26.3 Post-exposure prophylaxis (PEP)
The most effective (and cheapest) way to deal with exposure to disease-causing agents is prevention, so the implementation of universal precautions, with appropriate training and monitoring should be your immediate priority. However, although universal precautions will decrease the occurrence of occupational exposure, ‘accidents’ and unanticipated exposures will sometimes occur, and it is essential to know how to deal with them.
Chemoprophylaxis means using drugs to prevent a disease from developing in the first place. Post-exposure prophylaxis (PEP) for HIV means taking antiretroviral medication (ARVs were described in Study Session 22) as soon as possible after a possible occupational exposure to HIV, so that the exposure will be less likely to result in HIV infection. PEP is also provided after rape to prevent possible HIV transmission. Due to the psychosocial impact of HIV/AIDS, and the fact that the disease is not curable, PEP for HIV is made freely available in Ethiopia.
Note that you cannot prescribe ARVs for PEP. You must refer such cases to health centres providing ARVs as a matter of urgency.
What does occupational exposure mean?
Occupational exposure means coming in contact with infectious agents whilst carrying out your duties as a healthcare worker.
Examples of occupational exposure to HIV are needle-stick or other sharps injuries, a splash of infected body fluid into the eyes or onto cracked skin, bites and sexual assaults by infected patients. Procedures such as gynaecological examinations, spinal taps, labour and delivery, and surgery can also place the healthworker at risk. Splash exposure carries a lower risk than a needle-stick injury, but it should be taken seriously in both the workplace and the patient’s home.
For healthcare workers, PEP usually relates to exposure to HIV or hepatitis virus, but we will only deal with HIV exposure here. (Note: you learnt about hepatitis B in Study Session 4.) The risk of transmission of HIV after accidental occupational exposure is about 100 times less than the risk of occupational transmission of the hepatitis B virus.