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OCC-HEALTH  January 2009

OCC-HEALTH January 2009

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Subject:

Re: Innoculation Injuries (Unknown Source)

From:

Wade Louise <[log in to unmask]>

Reply-To:

Occupational Health mailing list <[log in to unmask]>

Date:

Mon, 5 Jan 2009 17:28:36 -0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (118 lines)

Hi Amanda

1. We would usually do blood for storage at the time of the incident so
that any future symptoms or results can be compared to his sample at the
time. It is not routinely tested for anything though at the time of the
incident.
2. Whether he has PEP or not is dependent on the risk assessment of the
situation but should be considered
3. We use the Health Protection Agency recommendation for follow up
bloods which are
At 6 weeks post injury - test for Hep C rna
At 12 weeks post injury - test for Hep C antibody and rna and also for
HIV
At 24 weeks post injury - test for Hep C antibody

I HAVE EXTRACTED THE RELEVANT BIT FROM THE GUIDANCE BELOW

"In accordance with HPA's recommendations, HCWs exposed to an
HCV positive source should have blood samples taken at the
time of the incident (baseline sample), six weeks, 12 weeks and
24 weeks post-exposure. These guidelines also recommend
that HCV RNA (genome) testing should be performed on the six
week and 12 week serum samples, and that testing for HCV antibodies
(anti-HCV) should be carried out on the 12 week and 24
week sera. The stored baseline serum is only tested if a positive
result is found, to rule out HCV carriage at the time of exposure.
The rationale for the timing of the tests is that, HCV RNA is
usually detectable (as early as 10 days after exposure) before the
antibodies to HCV develop in the event of a seroconversion and
will be positive at six weeks following the exposure, will remain
positive whilst viral replication continues and will disappear with
spontaneous viral clearance or with sustained virologic response
following treatment. Antibodies develop between 50-70 days
post-exposure and should be detectable on the 12 week serum
sample. At 24 weeks only HCV antibody testing is conducted
because around 15% of patients will spontaneously clear the
virus. Thus, not detecting HCV RNA at 24 weeks does not
exclude HCV infection, only a negative HCV antibody test
signifies no previous HCV infection."

For more info see 
http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1227688080528?
p=1158945066450

Regards
Louise
Louise Wade
Occupational Health Nurse Consultant
Royal Bolton Hospital NHS Foundation Trust
Minerva Rd
Bolton
BL4 0JR
01204-390607
[log in to unmask]


-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]] On
Behalf Of Amanda Savage
Sent: 05 January 2009 15:16
To: [log in to unmask]
Subject: [OCC-HEALTH] Innoculation Injuries (Unknown Source)


Please can I ask my NHS colleagues for advice here.
We have a fire fighter who attended an incident and sustained a needle
stick 
injury on Christmas eve.
He attended A&E & was given a Hep B booster (although he was already 
covered) but nothing else. Now its been a while since I worked in the
NHS but 
we used to take bloods & offer 'PEP' has this cahnged?
Also I have told him he will need to be screened at 3 months & 6 months
for 
HIV - is this correct as his GP has said 3 months will be sufficient.

Ideally I suppose Im looking for some simple guidance that will help
both him & 
me.
Can anyone help
& Happy New Year to all.

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