Post-Exposure Prophylaxis

2019 ◽  
Author(s):  
C. Y. William Tong
Keyword(s):  
Risk Assessment ◽  
Hepatitis B ◽  
Severity Of Illness ◽  
Unknown Origin ◽  
Needle Stick Injury ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Stray Dog ◽  
Mode Of Transmission ◽  
Exposure Prophylaxis

Post-exposure prophylaxis (PEP) is a treatment administered to an individual to prevent the development of infection or reduce the severity of illness after a potential or documented exposure to a microorganism. This may primarily be for the protection of the exposed individual concern, or in the case of a pregnant woman, for protecting the foetus in utero. PEP may also be useful in public health to reduce the risk of secondary spread of infection. A good history is required in order to make a proper assessment of the risk. The following questions should be asked: A. Which infection is suspected and is the source infectious? It is straight forward if the diagnosis of the source of exposure is already known, e.g. known HIV, established diagnosis of tuberculosis. However, in many cases, the diagnosis of the source may not be certain, e.g. needle stick injury involving a needle of unknown origin, bitten by a stray dog, exposed to a child with a non-specific rash. In such cases, a risk assessment is required to assess the likelihood that the source may be infectious. Knowledge of local epidemiology or recent outbreaks in a particular locality may help in such risk assessment. B. What is the nature of the exposure? Knowledge of the mode of transmission of a microorganism is important to establish if there is any risk of transmission through the exposure In the case of mother-to-child transmission, PEP to the neonate born to a mother with an infection is effective if the mode of transmission is predominately perinatal, e.g. hepatitis B. If the mode of transmission is transplacental, it is too late to administer PEP to the baby after delivery. Instead, the expected mother should be given prophylaxis during pregnancy to prevent infection, e.g. chicken pox, or given antivirals to reduce infectivity, e.g. maternal hepatitis B with a high viral load when transplacental infection may occur. In HIV, where transmission can occur both transplacentally and perinatally, antiretroviral therapy (ART) needs to be given during pregnancy and often during labour as well as to the baby after birth.

scholarly journals Prevalence of Needle Stick Injury among Surgeons

2021 ◽  
pp. 89-94
Author(s):  
Nasima Iqbal ◽  
Faiza Quraishi ◽  
Muhammad Aslam Bhatti ◽  
Faizah Mughal ◽  
Tayyaba Mumtaz ◽  
...  
Keyword(s):  
Reporting System ◽  
Medical Center ◽  
Working Hours ◽  
Work Load ◽  
Needle Stick Injury ◽  
Post Exposure Prophylaxis ◽  
Cross Sectional ◽  
Needle Stick ◽  
Post Exposure ◽  
Exposure Prophylaxis

Aim: To find out the prevalence of needle stick injury, its reporting system and the reasons behind it. Study design: Descriptive cross-sectional Place and duration of study: Study was conducted at Jinnah post-graduate medical center (JPMC) Karachi during the period of March to September 2019 Methodology: A self-designed, self-explanatory questionnaire was used, consisting of two parts, the first part was about demographic information while second part is for information related to needle stick injury like probable cause, frequency, response after injury, post-exposure prophylaxis and about reporting of the incident. Questionnaire was validated by calculating the Cronbach’s alpha which was 0.78. data was analyzed by using the Statistical Package for the Social Sciences (SPSS) version 20. Results: Majority of the study participants were female (67.2%) and about 50% were postgraduate students. Out of total 134 doctors about 64.2% of the doctors had needle stick injury during their career. Finding out the most probable cause of needle stick injury during the survey it was found out that increased work load and prolonged working hours were the main reasons. Majority of the cases occurred in emergency department (41.9%). About 95.5% of the doctors didn’t get any post-exposure prophylaxis. Majority of the participants (96.3%) did not report to any authority because of the lack of knowledge about the reporting policy, it was noted that about 38.8% were confused either the reporting system exist or not. Most of the injuries occur during the procedure of suturing followed by recapping syringes. Conclusion: It has been concluded that majority of the doctors had faced needle stick injury during their career and a very negligible number of them got any post-exposure prophylaxis. Majority of them did not report to any authority. So there is a need of implication of safety measures and reporting policies for early detection and treatment of infections after needle stick injury.

