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Postexposure Prophylaxis Following an Occupational Exposure Incident
(Originally published in September 2003)

Question: What are the correct procedures following an exposure to blood or other potentially infectious materials?

Answer: Answer: An exposure can be defined as a percutaneous injury (e.g., needlestick or cut with a sharp object) or contact of mucous membrane or non-intact skin (e.g., exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, saliva, tissue, or other body fluids that are potentially infectious. Exposure incidents might place dental health-care personnel at risk for hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV) infection, and therefore should be evaluated immediately following treatment of the exposure site by a qualified health-care professional.

The following steps are recommended by the Centers for Disease Control and Prevention (CDC) for postexposure prophylaxis (PEP). The CDC provides an HIV PEP treatment hot line if questions about treatment or advice are needed. Call 1-888-448-4911, if desired.

1. Provide immediate care to the exposure site.
- Wash wounds and skin with soap and water.
- Flush mucous membranes (e.g., eyes, nose, mouth) with water.
- No evidence exists that using antiseptics for wound care or expressing fluid by squeezing the wound further reduces the risk of bloodborne pathogen transmission.

2. Complete the exposure report and refer to the qualified healthcare professional for evaluation and follow-up. The exposure report should include:

- date and time of exposure
- details of the procedure being performed
- details of the exposure (e.g., percutaneous injury, skin or mucosa contact, nonintact skin)
- details about the exposure source (e.g., HBV, HCV, HIV status)
- details about the exposed person (e.g., hepatitis B vaccination and vaccine-response status)
3. Follow Public Health Service/CDC guidelines for postexposure testing and management.
- Evaluate the exposure source (if known and permitted by law).
- For unknown sources, assess risk of exposure to HBV, HCV, or HIV infection.
- Do not test discarded needles or syringes for virus contamination.
- Evaluate the exposed individual.

4. Give postexposure prophylaxis (PEP)* for exposures posing risk of infection transmission, perform follow-up testing, and provide counseling.

HBV HCV HIV
- Give PEP as soon as possible, preferably within 24 hours
- Test for anti-HBs 1-2 months after last dose of vaccine if only vaccine given.
- Follow-up not indicated if exposed person immune to HBV or received hepatitis B immunoglobulin.







- PEP not recommended
- Perform testing for anti-HCV and ALT 4-6 months after exposure.
- Perform HCV RNA testing at 4-6 weeks if earlier diagnosis of HCV desired.
- Confirm repeatedly reactive anti-HCV enzyme immunoassays with supplemental tests.
- Initiate PEP within hours of exposure.
- Evaluate exposed persons taking PEP within 72 hours after exposure and monitor for drug toxicity for at least 2 weeks.
- Administer PEP for 4 weeks if tolerated.
- Perform HIV-antibody testing for at least 6 months postexposure (e.g., baseline, 6 weeks, 3 months, and 6 months).
- Perform HIV antibody testing for illness compatible with an acute retroviral syndrome occurs.
- Advise exposed persons to use precautions to prevent secondary transmission during the follow-up period.

* A complete description of PEP for HBV, HCV, and HIV can be found in

1. CDC. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR 2001;50(No.RR-11): 1-52. Accessed December 2005.

2. CDC. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. MMWR 2005;54(No. RR-9):117. Accessed December 2005.

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(Lt Col Harte)