Occupational HIV Exposure Prophylaxis - PowerPoint PPT Presentation

Loading...

PPT – Occupational HIV Exposure Prophylaxis PowerPoint presentation | free to download - id: 66b632-NTVmY



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Occupational HIV Exposure Prophylaxis

Description:

Occupational HIV Exposure Prophylaxis Dr Truong Anh Tan June 30th , 2010 This illustrates the risk of transmission of HIV, which is much less than that of ... – PowerPoint PPT presentation

Number of Views:64
Avg rating:3.0/5.0
Slides: 30
Provided by: blogAfrav8
Learn more at: http://blog.afravietmur.com
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Occupational HIV Exposure Prophylaxis


1
Occupational HIV Exposure Prophylaxis
  • Dr Truong Anh Tan
  • June 30th , 2010

2
Infected post-exposure rate/1000
  • Blood infusion 900
  • IDU (shared needle) 6,7
  • Anal sex receiver 5,0
  • Needlestick 3,0
  • Vaginal sex female 1,0
  • Anal sex giver 0,65
  • Vaginal sex male 0,5
  • Oral sex receiver 0,1
  • Oral sex giver 0,05

3
Estimated Pathogen-Specific Seroconversion Rate
Per Exposure for Occupational Needlestick Injury
.
AETC http//depts.washington.edu/hivaids
4
Type of Exposure Way Involved in Transmission of
HIV to Health Care Workers
AETC http//depts.washington.edu/hivaids
5
Source of HIV Involved in HIV Transmission to
Health Care Worker
AETC http//depts.washington.edu/hivaids
6
Risk Factors for HIV Transmission with
Occupational Exposure to HIV-Infected Blood
Risk Factor Odds Ratio Confidence Interval
Deep Injury 15 6.0-41
Visibly Bloody Device 6.2 2.2-21
Device Used in Artery or Vein 4.3 1.7-12
Terminally Ill Source Patient 5.6 2.0-16
Use of Zidovudine for PEP 0.19 0.06-0.52
Plt0.01 for all associations

7
Other Possible Risk Factors
  • Hollow bore vs solid bore
  • No documented cases to date of seroconversion
    from suture needles
  • Glove use
  • 50 decrease in volume of blood transmitted
  • Mucous membrane exposure
  • Mosquitoes bite?

8
Standard Precautions
  • Definition
  • Standards developed to prevent exposure and
    transmission of disease in occupational setting
  • Provide guidance for the safe handling of
    infectious material

9
Components of Standard Precautions
  • Hand washing
  • Use protective barriers when indicated
  • Gloves mucus membranes, body fluids, broken skin
  • Goggles procedures
  • Masks procedures

10
Components of Standard Precautions (2)
  • Sharps and waste - handle with gloves and dispose
    in designated containers
  • Needles
  • Scalpels
  • Suture material
  • Bandages
  • Dressings
  • Anything contaminated with any body fluid

11
Handling with Disposing Sharps
  • Do not recap needles!
  • Put containers within arms reach
  • Use adequate light source when treating patients
  • Wear heavy-duty gloves when transporting sharps
  • Incinerate used needles to a sufficient
    temperature to melt
  • Keep sharps out of reach of children

12
Components of Standard Precautions (3)
  • Re-usable instruments ? must be thoroughly
    disinfected
  • Speculums
  • Surgical tools
  • Thermometers
  • Immunizations for Healthcare Workers
  • Hepatitis A and B

13
Recommended Antiseptic Solutions
  • Alcohol 70
  • Chlorhexidine, 2-4 (e.g. Hibtane, Hibiscrub)
  • Iodine 3
  • Iodophores 7.5-10 (e.g. Betadine)

14
Recommended Disinfectants
  • Chlorine, 0.5 (Barkina)
  • Sedex and Ghion brands contain 5 Chlorine,
    dilute for use
  • Glutaraldehyde, 2-4 (e.g. Cidex)
  • Formaldehyde, 8
  • Hydrogen peroxide, 6
  • Soak the instrument for 20 minutes after
    decontamination and cleaning

15
Management of Occupational Exposure
  • HIV AB for both (giver and receiver)
  • Hepatitis B C
  • CBC
  • SGOT/SGPT
  • Blood Glucose
  • ? 1?3?6th month

16
Diagnostic Testing
Image courtesy of The Center for AIDS Information
Advocacy, www.centerforaids.org
17
The Early Stages of HIV Infection
Cell free HIV
T-cell
Immature Dendritic cell
PEP
Skin or mucosa
Via lymphatics or circulation
Burst of HIV replication
24 hours
48 hours
  1. HIV co-receptors, CD4 chemokine receptor CC5
  1. Mature Dendritic cell in regional LN undergoes a
    single replication, which transfers HIV to T-cell
  1. Selective of macrophage-tropic HIV

18
(No Transcript)
19
Wound Care
  • Gently wash wounds with soap and water/ 5 minutes
    ? alchol 70 5 minutes (dont scrub vigorously)
  • Allow wounds to bleed freely
  • Irrigate exposed mucosal surfaces with sterile
    saline

20
Post Exposure Prophylaxis (PEP)
  • Definition
  • Use of therapeutic agent to prevent establishment
    of infection following exposure either
    occupationally or non-occupationally to pathogen
  • Roles in Occupational Exposure
  • HIV prevention
  • HBV prevention
  • ? Tests before ARVs therapy

21
Step 1 Does This Patient Need HIV PEP?
Source patient
Unknown / Unwilling to get tested
HIV
HIV -
High back-ground risk
Low back-ground risk
PEP
No PEP
No PEP
CDC recom usually PEP unnecessary consider use
if source patient is high risk
22
Step 2 Determine HIV Status Code of Source (HIV
SC)
No PEP or PEP with 2 drugs
PEP
23
CDC Sep 2005
24
(No Transcript)
25
Occupational HIV PEP
  • 2 drug regimen
  • Zidovudine plus lamivudine (combivir)
  • Stavudine plus Lamivudine
  • Tenofovir plus lamivudine
  • 3 drug regimen
  • LPV/r or Indinivr or Nelfinavir plus NRTI
    backbone
  • Efavirez plus NRTI backbone
  • Consider resistance potential of source patient
  • Dont use NVP (hepatotoxic)
  • When to start ? ASAP
  • PEP no efficacy after 72 hours

26
PEP Guideline from MOH
  • - PEP 1 AZT 3TC
  • AZT 300mg bid 3TC 150 mg bid.
  •  
  • -  PEP 2 3TC d4T
  • 3TC 150mg bid d4T 30-40mg bid.
  • lt 60 kg, d4T 30 mg bid.
  • gt 60 kg, d4T 40 mg bid.

AZT(Zidovudine)3TC(Lamivudine)D4T(Stavudine)
27
Advanced PEP(for high risk)
  • PEP 1 or 2 plus 1of following agents
  • - NFV 1,25 g bid.
  • - EFV 300 mg bid
  • - LPV/r 500 mg bid (recommended)
  • ? 28 days duration

(MOH guideline for PEP updated on 9/2009)
28
Follow-up HIV Testing
  • -CDC HIV Ab at 6th week, 3rd month, 6th month
  • -Extended HIV Ab testing at 12 months recommended
    if a source patient co-infected HCV
  • VL testing not recommended unless Primary HIV
    Infection (PHI) suspected
  • -Early diagnosis HIV RNA PCR at 3th week

MMWR June 29, 2001 / 50(RR11)1-42.
29
  • Thank you for
  • your attention!
About PowerShow.com