26.3.2 Immediate actions after occupational exposure to HIV
The following measures should be taken immediately after an accidental occupational exposure to a possible source of HIV infection.
Care of the exposure site
Wash the wound from a needle-stick or other sharps injury with soap and water, and let it bleed freely. The wound should be irrigated (flushed) with sterile saline and a disinfectant. Exposure to mucosal membranes (e.g. broken skin, mouth, eyes) should be dealt with by washing the affected area thoroughly with clean water, sterile saline or sterile eye irrigant from an eye-wash bottle.
Assessing the exposure risk
The level of risk will depend on the type of injury as described in Section 26.3.1 above.
Testing the source of the exposure
If the HIV status is unknown, a rapid HIV test should be performed on the individual or patient who is the source of the exposure, after counselling and consent has been secured. If the source is found to be HIV negative, there is no need for further assessment of the exposed healthcare worker. If the result is positive, the healthcare worker needs to be HIV tested.
Testing the healthcare worker
A rapid HIV test should be performed on the healthcare worker immediately after exposure. If the result shows that the healthcare worker is already HIV positive PEP cannot help them. If the test is negative then the healthcare worker should be administered PEP as described below. The HIV test should be repeated at six weeks, three months, and six months after exposure. If, as a consequence of these repeat tests, the healthcare worker is found to have become HIV positive, then they will be assessed for HIV care and treatment.
Following exposure to HIV, there is a need for psychosocial support and counselling on safer sexual practises. If ARVs are prescribed, close monitoring will need to follow to support adherence and identify any adverse side-effects of treatment (as described in Study Sessions 22 and 23).
Why should the HIV test be repeated at intervals up to six months after the exposure?
It takes up to three months before the body of a person newly infected with HIV produces enough anti-HIV antibodies to be detectable in an HIV rapid test. This is called the ‘window period’. A negative test result during this period cannot be taken as evidence that the exposure did not transmit HIV.
You must refer yourself, or any health worker you witness suffering a sharps injury from a contaminated instrument, or a splash exposure to their mucus membranes, as quickly as possible to an appropriate health facility.
If you suffer an occupational exposure to blood or body fluids from any patient, you should seek PEP immediately, even before the HIV status of the source is known. To be effective, PEP has to be started as soon as possible, ideally within one to two hours after exposure. It is not worth undertaking PEP beyond 72 hours after the exposure, because by this time, if the virus has been transmitted, it will have entered the person’s bloodstream. PEP cannot prevent it from circulating around the body and possibly causing HIV infection. A standard course of PEP will normally last for 28 days. It can be provided only by trained nurses, health officers or physicians at health facilities offering antiretroviral therapy (ART). Most of the health centres and hospitals offer PEP services.
26.3.1 Risks of HIV infection after accidental occupational exposures
26.4 Referral after rape for post-exposure HIV prophylaxis