What is the recommended prophylaxis for a patient exposed to blood-borne pathogens with a risk of Hepatitis C (HCV) transmission?

Hepatitis C Post-Exposure Management

No post-exposure prophylaxis exists for Hepatitis C virus (HCV) exposure—neither immune globulin nor antiviral medications are recommended or effective for preventing infection after blood-borne exposure. 1, 2

Immediate Wound Care

After any blood exposure potentially involving HCV:

• Wash the wound immediately with soap and water 2, 3
• Flush mucous membranes with water or saline if blood splashes into eyes, nose, or mouth 2, 3
• Do NOT squeeze the wound, apply caustic agents like bleach, or inject antiseptics into the wound 2
• Report the incident to your supervisor within 1 hour and document the exact time 3

Why No Prophylaxis for HCV?

The evidence is unequivocal across multiple guidelines:

• Immune globulin (IG) does NOT prevent HCV infection—studies in chimpanzees showed IG administered even one hour after HCV exposure failed to prevent infection or disease 1, 2
• Antiviral agents (including direct-acting antivirals) are NOT recommended for post-exposure prophylaxis—interferon and newer DAAs have not been studied for this indication, and the mechanisms suggest they work only in established infection, not for prevention 1, 4
• The low transmission risk (approximately 1.8% per needlestick from confirmed HCV-positive source), combined with high treatment success rates if infection occurs, makes prophylaxis neither cost-effective nor scientifically justified 3, 4, 5

Testing Protocol After HCV Exposure

Since prophylaxis is not available, early detection through systematic testing is the cornerstone of management 2, 3:

Baseline Testing (Within 48 Hours)

• HCV antibody (anti-HCV) 1, 2
• Alanine aminotransferase (ALT) 1, 2
• HCV RNA (optional at baseline, but recommended to establish infection status) 1, 2

Source Patient Testing

• Test the source patient for anti-HCV antibody as soon as possible 1, 2
• If source is HCV-positive or unknown, proceed with exposed worker follow-up 2

Follow-Up Testing Schedule

• Repeat anti-HCV antibody and ALT at 4-6 months post-exposure 1, 2
• HCV RNA testing at 4-6 weeks if earlier diagnosis is desired (can detect infection before antibody seroconversion) 3, 6
• Consider extended follow-up to 12 months for high-risk exposures or if source has HIV/HCV coinfection 3

Confirmatory Testing

• All repeatedly reactive anti-HCV results by EIA must be confirmed with supplemental testing (such as HCV RNA or recombinant immunoblot assay) 1
• This prevents false-positive results from causing unnecessary anxiety 1

Counseling the Exposed Healthcare Worker

During Follow-Up Period

• No special precautions are needed to prevent secondary transmission during the follow-up period 1, 3
• No modification of patient care responsibilities is necessary 1, 3
• Use barrier protection during sexual activity and do not donate blood, plasma, organs, tissue, or semen 3

If Infection Is Detected

• Modern direct-acting antiviral therapy achieves cure rates >90% in most patients, including those with acute infection 1, 7, 5
• Early treatment during acute HCV infection may be associated with higher sustained response rates 1
• Refer to hepatology or infectious disease for treatment evaluation 1, 5

Common Pitfalls to Avoid

• Do NOT administer immune globulin—it is ineffective and wastes resources 1, 2
• Do NOT start antiviral therapy as prophylaxis—this is not evidence-based and exposes the worker to unnecessary medication risks 1, 4
• Do NOT fail to test the source patient when possible—knowing the source's HCV status guides the intensity of follow-up 2, 3
• Do NOT rely solely on antibody testing at 4-6 months—consider HCV RNA at 4-6 weeks if earlier diagnosis would change management or reduce anxiety 3
• Do NOT forget to ensure follow-up compliance—establish a tracking system to ensure exposed workers return for all scheduled tests 3

Concurrent HIV and HBV Considerations

When managing HCV exposure, always assess and manage HIV and HBV exposure risks simultaneously 2, 3:

• HIV post-exposure prophylaxis must be initiated within 72 hours if indicated (ideally within 2-4 hours) 2, 3
• Hepatitis B immune globulin (HBIG) and/or hepatitis B vaccine should be administered based on the exposed worker's vaccination status and source patient's HBsAg status 2, 3
• Test source patient for HIV antibody, HBsAg, and anti-HCV simultaneously 2, 3