4th Pediatric Infectious Diseases Conference
 
 
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Pedi Poll
Today's Poll
Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?
No, it should be used only after drug sensitivity report
Yes, under guidance of an infectious disease expert
POST-EXPOSURE PROPHYLAXIS (PEP)
Post Exposure Prophylaxis(PEP)
PEP Risk Factors
Who is at risk and Factors Influences This Risk
Dr Tripti Pensi
Professor of Pediatrics, Dr.R.M.L Hospital, New Delhi

Who is at Risk?

All categories of Health Care Personnel (HCP) are at a potential risk of acquiring HIV infection during care of an HIV infected patient.

Definition of "Health Care Personnel" & Exposure
"Health Care Personnel (HCP)" are defined as "any person (e.g. employees, students, clinicians, public safety workers or volunteers) whose activities involve contact with patients or with blood or other body fluids from patients in a health care or laboratory setting".

An "exposure" that may place an HCP at risk of HIV infection is defined as a percutaneous injury (e.g. needle-stick or cut with a sharp instrument), contact of mucous membrane or non-intact skin (esp. when the exposed skin is chapped, abraded, or afflicted with dermatitis), or contact with intact skin when the duration of contact is prolonged (e.g. several minutes or more) with blood or other potentially infectious body fluids. Body fluids that are potentially infectious include - blood, semen, vaginal secretions, cerebrospinal, synovial, pleural, peritoneal, pericardial and amniotic fluids or other body fluids contaminated with visible blood. Exposure to tears, sweat, urine, faeces, saliva of an HIV infected person is normally not considered as an "exposure" unless these secretions contain visible blood.

Professionals with frequent blood exposures :
  • Surgeons
  • Emergency care providers
  • Dentist
  • Nurses
  • Labour and delivery personnel
  • Laboratory technicians

What is the average risk of acquiring HIV infection after an occupational exposure?



The risk is normally very low, but it is not zero. The average risk of acquiring HIV infection after different types of occupational exposure is given in Table.

  Average risk of HIV infection after an Occupational Exposure
  • Small amount of blood on intact skin
No risk  
  • Risk with damaged skin / prolonged exposure
1 in 1000 (0.01%)
  • Exposure on eyes, nose or mouth
1 in 1000 (0.01%)
  • Needle Stick / other sharp injuries
1 in 300 (0.3%)
(Risk from all "exposures" increases further if exposure involves a large volume of blood or a higher amount of HIV in patient's blood as in patients with acute HIV infection or patient near death.)

As is evident, the average risk of acquiring HIV infection after a needle stick injury is 0.3%, while the comparable risk for HBV is 9 - 30% and 1 - 10% for HCV.

How many health care personnel have been infected occupationally?


As on June 2000, in USA, there are 56 reported cases of HCP with documented HIV seroconversion associated with an occupational exposure. Another 138 cases are considered possible occupational exposure as these had history of occupational exposure to HIV, no other risk factors for HIV but seroconversion was not documented. However, as per reported data globally there are 98 confirmed and 194 possible cases of HCP getting infected occupationally. In our country there is only one documented case reported to NACO of a HCP acquiring HIV due to occupational exposure.

Type of Exposure of 55 documented cases Type of fluid involved in exposure
Needle stick / cuts/sharp injuries 48 Blood 50
Eye, Nose, Mouth, Skin exposure 5 Conc.virus in lab. 3
Both injury & mucous membrane exposure 1 Visibly bloody fluid 1
Unknown 1 Unspecified fluid 1

What factors influences this risk?

Various epidemiological and laboratory studies have shown that the risk of infection varies with type of exposure factors such as
  • Type of needle (hollow bore Vs. solid)
  • Device visibly contaminated with patient's blood
  • Depth of injury
  • The amount of blood involved in the exposure
  • The amount of virus in patient's blood at the time of exposure.
  • Whether Post Exposure Prophylaxis (PEP) was taken within the recommended time






 
 
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