NSI guidelinessfrom UPUMS dept

1. mRrj izns”k vk;qfoZKku fo”ofo|ky;] lSQbZ] bVkok&206130
Uttar Pradesh University of Medical Sciences, Saifai, Etawah-206130
(Formerly U.P. Rural Institute of Medical Sciences & Research)
Phone: (05688) 276569 Fax: (05688) 276509
NEEDLE STICK INJURY
Wash the exposed area with Soap & water
Do not panic
Do not squeeze the exposed area
Do not use betadine, Iodine or anti septic agents
Report to Medicine OPD /CMO on duty in Emergency ASAP
Ascertain serological status & vaccination status of HCW and source
(As per Performa attached)
Start PEP for HIV & HBV as per attached guidelines of NACO & AASLD.
(As per Performa attached)
Serological Testing in Source & HCW
Source Negative Source Positive for HIV or HBV
Stop PEP & Monitor Continue PEP and monitor
Seek expert opinion in case of:
 Delay in reporting >72 hrs
 Unknown source
 Pregnancy
 Breast feeding mothers
 Source patient on ART
 Adverse reaction to PEP

2. mRrj izns”k vk;qfoZKku fo”ofo|ky;] lSQbZ] bVkok&206130
Uttar Pradesh University of Medical Sciences, Saifai, Etawah-206130
(Formerly U.P. Rural Institute of Medical Sciences & Research)
Phone: (05688) 276569 Fax: (05688) 276509
NEEDLE STICK INJURY PROFORMA
Name of HCW:_____________________ Name of Source patient:___________________
Designation:_______________________ OPD/IPD No:____________________________
Department:_______________________ Address:________________________________
Phone No:_________________________ Phone No:______________________________
INCIDENT
Date & Time of Incident:________________ Procedure:_____________________________
Location of Incident:___________________ Sharp used:____________________________
Date & Time of Reporting:______________ Part of body Injured:______________________
Nature of Injury:______________________ Cause of Injury:__________________________
Type of Contamination:
Blood No blood stained fluid
Blood stained fluid Others_______________________________
Serological Status of HCW Serological Status of Source
Unknown Positive Negative Unknown Positive Negative
Anti HIV Anti HIV
HBsAg HBsAg
Anti HCV Anti HCV
Vaccination Status of HCW Vaccination Status of Source Patient
Unvaccinated 3 doses Unvaccinated 3 doses
1 dose 3 dose 1 dose 3 dose
2 doses Nonresponder 2 doses Non responder
Anti HBsAg antibody level_________________ Anti HBsAg antibody level___________________
PEP Advised: YesNo Source sample taken for storge
Monitoring& Counselling advised Serological status after testing
(Protocol attached) HCW Source patient
Anti HIV
Anti HCV
HBsAg
Signature & Stamp of CMO
Continued………..

3. Counselling & Monitoring
 Explain risk of transmission of HIV(0.3%), HCV (03%), HBsAg(30%) .
 Barrier protection during sexual intercourse for 03 months.
 Avoid blood donation, pregnancy or breast feeding for 6-12 month.
 Serological testing 03 months and 06 months after exposure.
 Start PEP preferably with in 2 hrs and most certainly with in 72 hrs.
 Explain the possibe side effcte of PEP.
 Monitoring signs & symptoms of seroconversion such as fever, generalized
lymphodenopatny & flu like symptoms.
 Follow up.
 Psychological support & mental health counselling.
HIV Post Exposure Prophylaxis
Exposed Person Preferred PEP Regimen Alternate Regimen
Adults and
Adolescents 10 years
or more and weight
30kgs or more
Tenofovir (300mg) +
Lamivudine (300mg) +
Dolutegravir (50mg) – one
tablet OD
Tenofovir (300mg)+ Lamivudine (300mg)
FDC- one tablet OD +
Lopinavir(200mg/Ritonavir (50mg) (two
tablets BD)
Or
Tenofovir (300mg) + Lamivudine (300mg) +
Efavirenz (*600mg) one tablet OD
Children (weight
20kgs or more and
age 6 years or more
Zidovudine + Lamivudine
(dosage as per weight band)+
Dolutegravir (50mg) one
tablet OD
If Hb<9gm/dl
Abacavir+ Lamivudine (dosage as per weight
band) + Dolutegravir (50mg) one tablet OD
Or
Zidovudine+Lamivudine+
Lopinavir/Ritonavir (dosage as per weight
band)
Children (weight 20
kgs or less and age 6
years or less
Zidovudine+Lamivudine+
Lopinavir/Ritonavir (dosage
as per weight band)
If Hb<9gm/dl
Abacavir+ Lamivudine (dosage as per weight
band) + Dolutegravir (50mg) one tablet OD
HBV Post Exposure Prophylaxis
HBV Vaccination Status Action after Exposure
Never Vaccinated Give Single dose of Hepatitis B Immunoglobulin
intramuscularly and start Bepatitis B vaccination
series 0, 1 and 6 months simultaneously.
Vaccinated but Anti HBs antibody < 10IU/ml or
not known
Give Single dose of Hepatitis B Immunoglobulin
intramuscularly and a booster dose of Hepatitis
B vaccine.
Vaccinated more than 5 years ago Hepatitis B Vaccine Booster dose
Vaccinated Less than 5 years ago and Anti HBs
antibody >10IU/ml
No action required
HBIg Dosage:
0-4 years: 200 IU
5-9 years: 300IU
10 years or more: 400 IU