See also: AES

A accident of exposure to blood (AES) is an accidental exposure with blood (or a biological liquid) at the time:

• of a cutaneous effraction due to a puncture with a needle or a cut with an object slicing
• of a contact with blood or liquid contaminated on a wound, a nonintact skin or a mucous membrane, allowing the penetration of the infectious agent.

A AES can occur at one looking after in a professional framework, a professional framework except field of the care, or professional framework.

At the time of a AES, one fears in particular the contamination by HIV. Studies on looking after having had AES with blood infected by the HIV made it possible to find a transmission risk of 0,32% after a percutaneous exposure and identified one case of seroconversion after projection on the mucous membranes or the injured skin. Moreover any study does not exist concerning the accidental wounds except activity of care, only two cases of contamination were brought back in France, one in a street sweeper and the other at a collector of waste.

Action to be taken

1. Immediately :

Urgent local care:

• If puncture or wound or contact on injured skin:
• To clean with water and the soap
• To rinse
• To disinfect with a chlorinated derivative (pure solution of Dakin or bleach to 12° diluted with 1/10e) or, failing this, with alcohol with 70° or yellow Bétadine dermic pure, by ensuring a time of contact of at least 5 minutes.

• In the event of projection on eyes or mucous membrane:

• To rinse 10 minutes with Physiological salt solution
• To disinfect with a Eye lotion disinfectant

2. In the 1st hour :

• To seek the statute potentially serologic of the patient contaminant:

• To find its assessment serologic in its file
• Or to carry out in urgency the assessment serologic of the patient source (with its agreement, on medical regulation): Ac anti HVC, ac anti HIV, Ag HBs

• To contact the doctor referent AES or the service of infectiology in order to evaluate the risk of contamination:

This evaluation of the risk depends on many factors:

• puncture or deep cut: risk maximum
• switches hollow: risk maximum
• blood: risk maximum
• absence or presence of means of protection: gloves or glasses
• clinical and serologic state of the patient source

A medical opinion in urgency is essential in the first 2 hours if the risk of contamination by HIV or VHB is real.

A treatment by Trithérapie can then be proposed:

• Beginning in the 4 hours which follow the AES of a trithérapie including/understanding AZT + 3 TC + Inhibiteur of protease, during 48 hours.
• Revaluation with the 48e hour for if required continuing the treatment during 4 weeks.

3. In the 24 hours :

• To make draw up an initial doctor's certificate mentioning the biological risk.

• To consult its company doctor

4. In the 48 hours :

• To declare the industrial accident near the framework of the service

5. A monitoring with a follow-up serologic is installation :

• ac anti HIV with J0-8; M3 and M6

• ac anti HVC with J0-8; then monitoring of the ALAT and PCR VHC if there exists a risk of contamination by VHC
• Ag HBs in J0-8 if the patient is HBs > 10 Mui

References