Post Exposure Prophylaxis and Testing
Background
Certain occupations are at increased risk of exposure to infectious disease due to the work environment, such as first responders, animal handlers, etc. Infectious diseases may be transmitted through a number of means, including but not limited to blood, saliva and other bodily fluids. If, in the course of employment, a worker is exposed to an infectious disease, rapid medical treatment may be required to prevent infection.
Policy
The Industrial Insurance Act (RCW 51.36.010, WAC 296-20-03005) allows the department or self-insured employer to pay for post-exposure prophylaxis (PEP) whenever an injury occurs (e.g., needle stick or laceration) and there is a potential exposure to an infectious disease.
It also allows for PEP in cases in which a work-related activity has resulted in probable exposure of the worker to an infectious disease, but with no injury. However, there must be a documented or probable work-related exposure in an occupation with a greater likelihood of contracting the disease on the job and there must be an employee/employer relationship.
Authorization of PEP does not bind the department or self-insured employer in the allowance of a claim should the worker contract the disease; a separate determination of such a claim is required.
Proper documentation of post-exposure testing and treatment may facilitate a claim allowance determination if the worker should later contract the disease.
Exposure with Injury
When a claim is filed for an exposure with injury (e.g., needle stick or animal bite) PEP may be authorized by the insurer through the following process:
- A claim must be filed within one (1) year from the date of the injury in order for the insurer to pay for PEP, testing and/or treatment.
- Following PEP the claim may close. Should the worker contract the disease following claim closure, a reopening application must be filed.
Exposure without Injury (Probable Exposure)
When a claim is filed for probable exposure (e.g., exposure to bodily fluid) PEP may be authorized by the insurer through the following process:
- A claim is filed documenting the probable exposure.
- The claim WILL BE REJECTED (there is no injury or evidence of disease at this point, only potential). HOWEVER, PEP may be authorized if there is a greater likelihood that the worker was exposed to the disease while working.
Criteria to consider when filing a claim for probable exposure:
- Was there a greater likelihood of contracting the condition due to the worker's occupation (e.g., first responder or health care worker)?
- If not for their job, would the worker have been exposed to the disease?
- Can the worker identify a specific source or event during performance of his or her employment that resulted in exposure?
If subsequent testing shows that the worker has contracted the disease:
- A new claim must be filed.
- Claim filing must occur within two (2) years from the date the worker receives written notice from a physician of the occupational disease diagnosis.
Adverse Reactions to Work-Related Vaccinations
The department or self-insured employer may pay for treatment related to adverse reactions caused by vaccinations only when:
- The vaccinations are mandated for employment and provided by the employer.
- A claim has been filed for the adverse reaction.
- A claim must be filed within one (1) year from the date of the mandatory vaccination.
Post-exposure Testing
The department or self-insured employer may pay for post exposure testing in accordance with the most recent U.S. Public Health Service (PHS) Guidelines and/or the Centers for Disease Control and Prevention (CDC) recommendations. Please see the CDC for the most current testing and treatment recommendations.
Please note, the department or self-insured employer will not pay for source testing under the claim. However, the Division of Occupational Safety & Health may require employers to pay for source testing under certain circumstances.
Post-exposure Prophylaxis Regimens
Appropriate post-exposure prophylaxis depends upon many factors unique to the patient and the exposure. The determination of whether to treat and which drug regimen to use is a medical decision made by the treating physician. The department or self-insured employer may pay for post-exposure prophylaxis in accordance with the most recent U.S. Public Health Service (PHS) Guidelines and/or the Centers for Disease Control and Prevention (CDC) recommendations. Please see the CDC for the most current testing and treatment recommendations.
