Seroconversion
HIV
Risk seroconversion
- 1 in 250
- 50% less with gloves & blunt needle
US Public Health Service Guidelines
- recommend 2 drug therapy for 4 weeks post exposure (AZT and 3TC)
- consider if patient's virus is resistant, and change medications accordingly
Hepatitis C
Seroconversion risk varied reports
Kubitschke et al Internist 2007
- systematic review
- average rate of seroconversion 0.75%
US Public Health Service Guidelines
- do not recommend prophylaxis post exposure
Management
- wait to see if seroconvert
- 2/3 will eliminate HCV RNA
- otherwise can use interferon
Hepatitis B
Most likely to seroconvert if not immunised
- 20%
Contamination
Sharp injury in 1.3 - 15.4% of operations
- half from suture needle
Mucous membrane contamination
- facial 100% in THR
- risk unknown
Management of Needlestick
1. Wash wound +++ with betadine
2. Take blood for serology from health care worker
- repeat at regular intervals
- important for management
- important for insurance
3. Take blood for serology from patient
- history of risk / exposure
- consent obtained
- need to repeat at 6/12
Reduction of Exposure
Universal Precautions
Known infective status of patient
- warn OT staff of status / risks
- maintain confidentiality
- minimal equipment
- ergonomic setup
- most experienced staff & surgeon
- glasses / hood
- impervious disposable gowns & drapes
- boots
- universal precautions
- double gloves
- taperpoint needles & staples
- single suturing surgeon
- instrument only technique
- sharps tray
Screening HCV & HBV in high risk groups
- of dubious value
- windown periods for HIV