Pre and Post Exposure Prophylaxis

Pre and Post Exposure Prophylaxis

Health care workers are at risk of acquiring infection through occupational exposure. They can also transmit the infection to the patients and other employees.

Needle prick injury

First Aid

1.     Allow bleeding and wash with soap and running water

2.     Clean the site with disinfectant like 70% alcohol

3.     Take blood for virology (HIV, Hep B, Hep C) from injured worker

4.     The source should also be tested for HIV, Hep B & Hep C

Follow up

If the status of the patient & healthcare worker is unknown and

immune status cannot be obtained within 48 hours, then give:

Hep B immuneoglobulin

Hep B vaccine

If the healthcare worker is HBV immune then no further Hep B vaccine is required

but if HBV susceptible, then treat with immunoglobulin and vaccine

Complete the course of Hepatitis vaccine

Follow up serology 6 weeks, 3 months, 6 months & 12 months.

Pre exposure prophylaxis:

Vaccination of the employee at the time of employment as per the following schedule:

First dose (1ml IM)         Day 0

Second dose (1ml IM)     1 month

Third dose (1ml IM)        6 months

Post Exposure prophylaxis:

1.     For Hepatitis B

Test the source person for HBsAg.

If source person is HBsAg negative: no further treatment required for HBV.

If source person is HBs Ag positive: Test the HCW for HBs Ag and Anti HBs antibody.

HCW is HBs Ag positive: no further treatment required for HBV.

HCW is HBs Ag negative:

a)  For previously immunized HCW with Anti HBs antibody titre of above 10mIU/ml, no further treatment required.

b)  For non immunized HCW: Give Intramuscularly Hepatitis B immunoglobulin preferably within 48 hours and not later than a week after exposure. This is followed by a complete course of Hepatitis B virus vaccine.

2.     For HIV infection

Protocols to be followed

a)   Pre-test/post-test counselling

b)  Send the blood sample for HIV testing

c)   1st sample (baseline): immediately after exposure

d)  2nd sample: 6 weeks full exposure

e)   3rd sample: 12 weeks full exposure

f)    Last sample: 6 months

During follow-up period:

a)  Refrain from Donating blood, semen, organ 

b)  Abstain from sexual intercourse/use condom

c)   Do not breast feed.

Recommendations for the management of potentially exposed HCP

a)     Written protocols are available with Administrator for prompt reporting, evaluation, counselling, treatment and follow up of occupational exposures that may place HCP at risk of acquiring any blood-borne infection including HIV

b)     Exposure reporting is mandatory

c)     Clinician responsible for providing care is available during duty hours.

d)     PEP drugs are made available for timely administration for high risk patients