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Vol. 5, No. 1 January 1997 |
Update on the Protocol for Health Care Workers Following a Potential Exposure to Bloodborne Pathogens
In June, 1996 the CDC published an update on its Public Health Service recommendations for chemoprophylaxis following an occupational exposure to HIV.
In light of these revised recommendations, the Infectious Disease Service in conjunction with the Infection Control Unit and the Occupational Health Department at The Toronto Hospital developed a hospital-wide 24 hour rapid response team to evaluate the need for, and if indicated, the provision of triple therapy chemoprophylaxis against HIV infection for exposed and potentially exposed Health Care Workers.
Triple antiretroviral therapy post-exposure prophylaxis (PEP) is recommended starting within two hours and no longer than 36 hours after exposure for deep percutaneous, major mucosal contact, or major non-intact skin contact with blood or fluid containing visible blood from a source patient. A source patient is known to be HIV-infected or is known to be at high risk for HIV. The triple therapy includes AZT, 3TC, and Indinavir. A starter kit is available at all times in the Emergency Room at either site.
Attached is an algorithm incorporating all the steps from first aid following exposure to baseline and follow-up blood work and employee counselling regarding risks and possible drug side effects. The updated policy includes steps to prevent hepatitis B and tetanus infections, counselling and follow-up for HCV exposures.
The first step following all injuries is to report to Occupational Health (OH), or the Emergency Room when OH is closed. If the source patient is known to be HIV positive, or the exposure is considered high risk, the Health Care Worker, Occupational Health or the ER staff will contact the Rapid Response Team at ext "STUK"(7885) to determine appropriate HIV post-exposure Prophylaxis (PEP).
PLEASE REMEMBER:
* All injuries must be reported to Occupational Health even if the first contact is with the Emergency Room or the Rapid Response Team.
* Employees must complete an incident report for all occupational injuries.
Guest Editor
Dr. I. Salit
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