1. POST EXPOSURE PROPHYLAXIS IN HCW

2. Introduction
WHO:
2 million experience percutaneous exposure to infectious diseases each year
37.6% of Hepatitis B, 39% of Hepatitis C and 4.4% of
HIV/AIDS in Health-Care Workers due to need lestick injuries.
enormous emotional impact

3. Assess Risk for HIV Infection
Type of exposure
Less severe: solid needle or superficial injury
More severe: large-bore hollow needle, deep puncture, visible blood on device, needle used in patient’s artery or vein
Infection status of source:
Class 1: asymptomatic HIV infection or known low viral load (<1,500 copies/mL)
Class 2: symptomatic HIV, AIDS, acute seroconversion, or known high viral load

4. Post Exposure Prophylaxis for the Healthcare Worker
percutaneous injury (needlestick, cut or
Contact of mucous membrane Or
nonintact skin
Blood
Tissue
Other body fluids that are potentially
infectious (cerebrospinal,
pleura,pericard,ascitis)

5. Risk for Occupationa Transmissio
Needlestick mucous
HB s+, e Ag % Lower
HB s+ e Ag % Lower
HCV %
HIV % %

6. Management of needle stick
Clean wounds with soap and water
Flush mucous membranes with water
No application of antiseptics or disinfectants
No milking puncture sites
Avoid use of bleech

7. Eye splash
Irrigate the exposed eye immediately with clean tap water or normal saline.
Sit in a chair, tilt the head back and have a colleague gently
pour water or normal saline over the eye, pulling the eyelids
up and down to make sure the eye is cleaned thoroughly
Do not use soap or disinfectant on the eye

8. Mouth splash Spit the fluid out immediately.
Rinse the mouth thoroughly, using water or saline,
and spit again. Repeat this process several times.
Do not use soap or disinfectant in the mouth

9. Laboratories Tests HIV Ab HBSAg H.C.Ws
HBs Ab &Ag source (if available)
HBs Ag ALT/ AST/ Alk ph
HCV Ab
HIV Ab
HBSAg

10. source Management
Rapid determination of the source is essential to managment.
EIA testing
Consider rapid test if EIA testing cannot be completed
within hours
Positive results confirmed using wesrwen blot
Direct virus assays (e.g., PCR, p24 antigen) not recommended
HIV test of needles or other sharp instruments not recomanded

11. HIV RNA testing
If the initial HIV screening test is negative but the possibility of HIV exposure exists within 6 weeks prior to presentation.
If the initial HIV screening test is negative but clinical evidence primary infection or diseses
If the source patient has a positive antibody or antigen test but the confirmatory antibody differentiation test is indeterminate

12. REPORT Date and time Procedure details Exposure details
Information about source person and exposed person
Exposure management

13. PEP initiation Ideal 1-2 hours. Excellent 4 hours 24 hours- 36 hours
>72 hours – no evidence of efficacy but referal to centers is necessary

14. Recommended Regimen
Tenofovir +Emtricitabine +Raltegravir

15. Regimen
Tenofovir + emtricitabine+
Lopinavir + ritonavir (Kaletra)

16. Not Determinant HIV Source
Tenofovir + emtricitabine (Truvada)
Alternative:
Tenofovir+Lamivudine
Zidovudine + lamivudine

17. PEP 4 weeks of treatment is recommended.
Adherence to the full course of PEP had been unacceptably low.
Overall completion rate of only 56.6%

18. PEP
HIV-antibody testing (EIA) to monitor for seroconversion: at baseline, 6 weeks, 12 weeks, and 6 months
12 months in HCP who become infected with
HCV after exposure to an HIV/HCV coinfected source
HIV testing :acute retroviral syndrome

19. Exposed HCP Exposed HCP should be advised to use precautions
(eg, avoid blood or tissue donations, breast-feeding, pregnancy) to prevent secondary transmission, especially during the first weeks post exposure

20. Prevention of HBV Pre exposure: Vaccination 3 doses: 0, 1, 6 mo
Older age, obesity, heavy smoker, immunosuppression have lower Responses.
Test for anti-HBs 1-2 months after last dose
Except :If HBIG received )3-6 month)
non-responder:
anti-HBs is negative after 6 doses of vaccine

23. HCV Exposure
If the source patient is known to be positive for HCV antibody and/or HCV RNA :
Baseline HCV Ab & ALT
Week 4: HCV RNA and liver panel
Week 12: HCV RNA and liver panel
Week 24: Liver panel and HCV antibody