Six steps are indicated
for managing occupational exposures to HIV.
1. Manage the exposure site
a) Do remove gloves, if appropriate
b) Do wash the exposed site thoroughly with
running water
c) Do irrigate with water or saline if eyes or
mouth have been exposed
d) Do wash the skin with soap and water
e) Do not panic
f) Do not put the pricked finger in the mouth
g) Do not squeeze the wound to bleed it
h) Do not use bleach, chlorine, alcohol, betadine,
iodine, or other antiseptics/detergents on the wound
2. Establish eligibility for PEP
a) Three categories of exposure can be described
based on the amount of blood/fluid involved and the entry port. These
categories are intended to help in assessing the severity of the exposure but
may not cover all possibilities.
i) Mild exposure: mucous membrane/non-intact skin
with small volumes.
ii) Moderate exposure: mucous membrane/non-intact
skin with large volumes OR percutaneous superficial exposure with solid needle
iii) Severe exposure: per cutaneous with large
volume
b) A baseline rapid HIV testing should be done
before starting PEP. Initiation of PEP where indicated should not be delayed
while waiting for the results of HIV testing of the source of exposure.
Informed consent should be obtained before testing of the source as per
national HIV testing guidelines.
c) The exposed individual should be assessed for
pre-existing HIV infection intended for people who are HIV negative at the time
of their potential exposure to HIV. Exposed individuals who are known or
discovered to be HIV positive should not receive PEP. They should be offered
counselling and information on prevention of transmission and referred to
clinical and laboratory assessment to determine eligibility for antiretroviral
therapy (ART).
3. Counsel for PEP
a) Exposed persons (clients) should receive
appropriate information about what PEP is about and the risk and benefits of
PEP in order to provide informed consent. It should be clear that PEP is not
mandatory.
b) There are two types of PEP regimens
i) Basic: 2-drug combination
ii) Expanded: 3-drug combination
c) The decision to initiate the type of regimen
depends on the 63 type of exposure and HIV sero-status of the source person
d) PEP must be initiated as soon as
possible, preferably within 2 hours. All clients starting on PEP must take 4
weeks (28 days) of medication.
e) If the exposed person is pregnant, the
evaluation of risk of infection and need for PEP should be approached as with
any other person who has had an HIV exposure. However, the decision to use any
antiretroviral drug during pregnancy should involve discussion between the
woman and her health-care provider (s) regarding the potential benefits and
risks to her and her fetus.
Data regarding the potential effects of
antiretroviral drugs on the developing fetus or neonate are limited. There is a
clear contraindication for Efavirenz (first 3 months of pregnancy) and
Indinavir (prenatal).
In conclusion, for a female HCP considering PEP,
a pregnancy test is recommended if there is any chance that she may be
pregnant. Pregnant HCP are recommended to begin the basic 2-drug regimen, and
if a third drug is needed, Nelfinavir is the drug of choice.
4. Laboratory evaluation
f) When offered HIV testing, the exposed person
should receive standard pre-test counselling according to the national HIV
testing and counselling guidelines, and should give informed consent for
testing. Confidentiality of the test result must be ensured. Do not delay PEP
if HIV testing is not available.
g) Recommended baseline laboratory evaluations
within 8 days of exposure.
i) In persons taking PEP: HIV, HCV, anti-HBs,
complete blood count, transaminases
ii) In persons not taking PEP: HIV, HCV, anti-HBs.
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