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Postexposure Evaluation and Follow-up

Course Number: 472


Adherence to the principles of Standard and Transmission-based Precautions is the best means to minimize occupational exposure to blood and other potentially infectious material (OPIM).1-3 However, occupational exposures still occur. Healthcare facilities should have an organizational infrastructure that promotes a seamless response following such events to facilitate timely access (during all working hours) of exposed healthcare personnel (HCP) to physicians familiar with strategies to prevent postexposure healthcare-associated infections (HAIs).

The term HCP refers to all paid and unpaid persons working in healthcare settings who have the potential for exposure to blood and other potentially infectious material (OPIM).4 HCP include, but are not limited to, emergency medical service personnel, dental personnel, laboratory personnel, nurses, nursing assistants, physicians, technicians, therapists, pharmacists, students and trainees, and persons not directly involved in patient care but potentially exposed to blood and OPIM (e.g., clerical, dietary, housekeeping, security, maintenance, and volunteer personnel).

An exposure that might place HCP at risk for HAIs is defined as an event that results in the transfer of pathogenic organisms from a source to a host by contact transmission, i.e., direct or indirect contact transmission; or respiratory transmission, i.e., inhalation of droplets or droplet nuclei (airborne transmission).2,3 Droplets and droplet nuclei are generated when people talk, breath, cough, or sneeze; or when water is converted to a fine mist by medical/dental devices, such as high-speed handpieces, ultrasonic instruments, or by lasers and electrosurgical units.2,3

Pathogenic organisms associated with HAIs may be the result of person-to-person transmission, but contaminated patient-care items and environmental sources may also be implicated.1-3 Source persons may be patients, other HCP, visitors to the healthcare facility, and household members. A source person may have acute infection or may be transiently or chronically colonized by pathogenic organisms. It is also important to recognize the source person with an acute or chronic infection may be asymptomatic.

All HCP should be familiar with postexposure management strategies such as procedures for proper wound care and prompt reporting of an exposure. Postexposure evaluation, initiation of postexposure prophylaxis (PEP), and postexposure follow-up is to be performed by a physician familiar with strategies to prevent postexposure HAIs.4 PEP is any preventive medical treatment (e.g., administration of vaccines, immune globulins, antiviral, or antibacterial agents) started in a timely manner after exposure to a pathogenic virus or bacteria in order to prevent infection and/or the development of disease.