The United States Public Health Service recently updated their guidelines for managing and preventing HIV exposure in the workplace.
The biggest revision in the recommendations is the addition of a postexposure prophylaxis (PEP) regimen. Under the previous guidelines, healthcare professionals would be evaluated before determining a PEP regimen. Now, exposed workers will automatically receive a combination of three or more drugs for any type of potential HIV exposure.
Some of the other guidelines put forth by the USPHS include:
- Beginning a PEP regimen should be the first priority and should not be delayed, even if this means beginning the cycle before expert evaluation, which is also recommended.
- A PEP regimen should continue for four weeks after exposure.
- HIV testing should begin within 72 hours of exposure, and should generally continue for six months after exposure.
- Exposure testing may be concluded after four months if the newer, fourth-generation HIV antibody combination test is used.
“Preventing exposures should be the leading strategy to prevent occupational HIV infections,” said Dr. David Kuhar, author of the guidelines. “However, when an exposure occurs, it should be considered an urgent medical concern and a PEP regimen should be started right away, ideally within hours of the potential exposure.”
Dr. Silverman comments
As a surgeon, HIV and blood-borne pathogen exposure is a concern. It’s always in the back of your mind, but you can’t dwell on the idea or it can put your work, and the health of the patient, in jeopardy.
I operate on patients without screening, because this would prevent patients from getting the care they need in a timely manner, and if I do my job correctly, no transmission of fluids will occur. Screening also doesn’t make perfect sense, because HIV can be present despite a negative initial test.
Orthopedic surgeons use sharp instruments and we have very aggressive maneuvers during surgery to get done what we need to get done. I can honestly say during my time as a surgeon I have been pricked by a sharp bone, stuck by pins, and cut by knives. It’s the hazard of the business.
So far, I have been lucky that I haven’t contracted any blood-borne diseases. Some ways I mitigate the risk of blood-borne pathogen exposure is by:
- Cutting pins short and capping them.
- Carefully feeling bones with appropriate instruments, using them as an extension of my hand.
- Enforcing careful handling of knives among surgeons and staff members.
I am encouraged by the updated guidelines provided by the USPHS, and I am glad they are continuing to research methods for combating occupational HIV exposure.
Related source: Medscape