Download 20_PostexposureProphylaxis

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?
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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 known
Source: CDC, 2001 and 2005.
ARV Drugs for PEP – Guidelines
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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)
Guidelines for managing PEP should be established.
Source: CDC, 2005.