What are the initial management steps for healthcare personnel exposed to HIV?

Updated: Jul 27, 2020
  • Author: Ana Elizabeth Markelz, MD, FACP, FIDSA; Chief Editor: John Bartlett, MD  more...
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Answer

Answer

Initial management steps for healthcare personnel exposed to HIV include the following:

  • Immediate decontamination (if not already performed by the healthcare worker) - For percutaneous or cutaneous exposure, washing of the area with soap and water; for mucous membrane exposure, copious irrigation of the area with water or sterile saline; for puncture wounds, cleanse with alcohol-based hand wipes; for eye exposures, irrigation with copious amounts of sterile water or saline
  • Initiation of institutional PEP plan - Reporting of exposure; confirmation of medication availability; provision of the initial supply; authorizing release of the drugs; determination of how the healthcare worker will obtain the medications to complete the 28-day regimen
  • Ordering of blood tests, immediate treatment, and follow-up within 72 hours, at which time further review and evaluation can be carried out
  • Source of exposure - Voluntary testing for HIV, hepatitis C virus antibody, and hepatitis B surface antigen (HBsAg); if HIV test is positive, confirmatory HIV 1/2 Ab differentiation immunoassay; if HIV infection is known to be present, obtain relevant information about disease stage
  • Healthcare worker - Testing for HIV, HCV antibody, HBsAg, and hepatitis B surface antibody (HBsAb); in females of child-bearing age, pregnancy testing; if HIV PEP is initiated, baseline complete blood (CBC) count, renal and hepatic function

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