Page 268 - AIDSBK23C

Page 268

Recommended procedures following an exposure by a health care worker to blood or
body fluids that contain HIV may include:[161]

1. Administer first aid as needed to the injured health care worker.

2. Decontaminate the exposure site when the safety of the health care worker permits.

3. Wash open wounds first with soap and water and then irrigate with sterile saline or a
disinfectant.

4. Flush exposed mucosal surfaces extensively with water.

5. Exposed eyes should be irrigated with clean water, saline, or sterile eye irrigants.

6. Promptly report the exposure to the institutional occupational medicine department.

7. Counsel the exposed health care worker regarding the risks and benefits of antiretroviral
chemoprophylaxis and then offer chemoprophylaxis.

8. If chemoprophylaxis is accepted, then the first dose should be administered as soon as
possible, preferably within an hour of the time of exposure.

9. Specimens should be collected for baseline HIV testing on all persons provided with
chemoprophylaxis using a blood or oral fluid rapid test if available; otherwise,
conventional testing should be used. If the HIV test result is positive, chemoprophylaxis
can be discontinued and the person referred to a clinician experienced with HIV care for
treatment.

10. The chemoprophylactic drug regimen may be altered if the source and the drug resistance
pattern is known.

11. Follow up at 6 weeks, 3 months, 6 months, and 1 year (note: HIV seroconversion will
typically occur in the first 6 months if chemoprophylaxis has failed).

Though HIV testing of the person or specimen suspected of being the potential source of
HIV exposure may be done, such testing will not always resolve the issue of transmission
because: (1) even if the source is found to be positive for HIV, this does not prove that
transmission to the exposed worker occurred; (2) the laboratory tests employed, though they are
extremely good, are not 100% sensitive; and (3) persons recently infected by HIV may not be
detected by routine testing for days to months.
In all health-care settings, opt-out screening for HIV (performing HIV screening after
notifying the patient that the test will be performed, with assent inferred unless the patient
declines or defers testing) is recommended for all patients aged 13--64 years.
Cost alone would preclude routine screening of all patients, persons, bodies, or
specimens, nor would the detection of specific sources for HIV infection lessen the need for
routine infection control. Remember that other important infectious diseases such as hepatitis