What is the immediate treatment for skin exposure to blood potentially contaminated with Human Immunodeficiency Virus (HIV), Hepatitis B (Hep B), and Hepatitis C (Hep C)?

Immediate Management of Skin Exposure to Blood Potentially Contaminated with HIV, HBV, and HCV

For skin exposure to blood potentially contaminated with HIV, HBV, or HCV, immediately wash the exposed area thoroughly with soap and water, which is the most critical first step in preventing infection transmission. 1

Initial Response

• Immediately wash the exposed skin area thoroughly with soap and water 1
• If splashes to mucous membranes (eyes, nose, mouth) occur, flush the involved area with clean water, saline, or sterile irrigants 1
• Document the exposure details including type of fluid, source of exposure (if known), and condition of the skin (intact vs. non-intact) 1

Risk Assessment

The risk of infection transmission varies by pathogen and exposure type:

• Exposure through non-intact skin (chapped, abraded, or with dermatitis) poses higher risk than exposure to intact skin 1
• Body fluids considered potentially infectious include: blood, visibly bloody fluids, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid 1
• Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus are not considered potentially infectious unless they contain visible blood 1

Pathogen-Specific Management

Hepatitis B (HBV)

• Determine vaccination status of the exposed person 1
• For unvaccinated individuals or those with unknown antibody response:
  • Administer hepatitis B vaccine and consider hepatitis B immune globulin (HBIG) if the source is HBsAg-positive or unknown 1
  • HBIG should be administered within 24 hours when indicated, but can be given up to 7 days after exposure 1
• For previously vaccinated individuals with documented response, no treatment is necessary 1

Hepatitis C (HCV)

• No post-exposure prophylaxis is currently recommended for HCV exposure 1, 2
• Baseline testing for anti-HCV and ALT (alanine aminotransferase) should be performed 1
• Follow-up testing for anti-HCV and ALT should be conducted 4-6 months after exposure 1
• HCV RNA testing may be performed at 4-6 weeks if earlier diagnosis is desired 1

HIV

• For skin exposure to potentially HIV-contaminated blood:
  • Post-exposure prophylaxis (PEP) is generally not recommended for intact skin exposure 1
  • PEP might be considered if exposure involves non-intact skin and the source is known to be HIV-positive 1
  • If PEP is deemed necessary, it should be initiated as soon as possible (ideally within hours) 1
  • The basic PEP regimen typically includes a combination of antiretroviral medications 1

Follow-up Procedures

• Document the exposure thoroughly 1
• Arrange for follow-up testing based on the specific pathogens of concern 1
• Provide counseling about potential infection risks, symptoms to watch for, and precautions to prevent secondary transmission 1
• Advise the exposed person to seek medical evaluation for any acute illness occurring during the follow-up period 1

Important Considerations

• The risk of HIV transmission through intact skin exposure is extremely low (virtually non-existent if washed promptly) 3
• HBV is the most easily transmitted bloodborne pathogen in occupational settings and has the highest risk of transmission 4
• The timing of post-exposure interventions is critical, particularly for HIV PEP (most effective if started within hours) and HBV prophylaxis 1
• Proper documentation of the exposure is essential for follow-up care and potential workers' compensation claims 1