Post Exposure Prophylaxis (PEP)
- Low risk of HIV transmission following occupational exposure to HIV-infected blood
- Percutaneous exposure in healthcare settings: average risk1 per 300
- Mucocutaneous exposure: average risk < 1 in 1000
- Blood on intact skin: no risk
- Blood exposure also places health care workers (HCWs) at risk for other blood borne infections, such as hepatitis B and C, which are more easily transmitted than HIV. All HCWs should receive hepatitis B vaccination if available.
- Deep injury
- Visible blood on device that caused injury
- Injury with needle from artery or vein
- Terminal HIV illness in source patient (due to high viral load)
- Amniotic fluid
- Cerebrospinal fluid
- Human breast milk
- Pericardial fluid
- Peritoneal fluid
- Pleural fluid
- Saliva in association with dentistry
- Synovial fluid
- Unfixed human tissues and organs
- Vaginal secretions
- Any other fluid if visibly bloodstained
- Fluid from burns or skin lesions
Immediately after Exposure
- Clean the Exposure Site
Contact your On Site In-Charge/ Supervisor
- If a skin wound, wash with soap and running water. If the exposed area is an eye or mucous membrane, flush with copious amounts of clean water.
- DO NOT USE BLEACH or other caustic agents/disinfectants to clean the exposure site
Responsibilities of the Clinical Officer or Medical Officer
- HIV/ ARV Nurse In-Charge
- Over all Supervisor in Charge
- Laboratory Manager
- Determine if the exposure is potentially high risk based on the information in the information below
- If exposure is considered high risk: refer to closest VCT centre IMMEDIATELY and arrange for shortened version of pre-test counselling and HIV rapid test for exposed employee. If this is likely to take longer than 1 hour, give first dose of PEP before referring.
- Explain that all HIV testing is CONFIDENTIAL
- Ensure the exposed employee also has a FBC and liver test (ALT) done
- Arrange post test counseling
- Counsel regarding post-exposure prophylaxis (PEP): risks and benefits
- Complete the Report Form describing the details surrounding the exposure
- Determine the need for PEP based on the nature of the exposure and the risks and benefits of taking (or not taking) antiretroviral medications.PEP should be started preferably within 1-2 hours of the exposure. If not started within 72 hours of the exposure, PEP will not be provided, as it is not likely to be effective after this time period.
- Clean exposure site immediately with soap and running water (skin wound) or with copious amounts of clean water (eye or mucous membrane). Do not use bleach or other caustic agents/disinfectants.
- Contact on site in-charge/supervisor
- Responsibilities of clinical or medical officer:
- -Determine whether exposure high risk
- -If high risk, refer to closest VCT centre immediately, and arrange for shortened version of pre-text counseling and rapid HIV test fo exposed employee. If likely to take >1 hr, give first dose of PEP before referring.
- -Explain that all HIV testing is confidential
- -Perform FBC and liver test (ALT)
- -Arrange post-test counseling
- -Counsel regarding risk and benefits of PEP
- -Complete Report Forum describing details of exposure
- -Determine need for PEP based on nature of exposure and risks/benefits of taking ARVs.
- -PEP should be started within 1-2 hrs of exposure when possible. Do not start PEP if >72 hrs of exposure, as benefit unlikely.
- -Do not give PEP to employees who refuse HIV testing or who test positive
- -If employee tests positive, refer to ARV clinic after adequate counseling. Observe confidentiality
- Optimal ARV or regimen unclear, but the following are preferred:
No risk (intact skin): PEP not recommended
Medium risk (invasive injury, no blood visible on needle): AZT/3TC* + LPV/r x 28 days.
High risk (large volume, known HIV+ patient, hollow-bore needle, and/or deep extensive injury): same as medium risk
- *If Hgb <10 gm/dl,use TDF/FTC instead of AZT/3TC
Substantial risk (exposure of vagina, rectum, eye, mouth or other mucous membrane, non-intact skin, or percutaneous contact with blood, semen, vaginal or rectal secretions, breast milk, or any body fluid visible contaminated with blood when source known to be HIV+):
<72 hrs since exposure:
- -Source patient HIV+: nPEP recommended
- -Source patient with unknown HIV status: case by case determination
>72 hrs since exposure:
- -nPEP not recommended
Negligible risk (exposure of vagina, rectum, eye, mouth or other mucous membrane, intact or non-intact skin, or percutaneous contact with urine, nasal secretions, saliva, sweat or tears if not visibly contaminated with blood regardless of known or suspected HIV status of source):
- -nPEP not recommended
- If nPEP indicated follow recommended PEP regimens for Zambia
- Perform HIV test on day of exposure; repeat at 6 weeks, 3 months and 6 months
- Perform HIV test if client experiences acute illness that includes fever, rash, myalgia, fatigue, malaise, and lymphadenopathy
- Schedule evaluation by a medical or clinical officer within 72 hours after starting PEP
- Monitoring for side effects for at least 2 weeks after starting PEP