![]() Definition of Health Care Personnel (HCP)Īccording to the CDC, health care personnel (HCP) are all paid and unpaid persons providing health care, or working or training in health care settings, who have reasonably anticipated risks for exposure to infectious material, including blood or body fluids, contaminated medical supplies and equipment, or contaminated environmental surfaces. Mucosal exposures occur in approximately 22% of trainees per year, but only 17% of those with a mucosal exposure reported the exposure to occupational health. Most percutaneous exposures result from needles intended for intramuscular or subcutaneous injections (30.5%), or from suture needles (18.7%). Despite these declines, percutaneous exposures remain common, particularly among trainees, with an estimated 18% of trainees sustaining a percutaneous exposure annually. Much of this decline was attributed to greater use of effective and safer medical devices, which stemmed from the 2001 Needlestick Safety and Prevention Act and subsequent changes in safety standards implemented by the Occupational Safety and Health Administration (OSHA). Data from the University of Virginia Health System suggest the rate of percutaneous exposures decreased markedly from 1999 to 2011, falling from 39.6 injuries per 100 occupied beds in 1999 to 19.5 injuries per 100 occupied beds in 2011 ( Figure 3). In the United States, there are approximately 400,000 annual needlestick or sharps-related injuries to hospital-based HCP, many of which go unreported. The greatest risk of occupational HBV transmission occurs with a needlestick or sharps-related injury. These vaccine-related recommendations, paired with greater needle safety and improved use of standard precautions, led to a dramatic decline in the number of occupational HBV infections, with HBV infections among HCP falling by 98% between 19 ( Figure 2). In 1991, given the ongoing risk for HBV infection among health care personnel who do not respond to the hepatitis B vaccine series, the ACIP recommended consideration of postvaccination serologic testing for HBV in health care personnel at risk for needlestick exposures, and in 1997 ultimately recommended universal HBV postvaccination serologic testing 1 to 2 months after completing the hepatitis B vaccine series for all HCP who have ongoing risk for occupational exposure. In 1983, there were approximately 17,000 HBV infections among HCP, which corresponded to a three-fold higher incidence than in the general population. ![]() Soon after the first vaccines to prevent HBV infection became available in 1981, the Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination of HCP. Occupational HBV in the United Statesĭuring the 1970s, serologic studies conducted in the United States reported a seroprevalence of HBV among HCP approximately 10 times higher than in the general population. Beginning in the early 1980s, several key developments, recommendations, and policy changes have resulted in a marked reduction in the risk of HCP acquiring HBV in the United States ( Figure 1). For HCP, the potential to acquire HBV via occupational exposure is of particular concern and preventing occupational HBV acquisition is a high priority in the United States health care system. Hepatitis B is a highly infectious blood-borne pathogen that can remain viable on environmental surfaces for at least 7 days and can be transmitted even in the absence of visible blood. Health care personnel (HCP) are at risk for a variety of infectious pathogens following exposure to blood or body fluids, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Data for Occupational Postexposure Prophylaxis for HBV.Postexposure Prophylaxis for HBV in Perinatal Setting.Efficacy of Occupational Postexposure Prophylaxis for HBV.Special Precautions to Prevent Secondary Transmission.Monitoring of HCP after Occupational HBV Exposure.Unvaccinated or Incompletely Vaccinated HCP.Vaccinated HCP and Response Unknown after Complete Vaccine Series.Vaccinated HCP who has not responded after Two Vaccine Series.Vaccinated HCP with Vaccine-Induced Immunity.Management of Occupational Exposure to HBV. ![]() Interventions for HBV Occupational Postexposure Prophylaxis.Determining the HBV Status of the Source Patient.Determining the HBV Immune Status of the HCP. ![]()
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