HIV & HEPATITIS C EXPOSURE PROTOCOL
In each country that we serve, there are unique situations that can arise. Overall, consideration of each team member’s health and safety is very important. The potentially grave consequences of exposure to body fluids from people infected with HIV and Hepatitis C have prompted development of policies and procedures designed to reduce the risk in healthcare personnel (HCP). LEAP medical volunteers will follow these procedures after possible exposure to blood borne pathogens, which potentially include HIV and Hepatitis C:
1. Immediate cleansing of the exposed site – wound, mucous membrane, etc.
2. Consider the type of exposure and risk of transmission. Factors to think about include type of wound, instrument involved, risk of the patient involved, type of body fluid and extent of exposure if mucous membrane involved.
3. Test both the patient and the exposed person for both Hepatitis C and HIV. Many patients may already have been tested. If so, review lab work and when it was done. If no recent testing is available (<15 days), all patients will be tested with Alere HIV Ab/Ab test kits, which are available in the trip supplies. Consent to test for HIV will be governed by LEAP’s Disclosure and Consent Form.
4. Decide if you need to consider post-exposure prophylaxis (PEP).
5. If deemed a significant exposure and significant risk of HIV, then begin HIV PEP medication as soon as possible, preferably within an hour of being exposed with a maximum of 72 hours.
6. All teams are equipped with the appropriate HIV PEP medications. Protocol for treatment is 30 days of one tab daily of each. This protocol was recommended by Infectious Disease. All teams will have enough medication for two weeks, long enough for one volunteer to take daily for the duration of the trip, if necessary.
7. Although there is now treatment for Hepatitis C infection, we are not recommending post-exposure prophylaxis for Hepatitis C. If the patient is found to be positive for Hepatitis C, it is important for the exposed person to be tested at regular intervals after exposure. This should be addressed with the exposed person’s health care provider upon returning home.
8. The exposed person should follow up with their own health care provider upon arrival home to complete treatment, if initiated.
9. These medications are very well tolerated, and taking PEP for HIV exposure does not necessarily mean that one has to stop working or change one’s role on the trip. However, if the volunteer is concerned, he/she has the option of returning home. In the rare case of multiple personnel having needlesticks, the PEP medication should be distributed to ensure enough medication is available. This may also necessitate someone returning home earlier. Other post-exposure precautions are discussed in the Attachment.
10. Any local staff working with our team that suffers a needlestick are to be evaluated and treated according to local guidelines/policies. If none exist, then LEAP policies will be substituted.
11. When LEAP is traveling to high-risk countries (sub-Saharan Africa, etc.), ALL patients’ HIV status will be determined/confirmed pre-operatively based upon chart review. If status is still unknown, Alere HIV Ab/Ab testing fingerstick kits will be used.
12. In the event that a known HIV+ patient is being considered for surgery, the decision to operate on that patient will be made jointly by the surgeon and anesthesiologist. Patients who are not optimized from a medical and/or HIV treatment status will not undergo surgery. For those HIV+ patients who are offered surgery, limited teams will be utilized (i.e., essential personnel only will be scrubbed in or allowed in the operating room; no med students, volunteers, etc.). Universal precautions will be utilized, including double-gloving and eye protection for all personnel in the case.
Click below for a more detailed explanation of potential exposure to HIV or Hepatitis C and the recommended protocol for post-exposure management.DETAILED PROTOCOLS