Occupational exposure to HIV

Prompt management of accidental exposures of healthcare workers (HCWs) to HIV infected blood is critically important in a healthcare or laboratory setting. The following article provides guidelines for a standard operating procedure for occupational exposure to HIV.

ABC of what to do
Treatment of exposure site (at once)
Wash wounds and skin sites with soap and running water; mucous membranes should be flushed with water. There is no evidence that the use of antiseptics for wound care or expressing fluid by squeezing the wound further reduces the risk for HIV transmission. However, the use of antiseptics is not contraindicated. The application of caustic agents (e.g. bleach) or the injection of antiseptics or disinfectants into the wound is not recommended.

Blood requirements
After an occupational exposure, the source-person and the exposed HCW should be evaluated to determine the need for HIV post-exposure prophylaxis (PEP). Follow-up for Hepatitis B virus should also be conducted:

• obtain the name of the source patient
• take blood samples from the source patient after he/she has given consent
• test samples for Hepatitis B, Hepatitis C and venereal disease
• send samples to laboratory for testing

Drug treatment

• assess the exposure site (Step 1)
• determine the HIV status code of exposure source (Step 2)
• PEP recommendations (Step 3)

Step 1, Step 2 and Step 3 reproduced with kind permission of John G. Bartlett, MD, Medical Management of HIV Infection,1998 edition.

All HCWs should be vaccinated against Hepatitis B. HCWs who have not been immunized must receive Hepatitis B immunoglobulin and the first Hepatitis B vaccine. The HCW must make sure that follow-up vaccines and/or immunoglobulin is taken as prescribed.

1. If the HCWs Hepatitis B screen is antibody positive, no further treatment is necessary.
2. If the HCWs Hepatitis screen is antibody negative, further treatment is necessary. The HCW must receive the second and third Hepatitis B vaccinations.
3. If the source patient's Hepatitis B screen is antigen positive, the HCW must receive a second dose of Hepatitis immunoglobulin.

Evaluation
The exposed HCW should be encouraged to be tested on HIV and Hepatitis B antibodies as soon after exposure has occured (baseline). An ELISA HIV test should be completed 6 weeks, 12 weeks and 6 months after the exposure. Because symptoms of acute retroviral infection (fever, lymphadenopathy, rash, headache) are associated with approximately 80% of reported occupational infections, persons sustaining exposure should be evaluated if a compatible illness occurs.

Follow-up
Post-exposure counselling should be received. Counselling should provide information about:

• present degree of risk
• options for follow-up
• infection-control procedures to prevent similar occurences in the future
• advice on the concerns of sexual partners, co-workers, family and friends of exposed HCW
• confidentiality procedures in place

First 6-12 weeks (when most HIV-infected persons are expected to seroconvert)
To prevent secondary transmission during the follow-up period, the HCW should

• use sexual abstinence or condoms to prevent sexual transmission
• avoid pregnancy (if breast-feeding, the HCW should discontinue breast-feeding, especially following a high-risk exposure)
• refrain from donating blood, plasma, organs, tissue, or semen.
  
  

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