If You've Been Exposed

Wash off or flush out exposure site immediately and thoroughly. Do not skip this necessary precaution!

Quick access to various sections of this larger page are provided by the bulleted items below.

• Where Do I Get Care?
• Risk After Exposure
• Time-critical Exposures
  • HIV
  • Hepatitis B
  • Hepatitis C
  • Rabies
  • Monkey B
• Other Exposures
• Tuberculosis

These procedures should be followed in the event of an exposure.

• Needlesticks and cuts should be washed with soap and water.
• Splashes to the nose, mouth, or skin should be flushed with water.
• Eyes should be irrigated with clean water, saline, or sterile irrigants.

No scientific evidence shows that the use of antiseptics for wound care or squeezing the wound will reduce the risk of transmission of HIV. The use of a caustic agent such as bleach is not recommended.

Report the exposure to the appropriate parties responsible for managing exposures. Prompt reporting is essential because, in some cases, postexposure treatment may be recommended, and it should be started as soon as possible--preferably within 1 hour if at all possible.

In addition to HIV, discuss the possible risks of acquiring Hepatitis B and Hepatitis C with your health care provider. You should have already received Hepatitis B vaccine, which is extremely safe and effective in preventing Hepatitis B.

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Where Do I Get Care?

If you believe you have been exposed to one of the pathogens that requires immediate evaluation (HIV, Hepatitis B, Hepatitis C, and Rabies), go to the nearest emergency room. For Monkey B exposures, go to the nearest designated care facility, as your site supervisor indicates.

If, however, you believe you have been exposed to one of the pathogens for which evalution is not time-critical, please see your site supervisor.

If your site supervisor is not available, call the 24-hour hotline number:

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Risk After Exposure

While the risk of transmission is very low, it is not zero. HIV infection has been reported after occupational exposures to HIV-infected blood through needlesticks or cuts; splashes in the eyes, nose, or mouth; and skin contact. As of December 1996, CDC had received reports of 52 documented cases and 111 possible cases of occupationally acquired HIV infection among health care workers in the United States.

• Exposures from needlesticks or cuts cause most infections. The average risk of HIV infection after a needlestick/cut exposure to HIV-infected blood is 0.3% (i.e., three-tenths of one percent, or about 1 in 300). Stated another way, 99.7% of needlestick/cut exposures do not lead to infection.
• The risk after exposure of the eye, nose, or mouth to HIV-infected blood is estimated to be, on average, 0.1% (1 in 1,000).
• The risk after exposure of the skin to HIV-infected blood is estimated to be less than 0.1%. A small amount of blood on intact skin probably poses no risk at all. There have been no cases of HIV transmission documented due to an exposure involving a small amount of blood on intact skin. The risk may be higher if the skin is damaged (e.g., by a recent cut) or if the contact involves a large area of skin or is prolonged.

While the risk of contracting disease from an occupational exposure is small, it is in your best interest to thoroughly review your options before making decisions that may affect the rest of your life. Reviewing the information below may help you get the best care and treatment possible.

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Time-critical Exposures

The best current medical information tells us that five pathogens have time-critical evaluation and/or treatment limits: HIV, Hepatitis B, Hepatitis C, Rabies and Monkey B (Herpervirus Simiae). This means that any exposure to a blood borne pathogen is time-critical. Evaluation and treatment guidelines appear below.

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HIV

Brief Synopsis of Treatment Guidelines

If you think you may have been exposed to HIV:

1. If it is a puncture or skin exposure, WASH THE AREA WITH SOAP AND WATER IMMEDIATELY. If it is a mucous membrane exposure, FLUSH THE AREA WITH WATER OR SALINE.
2. As soon as you have finished washing or flushing the area, get evaluated at the medical facility where you are or where you have been told to go. Ask your supervising instructor where to go if you are not sure. If the exposure is high risk, you may be advised to start antiviral medications WITHIN TWO HOURS OF THE EXPOSURE.
3. Inform your supervising instructor. They may be able to expedite the process for you. They may also be able to get information about the source patient (SP).
4. If possible, bring the source patient with you to the evaluation. The health care personnel who evaluate you will want to know the following:
   • Is the SP known to be HIV positive?
   • Did the SP receive blood products prior to 1984?
   • Does the SP have a history of a sexually transmitted disease?
   • Does or did the SP use injectable drugs?
   • Is the SP known to be infected with other blood borne pathogens?
5. During your evaluation, the health care personnel will want to know exactly how the exposure occurred.
   • What type of body fluid was involved in the exposure?
   • What type of exposure?
   • Was the exposure from a sharp object? If a needle, what type (large or small; hollow or solid; was it in contact with the SPs blood)?
   • Was the exposure to a mucous membrane?
   • Did it occur on intact or non-intact skin?
   • What was the duration of the exposure?
6. Your blood will be drawn for a baseline HIV antibody test, and you will be given a Tetanus booster, if you've not had one in the last 10 years.
7. You may have been exposed to other blood borne pathogens, such as Hepatitis B and Hepatitis C. Expect to be evaluated for these BBPs as well.
8. Review the university reporting requirements after exposure and treatment.

