TABLE 50.4.

Guide to Postexposure Prophylaxis and Prevention of Infection Transmission

PEP Step 1: Treat Exposure Site

•Use soap and water to wash areas exposed to potentially infectious fluids as soon as possible after exposure. •Flush exposed mucous membranes with water. •Flush exposed eyes with water or saline solution. •Do NOT apply caustic agents, or inject antiseptics or disinfectants into the wound.

PEP Step 2: Report and Document

•Date and time of exposure. •Details of the incident: where and how the exposure occurred, exposure site(s) on HCP's body; if related to sharp device, the type and brand of device. •Details of the exposure: type and amount of fluid or material, severity of exposure. •Documentation of counseling following exposure and postexposure management plan. •Details about the exposure source: If the source patient is known or unknown; whether the source material contained HIV, HBV, or HCV; if the source patient is HIV-infected, determine stage of disease, CD4 cell count, HIV viral load, history of antiretroviral therapy, and antiretroviral resistance information as available. •Details about the exposed HCP: hepatitis B vaccination and vaccine-response status (HBsAb titer); other medical conditions that may influence choice of prophylactic agent(s) if needed; current medications, and drug allergies; pregnancy status or lactation status.

PEP Step 3: Evaluate the Exposure

•The exposure should be evaluated for the potential to transmit HBV, HCV, or HIV based on the type of body substance involved, the route, severity and frequency of exposure. •Significant exposures to any of the following may pose a risk for bloodborne pathogen transmission and require further evaluation: blood, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, amniotic fluid. •Body fluids that do NOT pose a risk of bloodborne pathogen transmission unless visibly contaminated with blood include: urine, stool, tears, saliva, gastric secretions or vomitus, sweat, nonpurulent sputum, nasal discharge

PEP Step 4: Evaluate the Exposure Source

When source patient is known:

• Test source patient for HBsAg, HCV antibody, and HIV antibody. • Use a rapid HIV antibody test. Use of fourth-generation HIV antigen/antibody testing is recommended if available. • HIV viral load assessment for routine screening of source patient is NOT recommended. • If the source person is NOT infected with a bloodborne pathogen, further follow-up testing of the exposed HCP is not necessary. Follow state regulations related to informed consent and confidentiality. •For patients who cannot be tested, consider medical diagnoses, clinical symptoms, and history of risk behaviors.

When source patient is NOT known/unable to be tested immediately:

• Evaluate the likelihood of high-risk exposure: • Consider the likelihood of bloodborne pathogen infections among patients in the exposure setting: What is the community infection rate? Does the clinic/hospital unit care for a large number of HIV-, HBV-, or HCV-infected or at-risk patients? • Is there a high suspicion for HIV infection and the patient is unable to be tested immediately? •Do not test discarded needles for bloodborne pathogens; the reliability of these findings is not known.

The “window period”:

•To date, there has not been a documented case of occupational HIV transmission from a source patient with a negative HIV antibody test result with risk factors for HIV acquisition. •Postexposure prophylaxis should be considered only if the source patient has risk factors and has been determined to have symptoms consistent with acute HIV infection.

HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus; HCP, health care personnel; HIV, human immunodeficiency virus.

From Mountain Plains AIDS Education and Training Center. PEP Steps, A Quick Guide to Postexposure Prophylaxis in the Health Care Setting (April 2006); PEP Steps: A Quick Guide to Postexposure Prophylaxis in the Health Care Setting (March 2014).