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post-exposure-prophylaxis-class 1

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post-exposure-prophylaxis-class 1

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post-exposure-prophylaxis-class 1

  1. 1. Post exposure prophylaxis
  2. 2. At the end of this module, you will be able to:  Define the terms: post exposure prophylaxis, blood borne disease.  Explain statistical view of blood borne diseases among the health care workers.  Discuss the, post exposure prophylaxis of blood borne diseases like HIV infection, hepatitis B,C and AIDS  Discuss the drug regimen of Post exposure prophylaxis for HIV, HEPATITIS B,C and AIDS  Describe the side effects of drugs, follow up treatment of post exposure prophylaxis.
  3. 3.  A blood borne infection or disease (sometimes referred to as a blood borne virus or BBV) is one that can be spread through contamination by blood and other body fluids. The most common. Example: HIV, Hepatitis B ,C, AIDS.
  4. 4. HIV:  HIV infection is sharp injury is about 0.3% .CDC has reported 57 documented cases and 140 possible case of HIV transmission in US.  India .estimated at 24 lakhs cases are identified in 2009 HIV health care workers.  Hepatitis B : National hepatitis surveillance data shows that 400 health workers are affected.  OSHA surveillance data shows that 2100 cases of clinical hepatitis, 400-440 hospitalization and approximately 200 deaths in each year in health care workers.
  5. 5. Hepatitis C:  CDC reported Overall 54.5% dentist are reported hepatitis c virus infection because of improper clinical practice .  WHO estimated that in 66,000 hepatitis B and 16,000 hepatitis C and 1000 HIV infections were caused by needle stick injuries in health care workers in past 5years.  The central disease control estimates that there are approximately 8,700 infections in health care workers in occupational exposure to blood and other potentially infection material in US in each year.  The mortality rate from hepatitis b has been reported 10% Cont…..
  6. 6. Exposed person is the person who is at risk of acquiring HIV/HBV/HCV infection through exposure to blood or body fluids . Who is at Risk ? –  - Dentists  - Surgeons and operation theater staff  - Nursing Staff  - Emergency Care Providers  - Labor & delivery room personnel  - Lab Technicians  - Health cleaning/ mortuary staff / Waste Handlers
  7. 7. - Handle with contamination of blood and other body fluids. - Needle stick injury - Lack of proper needle disposal technique - Blood transfusion
  8. 8.  A needle stick injury is a percutaneous piercing wound typically set by a needle point, but possibly also by other sharp instruments or objects.  Commonly encountered with people handling needles in the medical settings like laboratory, casuality,etc.
  9. 9.  Used needles and other sharps are dangers to people and pets if not disposed of safely because they can injure people and spreads health conditions.
  10. 10.  Blood borne pathogen transmission occurs predominantly by percutaneous or mucosal exposure of workers to the blood or body fluids of infected patient.  The risk for HIV transmission after a percutaneous exposure is approximately 0.3% the risk of HB V transmission 6 to 30% and the risk of HCV transmission is approximately 1.8% .
  11. 11.  Both the patient and dental heath care personnel can be exposed to pathogen.  Contact with blood, oral and respiratory secretion.  The blood born infection are: - HIV - HEPATITIS B - AIDS - HEPATITIS C
  12. 12. • Human: Infecting human beings. • Immunodeficiency: Decrease or weakness in the body’s ability to fight off infections and illnesses. • Virus: A pathogen having the ability to replicate only inside a living cell.
  13. 13.  HIV 1  Most common in sub-Saharan Africa and throughout the world  Groups M, N, and O  Pandemic dominated by Group M Group M comprised of subtypes A - J  HIV 2  Most often found in West Central Africa, parts of Europe and India 15
  14. 14.  Sexual transmission, presence of STD increases likelihood of transmission.  Exposure to infected blood or blood products.  Use of contaminated clotting factors by hemophiliacs.  Sharing contaminated needles (IV drug users).  Transplantation of infected tissues or organs.  Mother to fetus, perinatal transmission variable, dependent on viral load and mother’s CD 4 count.
  15. 15.  A serious liver infections caused by the hepatitis B virus that's easily preventable by a vaccine.  The virus is found in the blood body fluids of an infected person.
  16. 16. SEXUAL CONTACT: You may become infected if you have unprotected sex with an infected partner whose blood, saliva, semen or vaginal secretions enter your body. SHARING OF NEEDLES: HBV is easily transmitted through needles and syringes contaminated with infected blood. Sharing intravenous (IV) drug paraphernalia puts you at high risk of hepatitis B.
  17. 17. Contaminated instruments - In haemodialysis, reuse of contaminated instruments in oral surgeries, acupuncture needles. Direct contact - Contact without barrier protection with concentrated virus in a clinical practice.  Body fluids, like saliva,blood,pus,urine,etc..,  Blood transfusion-contaminated blood transfusion.
  18. 18.  The hepatitis C transmitted by other routes breast feeding, Hugging , Kissing or Holding hands, coughing, sneezing.  Sexual transmission.  Sharing razors and toothbrushes .  Tattooing.
  19. 19. POST EXPOSURE PROPHYLAXIS(PEP): Post Exposure Prophylaxis refers to the preventive medical treatment started immediately after exposure to diseases causing virus such as HIV, Hepatitis B, Hepatitis C to prevent infection by these virus and development of diseases.
