Postexposure Care and Prophylaxis for Providers

Risk of HIV Infection after Occupational Exposure

If 300 people receive needle-stick or sharp-instrument injuries at their job sites, from an HIV-infected source, how many do you think will be infected with HIV?

• 1 in 300• 10 in 300• 100 in 300

Source: Bell, 1997.

Risk of HIV Infection after Occupational Exposure

If 1000 people had mucous membranes or broken skin exposed to HIV, how many do you think will be infected?

• 1 in 1000• 50 in 1000• 100 in 1000• 200 in 1000

Source: Bell, 1997.

Risk of HIV Infection after Occupational Exposure

What factors do you think might influence whether a provider becomes infected after exposure?

Risk depends on:• Amount of blood on the needle/device • Depth of the injury• Whether needle or device was placed directly

in patient’s artery or vein• Infectious status of source person

Source: CDC, 2005.

Postexposure Care:

Immediately

• Wash injured area with soap and water

• If water is not available, use antiseptic solution to flush area

• If eyes, mouth, or nose are splashed, irrigate with clean water, saline, or sterile irrigation solution

• Do not apply caustic agents (e.g., bleach)

Source: CDC, 2001.

Postexposure Care:

After Providing Immediate Care

continued …

• Evaluate risk of infection based on exposure: – type and amount of contaminated body fluid– type and severity of wound – infectiousness of source patient

• Determine HIV status of source patient, following appropriate counseling and disclosure guidelines

• Provide counseling, HIV testing, PEP treatment, and follow-up care

Source: CDC, 2001 and 2005.

Postexposure Care:

Additional Recommendations

Until status is known:• Avoid donating blood, organs, tissue, semen• Abstain from intercourse or use a condom • Comply with ARV regimen (if accepting therapy)• Obtain counseling for self and partner(s)

If pregnant or breastfeeding, counsel about:• Risk of MTCT (first trimester, maximum risk)• Availability of MTCT drug therapy, side effects• Avoiding breastfeeding until status knownSource: CDC, 2001 and 2005.

ARV Drugs for PEP – Guidelines

• Start as soon as possible• Continue for 4 weeks• Use multidrug therapy – more effective• Conduct routine toxicity tests • Report sudden or severe flu-like symptoms• Conduct antibody tests (baseline, 6 weeks,

12 weeks, and 6 months)

Source: CDC, 2005.

Guidelines for managing PEP should be established.Guidelines for managing PEP should be established.