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Management of Post Exposure Prophylaxis for HIV. Dr. Alap J. Mehta M.B.B.S. Fellow in HIV Medicine ( New Delhi) Fellow in Industrial Health ( Ahmadabad) Diploma in HIV Medicine (London, U.K.) cont. Abbreviations. HCP – Health Care Provider PEP – Post Exposure Prophylaxis - PowerPoint PPT Presentation
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Management ofPost Exposure Prophylaxis for HIV
Dr. Alap J. MehtaM.B.B.S.
Fellow in HIV Medicine ( New Delhi)Fellow in Industrial Health ( Ahmadabad)
Diploma in HIV Medicine (London, U.K.) cont..
Abbreviations
• HCP – Health Care Provider• PEP – Post Exposure Prophylaxis• OE – Occupational exposure• HIV – Human Immunodeficiency Virus• HBV – Hepatitis B Virus• HCV - Hepatitis C Virus
608, KASHI PLAZA, MAJURA GATE,SURAT
Source
• New York State Guideline• CDC, Atlanta Guideline for PEP
608, KASHI PLAZA, MAJURA GATE,SURAT
PrincipleNon Discrimination Confidential
608, KASHI PLAZA, MAJURA GATE,SURAT
Who are at Risk• Nursing staff and students
• Laboratory technicians
• Emergency care providers
• Labour and delivery room personnel
• General Practitioner
• Physicians
• Surgeons
• Dentists
• Health facility cleaning staff and clinical waste handlers
• Interns and medical students
608, KASHI PLAZA, MAJURA GATE,SURAT
Common Procedure Prone to• Recapping Needle
• Blood collection
• Intracath insertion
• Aspiration of close cavity collection
• Aspiration of abscess and lymph node
• Injecting medicine
• Intra operative (More Risk if Assisting)
• Discarding infective material etc.
• Splashes of blood/serum on face
• Transferring body fluids between containers
608, KASHI PLAZA, MAJURA GATE,SURAT
Magnitude of Risk• 0.3% for HIV
• 3-10% for HCV
• 9-30% for HBV
608, KASHI PLAZA, MAJURA GATE,SURAT
Fluids need consideration
608, KASHI PLAZA, MAJURA GATE,SURAT
Route wise transmission of HIV
608, KASHI PLAZA, MAJURA GATE,SURAT
Common C/F to suspect HIV Symptoms
• Weight Loss
• Chronic Diarrhea
• Newly diagnosed TB
• Chronic Fever
• On Chronic Therapy
• Recurrent Respiratory Illness
• Presenting complaints
Signs
• STDs
• Lymphadenopathy
• Herpes Zoster
• Herpes Labialis
• Candidacies
• Wasting
• Mollusum Contagious
608, KASHI PLAZA, MAJURA GATE,SURAT
608, KASHI PLAZA, MAJURA GATE,SURAT
Approach to Occupational Exposure
608, KASHI PLAZA, MAJURA GATE,SURAT
“S.T.U.M.P.E.D.” strategy
• S – SOURCE PATIENT• T – TYPE OF EXPOSURE• U – UNIVERSAL WORK PRECAUTION FOLLOWED• M – MATERIAL EXPOSED• P – PERIOD SINCE LAST USE OF EQUIPMENT• E – EXPOSED BEFORE• D – DESCRIPTION OF WOUNDOnline evaluation will be available shortly on my website
Most common Don’t done by HCP• Squeezing the exposed part
• sucking the exposed part
• Applies irritant disinfectant on exposed part
608, KASHI PLAZA, MAJURA GATE,SURAT
608, KASHI PLAZA, MAJURA GATE,SURAT
Immediate StepsFor Broken or Damaged Skin•Immediately wash the wound and surrounding skin with water and soap, and rinse.•Do not scrub. •Do not use antiseptics or skin washes (bleach, chlorine, alcohol, betadine).
For Eyes:Sit in a chair, tilt head back and ask a colleague or assistant to gently pour water or normal saline over the eye.
For Unbroken Skin:•Wash the area immediately with soap and water•Do not use antiseptics
If wearing contact lens:
•leave them in place while irrigating, as they form a barrier over the eye and will help protect it. Once the eye is cleaned, remove the contact lens and clean them in the normal manner. This will make them safe to wear again•Do not use soap or disinfectant on the eye.
For Mouth :Spit fluid out immediatelyRinse the mouth thoroughly, using water or saline and spit again. Repeat this process several timesDo not use soap or disinfectant in the mouth
Steps Help a Lot• Don’t Create panic atmosphere
• Separate yourself from the site and hand over the procedure to assistant if
it requires continuation
• Don’t blame or misbehave with patients
• Call to expert after immediate step
• Become a good patient and try to complete PEP if required
• Get counsel your self from experts during PEP treatment
608, KASHI PLAZA, MAJURA GATE,SURAT
Plan your Regime
608, KASHI PLAZA, MAJURA GATE,SURAT
• Basic regime :Tenofovir + Emtricitabine
Expanded Regime :Basic + Lopinavir / Ritonavir or Raltegravir
Health hazards During PEP TreatmentDue to medicines
• Gastritis
• Nausea
• Vomiting
• Abdominal Pain
• Itching
• Giddiness
• Fatigue
• Malaise
• Anemia
Due to Psych-Social issues
• Re- exposure
• Depression
• Suicidal tendency
608, KASHI PLAZA, MAJURA GATE,SURAT
Unique Situations• For sexually Active Life: Use barrier contraception FOR 6 MONTHS• For Pregnant Mother: Same protocol like other HCP • For Nursing Mothers: Stop breast feeding and top feed
608, KASHI PLAZA, MAJURA GATE,SURAT
Laboratory Work Up
608, KASHI PLAZA, MAJURA GATE,SURAT
Thank You
CENTRE OF EXCELLENCE FOR TREATMENT
OF HIV/AIDS608, KASHI PLAZA, MAJURA GATE,SURAT