Because the efficacy of prophylactic therapy may be highly time-dependent, the acute care management of occupational or other blood and body fluid exposures must include rapid determination of the need for prophylaxis, testing, and treatment. Attention to wound care principles and referral for social, medical, or advocacy services remain important in all cases.
EXPOSURE EPIDEMIOLOGY AND TRANSMISSION RISK
There were an estimated 78,123 visits to United States emergency departments (EDs) annually during 1998–2000 for work-related exposures to blood or body fluids. More than 90,000 females of all ages present annually for medical care after sexual assault. The frequency of ED visits for other populations and for other types of blood or body fluid exposures is not well known.
The Centers for Disease Control and Prevention (CDC) estimates that 5.6% of 20- to 59-year-olds in the United States have been infected with hepatitis B, though the prevalence and incidence has decreased over the past 20 years (see Chapter 13, Viral Hepatitis). This reduction is likely due to widespread use of the hepatitis B vaccination, universal precautions in health care settings, and educational campaigns to increase condom usage and reduce injection-needle sharing.
Although it is found in other body fluids (e.g., bile, breast milk, cerebrospinal fluid, saliva, semen, and sweat), hepatitis B is primarily transmitted through contact with blood.