  20. 20. 1st step: Management of exposed site - First Aid  Skin: Do not squeeze the wound to bleed it, do not put the pricked finger in mouth. Wash with soap & water, don’t scrub, no antiseptics or skin washes (bleach, chlorine, alcohol, betadine).  Eye: wash with water/ normal saline/ don’t remove contact lens immediately if wearing, no soap or disinfectant.  Mouth: spit fluid immediately, repeatedly rinse the mouth with water and spit / no soap/ disinfectant.
  21. 21.  Evaluation must be made rapidly so as to start treatment as soon as possible-ideally within 2hours but certainly within 72 hours of exposure. However all exposed cases don’t require prophylactic treatment. Factors determining the requirement of PEP-  Nature/Severity of exposure and risk of transmission.  HIV status of the source of exposure.  HIV status of the exposed individual.
  22. 22. There are 2 types of regimen:  Basic - 2 drug combination  Expanded regimen - 3 drug combination Drug 2 drug regimen 3 drug regimen Zidovudine(AZT) Or Stavudine (d4T) + Lamivudine (3TC) Protease inhibitors If Protease inhibitors is not available 300 mg twice a day or 30 mg twice a day + 150 mg twice a day Nil Nil 300 mg twice a day or 30 mg twice a day + 150 mg twice a day + 1st choice: Lopinavir/ ritonavir 400mg/100mg twice a day or 2nd choice: Nelfinavir 1250 mg twice a day Efavirenz (EFV) 600 mg once a day 3rd step – Prescribe PEP:
  23. 23. Drug Stock at the Healthcare facility:  PEP kit comprises of 2 drug regimen: Zidovudine(AZT) 300mg + Lamivudine (3TC) 150 mg as a fixed dose combination.  3rd Drug (PI) can be purchased from chemist near RML Hospital, Lok Nayak Hospital or AIIMS & amount will be reimbursed by DSACS.
  24. 24. 4th step - Laboratory Evaluation: Reason for testing soon after exposure is to establish “baseline’ against which to compare future test results. Timing In persons on PEP In persons not on PEP Baseline (with in 8 days of exposure) HIV, anti- HCV, Complete blood counts Transaminases. HIV,HCV,HBV
  25. 25. LAB FOLLOW UP FOR HIV : Timing In persons taking PEP Weeks 2 & 4 Complete blood counts Week 6 HIV-Ab Month 3 HIV-Ab, anti - HCV, Month 6 HIV-Ab, anti –HCV, Exposed persons should have post PEP HIV test. Testing at end of PEP may give indication of zero conversion. To diagnose all persons who zero convert testing at 3 and 6 months is recommended.
  26. 26. 5th step – Follow up: Clinical –  Monitoring for appearance of signs of HIV zero conversion  Use precautions to prevent secondary transmission (Blood donation, Breast feeding ,Pregnancy, Unprotected Sexual relations especially during 6-12 wks. following exposure. Condom use is essential.  Drug adherence  Psychological support
  27. 27. Immediate care to the exposure site:  Wash wounds and skin with soap and water.  Flush mucous membranes with water. Determine the risk of Exposure:  Type of fluid – Body fluids saliva potentially infectious fluids or tissue.  Type of exposure – Percutaneous injury, mucous membrane or non intact skin exposure.
  28. 28. HEPATITIS B VACCINE:  Initiation of the hepatitis B vaccine within 12 to 24 hours of an exposure.  The vaccine should not be given later than 14 days post exposure.  The 3 doses of hepatitis B vaccine is given at 0,1 to 2 months, and 6 months.  Hepatitis B antibodies should be obtained 1 to 2 month after completion of the third dose of the vaccine.
  29. 29. Recommended PEP for Hepatitis B Virus: Vaccination/Ag response status of exposed patient Treatment when source patient is: HBsAg positive HBsAg negative Source unknown or not available for testing Unvaccinated/ non-immune HBIG ×1; initiate HB vaccine series Initiate HB vaccine series Initiate HB vaccine series Previously vaccinated, known responder No treatment No treatment No treatment Previously vaccinated, known non-responder HBIG ×1 and initiate revaccination or HBIG ×2 No treatment No treatment unless high-risk source; if high-risk source, treat as if source were HBsAg positive Previously vaccinated, response unknown Single vaccine booster dose No treatment No treatment unless high-risk source; if high-risk source, treat as if source were HBsAg positive Still undergoing vaccinated HBIG ×1; complete series Complete series Complete series
  30. 30. LAB FOLLOW UP OF HEPATITIS B VIRUS EXPOSED PERSON:  Perform follow up anti HBs testing in persons who receive hepatitis B vaccine.  Test for protective surface antibodies for 1 to 2 months after last dose of vaccine.  HBsAb responses to vaccine cannot be ascertained if HBIG was received in the previous 3 to 4 months.
  31. 31.  No vaccine or treatment will prevent infection - Immune globulin not recommended; does not work.  Early infection effectively treated with Peg-interferon +/- ribavirin
  32. 32. 57 38 18 16 14 6 0 20 40 60 80 100 Percent Nausea Fatigue Headache Vomiting Diarrhea Myalgias Adverse Effects of PEP Regimens
  33. 33. The health care worker (HCW) should wash the site of injury by sharps with soap and water. immediately report the incidents to the infection control nurse (ICN). ICN will take the health care worker to emergency room for wound dressing and TT injection .
  34. 34. ICN will take the venous blood sample from the heath care worker and the patient from whom the incident occurred and give the sample to laboratory test for HIV, HBsAg anti- HCV . The ICN will collect the result and take health care worker, medicine consultant and follow the consultant instructions. If the health care workers have positive for any of the three tests.
  35. 35. started for the post exposure prophylaxis drugs.
  36. 36.  So for we are discuss the blood borne diseases, and its causes risk of infection statistical report of blood borne diseases in health care professional and post exposure prophylaxis treatment of HIV, hepatitis B,C and its follow up care.

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