CDC recommendations on postexposure protocols
The following recommendations on HIV postexposure prophylaxis for health care workers are summarized from the new guidelines by the Centers for Disease Control and Prevention.1
PEP Availability: Health-care organizations should make available to their workers a system that includes written protocols for prompt reporting, evaluation, counseling, treatment, and follow-up of occupational exposures that may place health care workers at risk for acquiring any bloodborne infection, including HIV. Access to clinicians who can provide postexposure care should be available during all working hours, including nights and weekends. Antiretroviral agents for PEP should be available for timely administration, either by providing access to PEP drugs on site or creating links with other facilities or providers to make them available offsite.
Documenting exposures: If an occupational exposure occurs, the circumstances and postexposure management should be recorded in the health care worker's confidential medical record, usually on a form designated for this purpose. Relevant information includes:
· date and time of exposure;
· details of the procedure being performed, including where and how the exposure occurred, and if the exposure was related to a sharp device, the type of device, and how and when in the course of handling the device the exposure occurred;
· details of the exposure, including the type and amount of fluid or material and the severity of the exposure (e.g., for a percutaneous exposure, depth of injury and whether fluid was injected, or for a skin or mucous-membrane exposure, the estimated volume of material and duration of contact and the condition of the skin);
· details about the exposure source, including whether the source material contained HIV or other bloodborne pathogens; whether the source is an HIV-infected person; and if so, the stage of disease, history of antiretroviral therapy, and viral load;
· details about counseling, postexposure management, and follow-up.
Evaluation and testing of an exposure source: The person whose blood or body fluids are the source of an occupational exposure should be evaluated for HIV infection. Information available in the medical record at the time of exposure (e.g., laboratory test results, admitting diagnosis, or past medical history) or from the source person may suggest or rule out possible HIV infection.
· If the source is known to have HIV infection, available information about this person's stage of infection (i.e., asymptomatic or AIDS), CD4+ T-cell count, results of viral load testing, and current and previous antiretroviral therapy should be gathered for consideration in choosing an appropriate PEP regimen. If this information is not immediately available, initiation of PEP, if indicated, should not be delayed.
· If the source person's HIV serostatus is unknown at the time of exposure - including when the source is HIV-negative but may have had a recent HIV exposure - use of PEP should be decided on a case-by-case basis. Factors to consider include the type of exposure and the clinical and/or epidemiologic likelihood of HIV infection in the source. If these considerations suggest a possibility for HIV transmission and HIV testing of the source is pending, it is reasonable to initiate a two-drug PEP regimen until laboratory results have been obtained and later modify or discontinue the regimen accordingly.
HIV testing of exposed workers: Exposed workers should be evaluated for susceptibility to bloodborne pathogen infections. Baseline testing to establish serostatus at the time of exposure for HIV antibody should be performed. If the source patient is seronegative for HIV, baseline testing or further follow-up of the health care worker normally is not necessary. Health care workers with occupational exposure to HIV should receive follow-up counseling, postexposure testing, and medical evaluation regardless of whether they receive PEP. HIV-antibody testing should be performed for at least six months postexposure (e.g., at six weeks, 12 weeks, and six months).
Reference
1. Centers for Disease Control and Prevention. Public Health Service guidelines for the management of health-care worker exposures to HIV and recommendations for postexposure prophylaxis. MMWR 1998; 47(No. RR-7):1-33.
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