Occ health: Post-exposure prophylaxis

POST-EXPOSURE PROPHYLAXIS (PEP)

Needlestick injuries are frequent among health care workers, ambulance staff and firemen that perform resuscitations

PEP is prophylactic antiretroviral medication that gives employees some protection against the possible development of HIV after exposure to blood and body fluids

The OHSA (Act 85 of 1993) states that the employer is required to create a safe environment for their employees as far as reasonably possible. The COIDA (aAct 130 of 1993) provides payment for employees that got blood exposure diseases during the course of their employment

The employer and employee has interest in knowing whether the employee got work-related HIV in the course of their employment. For that reason bloods are drawn and the employee followed up post-exposure

There are different levels of risk in terms of blood and body fluid expsoure. The risk differs from exposure to bodily fluid of a person with full-blown AIDS for example not on medication, a person with HIV but on effective medication. The exposure to person suffering from full-blown AIDS creates a greater risk

A needle prick from a large bore hollow blood-filled needle, has greater risk than a needle prick from a solid needle, which has greater risk than blood splatter on clothes

If HIV prophylactic antivirals are given within the first 72 hours, the HIV virus blood level will not peak, as seen on the graph, and the HIV virus multiplication level can modified and progression can be halted immediately

PEP medication can have dire side-effects and the person receiving PEP antiretrovirals (ARVs) require close monitoring. ARVS affect the liver and liver function monitoring needs to be perfomed regularly. The employee may be HIV positive prior to the exposure and therefore a HIV test needs to be performed shortly after exposure, prerably within 48 hours. PEP can be initiated within 72 hours after exposure and still be effective. After 72 hours the initiation of PEP may not be so effective and there will be a risk that the exposed person can develop HIV

PEP is given in the form of capsules within 72 hours of exposure. The duration will vary according to the HIV status of the pricked person

Consent must be gained prior to the drawing of blood in order to test for HIV in the exposed. Pre-test counselling must be performed prior to testing in order to explain the concepts of positive tests, negative test, false-positive tests and false-negative tests. Discussions surrounding medication side-effects must also take place

Gaining access to knowledge of the HIV status of the source is extremely helpful as this also assists in the determination of risk. The source has the right to refuse HIV testing or the source may not be available for testing. This neccesitates the occupational health service to insitute PEP, if the risk is deemed to be present.