-Krishna prasad

CRRI
 HIV ( Human Immunodefieciency Virus) is a
Single stranded RNA virus belonging to Retroviridae
family
 It leads to AIDS (Acquired Immuno Deficiency
Syndrome)a condition in which the immune system
begins to fail leading to lifethreatening Oppurtunistic
infections.Immune deficiency is due to destruction of
CD4lymphocytes.
Doctors including (dentists)
Nurses
Paramedics
Lab technicians
Emergency and Ambulance service staffs
Clinical waste handlers
 HIGHER CONCENTRATIONS LOWER CONCENTRATIONS

 Blood most  Tears

 Semen common  Saliva
 CSF  Breast milk
 Cervical and vaginal secretions  Urine
 Anatomical waste
 HIV is NOT transmitted by casual contact
 Working or playing with an HIV positive person
 Shaking hands, Hugging
 Public pools and toilet

Occupational exposure can be through :

 Percutaneous injury- needle stick injury, cut with sharp objects
 Contact with Mucous membrane – Eyes, oral cavity
 Contact with non- intact skin- abraded skin, dermatitis lesions
 Screening test :Antibody detection
ELISA-Takes 2-3 hours
Rapid test takes <30 mins
 Supplemental tests :
Western blot /Immunoflourescence assay /Radio immune precipitation
assay/Line immunoassay
 Confirmatory tests:
P24 Antigen detection
Viral culture
HIV RNA(RT-PCR /Branched DNA assay/ Real time RT-PCR for viral load )
HIV DNA detection –for paediatric HIV
CD4 count –If falls below350 per millimeter cube
On exposure,
 Skin:
i. Wash the site and surrounding with water/soap
ii. Donot scrub/ use antiseptics
 Eye:
i. Eye irrigation with water or saline
ii. If using contact lens, leave them in place while irrigation and
remove once eye is cleaned
 Mouth:
i. Spit fluid immediately
ii. Rinse mouth with water and saline repeatedly
 Informed consent to be obtained
 Documentation on record and special leave from work(2weeksor
more)
 Psychological support:
Every exposed person needs to be informed about the risks and
measures that can be taken to relieve the anxiety .
 After obtaining informed consent from both patient and the person exposed ,
virology has to be done(anti-HIV, HbsAg, HCV)
 Types of exposure:
Small volume Solid needle or superficial injury
Large volume Large bore hollow needle ,deep puncture,visible blood on
device,needles used in patients artery or vein.

 Infectious status of source:

Class 1 Asymptomatic HIVor known viral load (<1500 copies /ml)

Class 2 Symptomatic HIV,AIDSor known high viral load
 Should be initiated within 72 hours of exposure
 Recommended WHO regimen is: 2 NRTIs :
Zidovudine 300 mg BD + Lamivudine 150 mg BD)
Zidovudine +Emtricitabine
Lamivudine+Stavudine
Lamivudine +Tenofovir{NNRTI}
 If HIV resistance is there PI (Indinavir 800 mg TDS) may be added
Lopinavir/ritonavir
 PEP should be taken for a period of 28 days
 Postexposure prophylaxsis for Hepatitis B should be taken
 HIV testing should be repeated after 3 and 6 months
  Infectious status
Exposure Type HIV posiive ,Class 1 HIV Positive class 2

Small volume Consider Basic 2 drug regimen Recommended 2 drug regimen

Large volume Recommended 2 drug regimen Recommended expanded 3 drug

regimen
 Direct syringe reuse
 Using the same syringe from patient to patient
 Indirect syringe reuse
 Accessing shared medication vials or IV bags with a used syringe
 Reuse of single dose vials
 Sharing of blood contaminated glucose monitoring equipment
 Proper hand hygiene -Washing hands with soap and water/ alcohol
based handrub before and after examination of a patient
 PPE (Personal Protective Equipments)
 Follow standard method of performing procedures
 Appropriate handling and de-contamination of equipments and
clothes
 Proper disposal of waste especially sharps
 Immunize workers against hepatitis B,
 Double gloves of appropriate size
 Apron
 Eye-wear: If fluid splash is expected as in normal vaginal delivery
 Protective footwear
 Any non intact skin should be closed using a water-tight dressing
Assess condition of PPE before use
 Proper cleaning, disinfection and sterilization of equipments and
instruments
 Prompt cleaning up of blood and body fluids spill
 Regular changing and washing of clothes
 Use syringes and needles only once
 Avoid RECAPPING, bending or breaking needles
 Avoid direct exchange of sharps such as blades used during surgical
procedures in OT
 Discard sharps only in appropriate puncture proof containers
 Dispose and never overfill sharp containers
 Proper health education among all the health workers regarding
prevention techniques as well as post exposure protocol
 Staff education and supervision is essential