1. Postexposure Care and Prophylaxis for Providers

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.