Audit of emergency department assessment and management of patients presenting with community-acquired needle stick injuries

2011 ◽  
Vol 35 (1) ◽  
pp. 57 ◽  
Author(s):  
Antonio Celenza ◽  
Lloyd J. D'Orsogna ◽  
Shervin H. Tosif ◽  
Samantha M. Bateman ◽  
Debra O'Brien ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Emergency Department ◽  
Hepatitis B ◽  
Emergency Departments ◽  
Hepatitis B Vaccination ◽  
Needle Stick Injury ◽  
Needle Stick ◽  
Post Exposure ◽  
Needle Stick Injuries

Objectives. To describe characteristics and management of people with community acquired needle stick injuries (CANSI) attending urban emergency departments; and suggest a guideline to improve assessment, management, and documentation. Methods. A retrospective analysis of cases with CANSI attending emergency departments in two tertiary hospitals between 2001 and 2005 using medical record review with follow up phone and written survey. Results. Thirty-nine cases met the criteria for CANSI. Persons younger than 30 years sustained 48.72% of all injuries. Source serology was available for only five cases (12.82%). Thirty-one of thirty-nine patients (79.49%) were classed as not immune to hepatitis B but only four of these (12.90%) received both hepatitis B vaccination and hepatitis B immunoglobulin. Six patients (15.38%) received HIV prophylaxis; of which two (33.33%) did not receive baseline HIV testing. Of ten patients referred to immunology clinic for follow up only two (20.00%) attended at 6 months. Conclusion. We have identified groups that are at high risk of CANSI, including young males, security workers and cleaners. In the majority of cases protection against hepatitis B was inadequately provided, and a substantial proportion had inadequate baseline assessment and documentation. A guideline is suggested that may be used to improve these deficits. What is known about this topic? Occupationally acquired needle stick injury guidelines are well established, but no guidelines currently exist for community acquired needle stick injuries (CANSI) which may require different risk stratification, assessment and management. Management of CANSI in Emergency Departments has not been well described. What does this paper add? An audit of Emergency Department management of community acquired needle stick injuries demonstrates deficits in risk assessment, documentation and use of post-exposure immunisation and prophylaxis. A guideline is suggested that may be used to improve these deficits. What are the implications for practitioners? Practitioners need to perform and document a risk assessment of the injury, perform baseline serology, and provide tetanus and hepatitis B immunisation. Use of HIV post-exposure prophylaxis is determined by local prevalence of disease, injury risk assessment, source serology if known, and time since injury.

scholarly journals Post-exposure prophylaxis following occupational exposure to HIV and hepatitis B: an analysis of a 12-year record in a Nigerian tertiary hospital

2017 ◽  
Vol 19 (4) ◽  
pp. 184-189 ◽  
Author(s):  
Salisu Abubakar ◽  
Garba Iliyasu ◽  
Farouq Muhammad Dayyab ◽  
Salisu Inuwa ◽  
Rabiu Alhassan Tudun Wada ◽  
...  
Keyword(s):  
Occupational Exposure ◽  
Hepatitis B ◽  
Healthcare Workers ◽  
Tertiary Hospital ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Increased Risk ◽  
Exposure Prophylaxis ◽  
North Western

Background: Healthcare workers (HCWs) have an increased risk of occupational exposure to blood-borne pathogens. Aims/objectives: We aim to examine the utilisation and outcome of post-exposure prophylaxis (PEP) for both HIV and hepatitis B (HBV) among HCWs. Methods: This was a retrospective study conducted in a tertiary hospital in North-Western Nigeria. We reviewed data on HIV or HBV PEP given to HCWs between 2004 and 2016. Results: A total of 115 HCWs presented for PEP during the study period. Intern doctors were the most exposed group (40/115; 34.8%). There were 86/115 (74.8%) needle stick exposures. While 53/115 (46.1%) of the sources of exposure were HIV-positive, 9/115(7.83%) were HBV-positive. Zidovudine-based regimen (40/70) was the most commonly prescribed. No seroconversion occurred among those that completed PEP treatment and follow-up. Discussion: No seroconversion occurred among those that received either or both HIV and HBV PEP and completed PEP treatment.

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