication taken after potential exposure to HIV to prevent infection. The use of PEP in the context of hepatitis B and C exposure is less clear:
- For hepatitis B, PEP may involve the administration of hepatitis B immune globulin (HBIG) and vaccination, if the officer is not already vaccinated 2
- For hepatitis C, there is no established PEP, and management involves monitoring for signs and symptoms of infection
Antiretroviral Therapy
In the context of HIV exposure, antiretroviral therapy (ART) may be used as PEP:
- The combination of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) has been shown to be effective in preventing HIV infection 3
- This combination has also been used to treat chronic hepatitis B, with good efficacy and tolerance 4, 5
Vaccination
Vaccination against hepatitis B is an important aspect of prevention:
- The hepatitis B vaccine is highly effective in preventing infection, and all healthcare workers, including police officers, should be vaccinated 3
- The vaccine is typically administered in a series of three doses, with booster doses given as needed
Monitoring and Follow-up
After exposure, the officer should be monitored for signs and symptoms of infection, including:
- HIV: monitoring for seroconversion, with repeat testing at 6 weeks, 3 months, and 6 months after exposure
- Hepatitis B and C: monitoring for liver function abnormalities, with repeat testing at 6 weeks, 3 months, and 6 months after exposure
- The officer should also be counseled on the risks and benefits of PEP, as well as the importance of safe practices to prevent future exposures 2, 6