Most common infectious diseases and post exposure prophylaxis (PEP) in workers' compensation
| Infectious Disease | Recommended PEP for Adult |
Consideration |
Animal |
||
Macacine herpesvirus 1 |
Valacyclovir 1000mg three times a day x 14 days |
PEP should be given within first few hours after exposure but only after first aid and cleansing have been done. |
Acyclovir 800mg five times a day x 14 days |
||
Rhabdoviridae lyssavirus |
Human rabies immune globulin (HRIG) 20 IU/kg |
Unvaccinated persons If feasible, full dose of HRIG should be infiltrated around and into wounds, any remaining volume should be administered at a site distant from vaccine administration. |
Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) on day 0 and 3 |
Vaccinated persons |
|
Bloodborne or Bodily Fluid |
||
Hepatitis B virus |
The choice of a specific regimen is based on many considerations |
PEP should be started IMMEDIATELY (preferably within 24 hours but at least within 7 days). See CDC guidelines at http://www.cdc.gov/hepatitis/Settings/index.htm. |
Hepatitis C virus |
No treatment |
Exposed person should receive appropriate testing and follow up. |
Human immunodeficiency virus (HIV) |
The choice of a specific regimen is based on many considerations |
PEP should be started IMMEDIATELY. If delays last more than 24-36 hours, seek expert consultation. For dosing of alternative regimens, See DHHS PEP guidelines for current recommendation: http://aidsinfo.nih.gov. |
Respiratory |
||
Influenza |
Oseltamivir 75mg once daily x 10 days
|
Unvaccinated health-care workers who did not use adequate personal protective equipment at the time of the exposure. PEP is not recommended if more than 48 hours have elapsed since exposure. |
Zanamivir 10mg (2 inhalations) once daily |
||
Bordetella pertussis |
Azithromycin 500mg on day 1 then 250mg once daily on days 2-5 |
Decision to administer PEP should be made after considering the infectiousness of the patient, intensity of exposure, potential consequences of in contact, previous vaccination with Tdap and possibility of secondary exposure at high risk from contact. |
Erythromycin 500mg four times a day x 14 days |
||
Clarithromycin 500mg twice a day x 7 days |
||
Mycobacterium tuberculosis (TB) |
Isoniazid 300mg once daily x 9 months |
Although a 9-month regimen of isoniazid is the preferred treatment, a 6-month regimen also provides substantial protection. The choice of specific regimen is based on many considerations, including length and complexity of the regimens, possible adverse effects and potential drug interactions. |
Isoniazid 900mg twice weekly x 9 months |
||
Isoniazid 300mg once daily x 6 months |
||
Isoniazid 900mg twice weekly x 6 months |
||
Rifampin 600mg once daily x 4 months |
||
Varicella zoster virus |
Monitor daily during days 10-21 after exposure |
Vaccinated persons (those who have been vaccinated with 2 doses). |
Single-antigen varicella vaccine x 1 within 3-5 days of exposure to rash |
Unvaccinated persons without evidence of immunity. |
|
Others |
||
Streptococcus pyogenes (Group A Streptolococcus) |
No specific recommendation |
It's not necessary for all persons exposed to receive antibiotic therapy to prevent infection. However, in certain circumstances, antibiotic therapy may be appropriate. |
Methicillin-resistance staphalococcus aureas (MRSA) |
No specific recommendation |
Follow infection control procedures (such as hand washing, keep wounds covered, avoid contact with other people's wounds or avoid sharing personal items) to prevent from acquiring MRSA infection. |
Neisseria meningitides |
Rifampin 600mg every 12 hours x 2 days |
PEP should be started as soon as possible (ideally <24 hours after identification of index patient). †Not recommended for persons aged <18 years or for pregnant and lactating women. |
Ciprofloxacin† 500mg x 1 |
||
Ceftriaxone 250mg IM x 1 |
||
Clostridium tetani |
Minor wounds |
Patient with <3 doses of absorbed tetanus toxoid or vaccination status is unknown.
*Such as (but not limited to) wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; avulsions; and wounds resulting from missiles, crushing, burns, and frostbite. |
Tetanus toxoid, reduced diphtheria toxoid & acellular pertussis (Tdap) or tetanus & diphtheria toxoid (Td) |
||
Other wounds* |
||
Tetanus toxoid, reduced diphtheria toxoid & acellular pertussis (Tdap) or tetanus & diphtheria toxoid (Td) x 1 |
||
Minor wounds |
Patient with 3 doses of absorbed tetanus toxoid. *If it has been 10 years or longer since the last dose. |
|
No treatment |
||
Tetanus toxoid, reduced diphtheria toxoid & acellular pertussis (Tdap) or tetanus & diphtheria toxoid (Td)* x 1 |
||
Centers for Disease Control (CDC) and the National Institute for Occupational Safety and Health (NIOSH): BLOODBORNE INFECTIOUS DISEASES: HIV/AIDS,
HEPATITIS B, HEPATITIS
Washington Administrative Code (WAC): Bloodborne Pathogens
