Occupational hiv exposure prophylaxis
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Occupational HIV Exposure Prophylaxis. Dr Truong Anh Tan June 30 th , 2010. Infected post-exposure rate/1000. Blood infusion 900 IDU (shared needle)6,7 Anal sex receiver5,0 Needlestick 3,0 Vaginal sex female1,0 Anal sex giver0,65 Vaginal sex male0,5

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Occupational HIV Exposure Prophylaxis

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Occupational hiv exposure prophylaxis

Occupational HIV Exposure Prophylaxis

Dr Truong Anh Tan

June 30th , 2010


Infected post exposure rate 1000

Infected post-exposure rate/1000

  • Blood infusion 900

  • IDU (shared needle)6,7

  • Anal sex receiver5,0

  • Needlestick3,0

  • Vaginal sex female1,0

  • Anal sex giver0,65

  • Vaginal sex male0,5

  • Oral sex receiver0,1

  • Oral sex giver0,05


Estimated pathogen specific seroconversion rate per exposure for occupational needlestick injury

Estimated Pathogen-Specific Seroconversion Rate Per Exposure for Occupational Needlestick Injury

.

AETC http://depts.washington.edu/hivaids


Type of exposure way involved in transmission of hiv to health care workers

Type of Exposure Way Involved in Transmission of HIV to Health Care Workers

AETC http://depts.washington.edu/hivaids


Source of hiv involved in hiv transmission to health care worker

Source of HIV Involved in HIV Transmission to Health Care Worker

AETC http://depts.washington.edu/hivaids


Risk factors for hiv transmission with occupational exposure to hiv infected blood

Risk Factors for HIV Transmission with Occupational Exposure to HIV-Infected Blood


Other possible risk factors

Other Possible Risk Factors

Hollow bore vs solid bore

No documented cases to date of seroconversion from suture needles

Glove use

50% decrease in volume of blood transmitted

Mucous membrane exposure

Mosquitoes bite?


Standard precautions

Standard Precautions

Definition

Standards developed to prevent exposure and transmission of disease in occupational setting

Provide guidance for the safe handling of infectious material


Components of standard precautions

Components of Standard Precautions

Hand washing

Use protective barriers when indicated

Gloves: mucus membranes, body fluids, broken skin

Goggles: procedures

Masks: procedures


Components of standard precautions 2

Components of Standard Precautions (2)

Sharps and waste - handle with gloves and dispose in designated containers

Needles

Scalpels

Suture material

Bandages

Dressings

Anything contaminated with any body fluid


Handling with disposing sharps

Handling with Disposing Sharps

Do not recap needles!

Put containers within arms reach

Use adequate light source when treating patients

Wear heavy-duty gloves when transporting sharps

Incinerate used needles to a sufficient temperature to melt

Keep sharps out of reach of children


Components of standard precautions 3

Components of Standard Precautions (3)

Re-usable instruments  must be thoroughly disinfected

Speculums

Surgical tools

Thermometers

Immunizations for Healthcare Workers

Hepatitis A and B


Recommended antiseptic solutions

Recommended Antiseptic Solutions

Alcohol 70%

Chlorhexidine, 2-4% (e.g. Hibtane, Hibiscrub)

Iodine 3%

Iodophores 7.5-10% (e.g. Betadine)


Recommended disinfectants

Recommended Disinfectants

Chlorine, 0.5% (Barkina)

Sedex and Ghion brands contain 5% Chlorine, dilute for use

Glutaraldehyde, 2-4% (e.g. Cidex)

Formaldehyde, 8%

Hydrogen peroxide, 6%

Soak the instrument for 20 minutes after decontamination and cleaning


Management of occupational exposure

Management of Occupational Exposure

  • HIV AB: for both (giver and receiver)

  • Hepatitis : B & C

  • CBC

  • SGOT/SGPT

  • Blood Glucose

  •  136th month


Diagnostic testing

Diagnostic Testing

1 mil

100,000

+

HIV RNA

HIV-1 Antibodies

_

10,000

Ab

1,000

HIV RNA

Exposure

100

Symptoms

10

0

14

21

28

7

Days

Image courtesy of The Center for AIDS Information & Advocacy, www.centerforaids.org


The early stages of hiv infection

The Early Stages of HIV Infection

Cell free HIV

T-cell

Immature Dendritic cell

PEP

Skin or mucosa

Via lymphatics or circulation

Burst of HIV replication

24 hours

48 hours

HIV co-receptors, CD4 + chemokine receptor CC5

Mature Dendritic cell in regional LN undergoes a single replication, which transfers HIV toT-cell

  • Selective of macrophage-tropic HIV


Wound care

Wound Care

Gently wash wounds with soap and water/ 5 minutes  alchol 70% 5 minutes (don’t scrub vigorously)

Allow wounds to bleed freely

Irrigate exposed mucosal surfaces with sterile saline


Post exposure prophylaxis pep

Post Exposure Prophylaxis (PEP)

Definition:

Use of therapeutic agent to prevent establishment of infection following exposure either occupationally or non-occupationally to pathogen

Roles in Occupational Exposure:

HIV prevention

HBV prevention

 Tests before ARVs therapy


Step 1 does this patient need hiv pep

Step 1: Does This Patient Need HIV PEP?

Source patient

Unknown / Unwilling to get tested*

HIV -

HIV +

High back-ground risk

Low back-ground risk

No PEP

PEP

No PEP

*CDC recom: usually PEP unnecessary; consider use if source patient is high risk


Step 2 determine hiv status code of source hiv sc

Step 2: Determine HIV Status Code of Source (HIV SC)

HIV Negative

HIV Positive

Asymptomatic/high CD4 = HIV SC 1

Advanced disease,primary infection or low CD4 =HIV SC 2

HIV Status Unknown or Source Unknown

= HIV SC Unknown

No PEP

No PEP or + PEP with 2 drugs

PEP


Occupational hiv exposure prophylaxis

CDC Sep 2005


Occupational hiv pep

Occupational HIV PEP

2 drug regimen

Zidovudine plus lamivudine (combivir)

Stavudine plus Lamivudine

Tenofovir plus lamivudine

3 drug regimen

LPV/r or Indinivr or Nelfinavir plus NRTI backbone

Efavirez plus NRTI backbone

Consider resistance potential of source patient

Don’t use NVP (hepatotoxic)

When to start  ASAP

PEP no efficacy after 72 hours


Pep guideline from moh

PEP Guideline from MOH

-PEP 1: AZT + 3TC

AZT: 300mg bid & 3TC: 150 mg bid.

-  PEP 2: 3TC + d4T

3TC: 150mg bid & d4T: 30-40mg bid.

< 60 kg, d4T: 30 mg bid.

> 60 kg, d4T: 40 mg bid.

AZT(Zidovudine);3TC(Lamivudine);D4T(Stavudine)


Advanced pep for high risk

Advanced PEP(for high risk)

PEP 1 or 2 plus 1of following agents:

- NFV: 1,25 g bid.

- EFV: 300 mg bid

- LPV/r: 500 mg bid (recommended)

 28 days duration

(MOH guideline for PEP updated on 9/2009)


Follow up hiv testing

-CDC: HIV Ab at 6th week, 3rd month, 6th month

-Extended HIV Ab testing at 12 months recommended if a source patient co-infected HCV

VL testing not recommended unless Primary HIV Infection (PHI) suspected

-Early diagnosis: HIV RNA PCR at 3th week

Follow-up HIV Testing

MMWR June 29, 2001 / 50(RR11);1-42.


Occupational hiv exposure prophylaxis

Thank you for

your attention!


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