EPPs Flashcards
What is UKAP?
UK advisory panel on BBV in HCW
What are EPPs?
Procedures where there’s an opportunity for HCW to patient transmission if workers blood contaminates patients open tissues this is “bleed-back”
What are the main points making a procedure an EPP?
Workers gloved hands in contact with
Sharp instruments
Inside an open body cavity
Hands may not be completely visible
What are: Category 1, 2 and 3 EPP procedures?
Category 1 = Hands usually visible and outside the possibility of injury is slight. Risk of bleed-back remote
Category 2 = Hands may not be visible at all times but possibility of injury is unlikely. If injury occurs its likely to be noticed and acted upon quickly, reducing bleed-back
Category 3 = Hands out of sight and distinct risk of injury, bleed-back could go unnoticed.
What standard (non-EPP) clearance is offered for new staff?
HBV vaccine (and titres)
HIV test
HCV test
What is an IVS sample?
Identified and validated sample
Taken at OCH dept, requires photo ID, and delivered to the lab in usual manner, when result returned this must be verified as a result for a test taken by OCH
What requirements of HBV testing (lab and test) need to be in place for EPP clearance testing?
Tested in an accredited lab
CE marked assay
Standardised to WHO international standard
Other than staff performing EPPs, what other staff group requires EPP monitoring for HBV?
Staff working in dialysis units
What tests are performed for HBV EPP clearance?
Test with HBsAg
If negative then vaccinate
If positive then > DNA
In dialysis/EPP staff, what is required if HCW is HBV non responder?
Requires HBsAg testing annually to ensure not infected
What is required for HBV infected HCW initial EPP clearance?
Two IVS samples collected no less than 4 weeks apart
Must be <200 IU/ml
What monitoring is performed in HBV infected HCWs for EPP monitoring?
Testing for DNA every 6 months (24-28 weeks)
If an EPP HCW is treated for HBV, when can they resume EPPs?
Not for at least 12 months after stopping HBV treatment
For clearance 2x IVS are required 6 months apart, with the first >6 m post stopping treatment
What would happen in an HBV EPP HCW if the results in the following monitoring samples:
<60 IU/ml
60-<200 IU/ml
=<200 IU/ml
<60 IU/ml = retest in 6 months
> 60-<200 IU/ml = case-by-case, either retest in 6 months or rpt at 10 days and review
?200 IU/ml = restrict EPP immediately, rpt in 10 days, risk assess for any potential transmission
What time period between monitoring samples is too late for HBV EPP monitoring and requires initial clearance again?
If 6 monthly check is >28 weeks since last VL = then stop EPP and require full clearance again (2x IVS at least 4 weeks apart)
What should happen to a HCW cleared for EPPs if they start immunosuppression?
They should have anti-HBV core testing
Stop EPPs to ensure HBV has not reactivated, discussions around NA prophylaxis and increased monitoring
What should happen to an HBV infected HCW cleared for EPPs if they start immunosuppression?
They should receive NAs
What testing is performed for HCV for EPP clearance?
Test with anti-HCV > RNA if positive
If RNA positive = No EPP
If RNA negative = EPP
In EPPs if cleared HCV (spontaneously or with treatment) what testing is required?
Test 12 weeks post clearance (12 w SVR) then EPP cleared
However retest at 24 w
What is the viral load level used for HIV EPP clearance?
> 200 copies/ml = excluded from EPP
What is required for initial HIV EPP clearance?
Patients must be on cART
and
2x VL 12-16 weeks apart <200 copies/ml
Elite controller with undetectable VL for at least 12 months, with 3 separate VLs
What is required for HIV EPP monitoring?
RNA testing every 12 weeks (10-14 weeks) and be engaged in care
What would happen in an HIV EPP HCW if the results in the following monitoring samples:
<50 copies/ml
=>50-<200 copies/ml
=>200-<1000 copies/ml
=>1000 IU/ml
Retest in 12 weeks
Case-by-case - may be no action or rpt in 10 days
Repeat test 10 d later - if still >200 then cease EPPs
Cease EPPs immediately. Repeat test in 10 d later. Risk assessment for transmission
