Bite in the playroom Flashcards
What is the incidence of bites at daycare?
If there are 60 kids at daycare, about one bite per day and one every 10 days that breaks the skin.
1.5 bites per 100 child-days of attendance
What are some cited risk factors for transmitting blood born infections? (3)
Aggressive behaviour with frequent biting
Oozing skin lesion
Bleeding disorders
How is HBV transmitted?
Contact with mucous membranes or open skin lesions with blood, saliva or genital secretions from actively infected individuals
Can you get HBV from a bite that does not break the skin?
No
Te virus is not transmitted by simple contact of saliva or blood with intact skin
Should daycares screen for HBV, HCV or HIV status?
Screening and exclusion is not acceptable
Parents should not be required to divulge the status of their child to the day care
Have there been reports of HBV transmission with bites? HIV transmission?
HCV transmission?
HBV: yes, case reports
HIV: no - because infectivity of saliva is low (saliva is inhibitory to HIV)
HCV: there are reports in adults, but none in children
Should kids get post-exposure prophylaxis for HIV after a bite?
It is only very exceptionally indicated and should be undertaken only in consultation with ID experts
What is the order of the most to least risk for transmission after blood exposure: HIV, HBV, HCV
1st: HBV
2nd: HCV
3rd: HIV
Can bites lead to bacterial infections?
Bites from young children very rarely lead to bacterial infection. They need to be fairly severe bites that break the skin significantly
So overall what is the risk of transmitting a blood born infection with a bite?
Extremely low
Do the parents need to divulge their child’s status if they bite another kid?
No. This is entirely up to the parents, because the risk is low
What kind of recommendations can we give daycares re HBV? In general (2) and if there is a kid in the daycare who is HBV (1)
- All staff should be immunised against HBV
- Parents should be encouraged to have their child immunised against HBV
- All kids and staff should be immunised, without revealing the identify of the infected child
What do you do if a bite occurred and the skin is not broken?
You clean the wound with soap and water, and a cold compress should be applied while the child is gently soothed.
What do you do if a bite occurred and the skin is broken? (6)
- The wound should be allowed to bleed gently without squeezing
- The wound should be carefully cleaned with soap and water, and a mild antiseptic should be applied
- An official report should be written and filed
- Both parents should be informed
- Report the bite to public health and refer both kids to a physician for assessment
- Advise given to parents to observe the wound for signs of infection.
What does the medical evaluation entail?
- Tetanus status +/- vaccine
- Consider HBV exposure
- Consider HIV exposure
- Consider HCV exposures
- Consider antibiotic prophylaxis
Which kids would you give antibiotics prophylactically?
- Wounds that have caused moderate to severe tissue damage
- Deep puncture wounds
- Bites to the face, hand, foot or genitalia
Which kids should get full HBV prophylaxis and what is the HBV prophylaxis
SITUATION 1:
The biter = known carrier
The bitten = nonimmune or incompletely immune
The wound = skin broken
SITUATION 2:
The biter = nonimmune or incompletely immune
The bitten = HBV carrier
The wound = skin broken
HBV x 3 doses (1, 2 and 6 months)
HBIG
What do you do if the HBV status is unknown for one of the kids?
If one of the kids is unknown, and the other is non-immune, then you give the non-immune kid HBV vaccine. You do not have to test them, because the risk of infection is low.
What do you do if the HBV status is unknown for both the kids?
Give HBV vaccine to both of them. You do not need to test them. The risk of infection is low.
What do you do if a kid with HIV bites another kid?
If there is no break in the skin: do nothing. Disclose nothing.
If there is break in the skin and blood is exchanged (mucosa to skin blood): consult HIV specialist for advise. Usually you only give post-exposure prophylaxis if there is a deep bloody wound.
If you want to start HIV prophylaxis after a bite, what is the appropriate time period for this?
Within 2 hours is idea, but up to 72 hours
What do you do if the biter is HCV positive
If blood exposure was significant, arrange follow up and serology at six months for exposed kid.