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HEPATITIS B

Brief Synopsis of Treatment Guidelines

If you think you have been exposed to Hepatitis B:

1. If it is a puncture or skin exposure, WASH THE AREA WITH SOAP AND WATER IMMEDIATELY. If it is a mucous membrane exposure, FLUSH THE AREA WITH WATER OR SALINE.
2. As soon as you have finished washing or flushing the area, GET EVALUATED IMMEDIATELY at the medical facility where you are or where you have been told to go. (ask your supervising instructor where to go if you are not sure)
3. If possible, bring the source patient (SP) with you to the evaluation. The health care personnel who evaluate you will want to know this information:
   • Is the SP known to be Hepatitis B positive?
   • Does the SP have a history of a sexually transmitted disease?
   • Does or did the SP use injectable drugs?
4. Inform your supervising instructor. They may be able to expedite the process for you. They may also be able to get information about the source patient.
5. Report it.

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HEPATITIS C

Brief Synopsis of Treatment Guidelines

If you think you have been exposed to Hepatitis C:

1. If it is a puncture or skin exposure, WASH THE AREA WITH SOAP AND WATER IMMEDIATELY. If it is a mucous membrane exposure, FLUSH THE AREA WITH WATER OR SALINE.
2. As soon as you have finished washing or flushing the area, GET EVALUATED IMMEDIATELY at the medical facility where you are or where you have been told to go. If possible, bring the source patient (SP) with you to the evaluation.
3. The health care personnel who evaluate you will want to know this information:
   • Is the SP known to be Hepatitis C positive?
   • Did the SP receive blood products?
   • Does the SP have a history of a sexually transmitted disease?
   • Does or did the SP use injectable drugs?
4. Inform your supervising instructor. They may be able to expedite the process for you. They may also be able to get information about the source patient.
5. Report it.

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RABIES

Brief Synopsis of Treatment

If you think you have been exposed to Rabies:

1. IMMEDIATELY CLEAN THE WOUND with soap and water. If providone-iodine solution is available, use it to irrigate the wound. If the exposure is to a mucous membrane (mouth, eye, or nose) flush it with water or saline for 10 to 15 minutes.
2. You will need to be evaluated by appropriate health care personnel within 24 hours. (ask your supervising instructor where to go if you are not sure)
3. Inform your supervising instructor of the exposure. They may be able to expedite the process for you. They may also assist in securing the source animal so that it can be observed for 10 days.
4. During the evaluation, the health care personnel will want to know exactly how the exposure occurred.
   • Was the exposure from a bite?
   • What kind of animal?
   • Where is the animal?
   • Is the animal known or suspected to be rabid?
5. During the evaluation, the health care personnel will want to know the following:
   • Have you been vaccinated for rabies?
   • If so, when?
   • Have you had a titer?
   • When was your last tetanus shot?
6. Report it.

If previously vaccinated:

1. Wound cleansing.
2. Rabies vaccine booster on day 0 and day 3.
3. Tetanus booster if more than 10 years since last dose.

If NOT previously vaccinated:

1. Wound cleansing.
2. Injection of Rabies Immuneglobulin (20 IU/kg body weight) at the site of the wound.
3. Rabies vaccine on days 0, 3, 7, 14 and 28.
4. Tetanus booster if more than 10 years since last dose.

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MONKEY B

Brief Synopsis of Treatment

If you think you have been exposed to Monkey B virus (Herpesvirus Simiae):

1. Thorough scrubbing of the bite or scratch wound with providone-iodine or chlorhexidine for at least 15-20 minutes is required. Deep wounds or punctures should be swabbed with Dakin's solution (laundry bleach in a 1:20 mixture with water) for five minutes, then scrubbed with a standard detergent solution for 10-15 minutes. For splashes or other contaminations of mucous membranes (eyes, mouth, nose), use only sterile saline solution or water. PERFORM APPROPRIATE CLEANING IMMEDIATELY.
2. If you are on MSU's campus, come directly to Olin Urgent Care Clinic for evaluation. If you are in the Lansing area, go to E.W. Sparrow, Emergency Department. If you are at another location, report the exposure to the site supervisor and get their directions to the nearest designated medical facility equipped to treat Monkey B exposures. Take emergency culture kit with you.
3. A health care professional will first assess your risk based on information you provide, and then treatment will be recommended. Treatment may include site culture, blood collection and/or medication(s).
4. You will be educated about signs and symptoms of the Monkey B virus that need to be reported and to whom to report them.
5. A follow up appointment will be scheduled for monitoring purposes. Monitoring after exposure typically lasts from 5 to 30 days.
6. Report it.

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Other Exposures

TUBERCULOSIS

Brief Synopsis of Treatment

1. If you think you have been in contact with a person, an animal or tissue infected with Tuberculosis (TB): Inform the local health department or infection control personnel (if you and the patient are in the same medical facility) that you think you have been exposed. The health department or infection control personnel can help you determine if you are a contact and arrange for follow up.
2. The health department or infection control personnel will find out if the source patient has been diagnosed with active TB, or is infectious. (A positive skin test indicates previous exposure to TB, it does not necessarily mean that the patient is infectious.)
3. If indicated, you will be asked to have a baseline TB skin test now and another follow up skin test 10 to 12 weeks after the exposure.
4. Report it

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