post exposure prophylaxis

1. Needle stick injury
(post-exposure prophylaxis)

2. What is occupational exposure?
Occupational exposure refers to exposure to potential
blood-borne infections (HIV, HBV and HCV) that may
occur in healthcare settings during performance of job
duties.
Post exposure prophylaxis (PEP) refers to
comprehensive medical management to minimize the
risk of infection among Health Care Personnel (HCP)
following potential exposure to blood-borne pathogens.

3. Risk factors for occupational exposure to body
fluids include the following:
• Failure to adhere to standard precautions
•Using equipment designed without appropriate
safety features
•Performance of exposure-prone procedures

4. What are “sharps”?
•Sharps are devices that are intentionally sharp to
puncture or cut skin (needles, scalpels, etc.), or
become sharp due to accident, such as broken glass
tubes.

5. •The most common diseases from needle stick injury
are:
1. HBV (Hepatitis B Virus).
2. HCV (Hepatitis C Virus).
3. HIV (Human Immunodeficiency Virus).

6. Risk of acquiring infection:
• The average risk of acquiring HIV infection from different types of
occupational exposure is low compared to risk of infection with HBV
or HCV.
• In terms of occupational exposure the important routes are needle
stick exposure (9–30% for HBV, 1–10% for HCV and 0.3% risk for
HIV).

8. How common are sharps injuries?
•Estimates indicate that 600,000 to 800,000
needle stick injuries occur each year in US.
Unfortunately, about half of these injuries
are not reported.
ALWAYS REPORT sharps injuries to ensure that you
receive appropriate follow-up care

11. Needlestick and other sharps injuries Prevention
1. Avoid the use of needles where safe and effective
alternatives are available.
2. Avoid recapping needles.
3. Plan for safe handling and disposal of needles before
using them.
4. Promptly dispose of used needles in appropriate sharps
disposal containers.
5. Report all needle stick and sharps-related injuries
promptly to ensure that you receive appropriate follow-
up care.
6. Participate in training related to infection prevention.

12. • Sharps Management - General Principles:
Needles should not be recapped, bent or broken by hand, removed
from disposable syringes or otherwise manipulated by hand.

14. Post exposure prophylaxis (PEP)
• Wash site immediately with soap and running water.
• Take a blood sample for baseline HIV, HBsAg and HCVAb.

15. Generally PEP works best the first 3-24 hrs
after the accident occurred. It can also be started up to
72 hrs after the accident, but not effective after that.

17. • For percutaneous or mucosal exposures to blood, several factors must
be considered when making a decision to provide prophylaxis, including
the HBsAg status of the source and the hepatitis B vaccination and
vaccine-response status of the exposed person.

19. • When HBIG is indicated, it should be administered as soon as possible
after exposure (preferably within 24 hours). The effectiveness of HBIG
when administered >7 days after exposure is unknown.
• When hepatitis B vaccine is indicated, it should also be administered as
soon as possible (preferably within 24 hours) and can be administered
simultaneously with HBIG at a separate site.

20. • For exposed persons who are in the process of being vaccinated but
have not completed the vaccination series, vaccination should be
completed as scheduled, and HBIG should be added as indicated.

22. Recommendations for Hepatitis C prevention:
• Prophylaxis Immunoglobulin and antiviral agents are NOT
recommended.
• Determine status of source.
• Establish baseline serology and serum ALT of employee and repeat
testing at 4-6 months post-exposure.
• Early treatment if infection occurs.
• Consider periodic HCV RNA screening (monthly?) if earlier detection
desired.

24. The need for HIV chemoprophylaxis (antiretrovirals) is not more based
on an assessment of the risk.
Three antiretrovirals for 28 days