Module 1
Module 8: Occupational Exposure
Learning Objectives
By the end of this module, you should be able to:
1. Define Occupational exposure
2. Describe the risk of HIV/HBV/HCV transmission after occupational exposure to
blood and body fluids
3. Describe how to effectively manage occupational exposure
4. Describe the key components of an occupational PEP and vaccination
programme
Occupational Exposure
World Health Organization (WHO) defines occupational exposure as contact with a
potentially harmful physical, chemical, or biological agent as a result of one's work e.g.
HIV exposure due to needle stick injury. Exposure can be through skin, mucous
membrane, eyes or parenteral routes in contact with blood or other infectious biological
specimen
Exposure Risk for HIV
• The risk of HIV transmission in relation to the mode of exposure is higher through
percutaneous route, as compared to other routes
Route Percentage risk
Percutaneous 0.3%
Mucous membrane 0.1%
Non-intact skin <0.1%
Devices that may Cause Percutaneous Injuries
• Hypodermic needles
• Blood collection needles
• Suture needles
• Needles used in IV delivery systems
• Scalpels
Factors Increasing the Risk of Sharps Injuries
Past studies show that sharps injuries are often associated with these activities:
• Recapping needles or other devices
• Transferring a body fluid between containers
• Failing to dispose of used needles or other devices properly in puncture-resistant
sharps containers
Factors Influencing Transmission
1. Amount of blood involved in exposure
2. Amount of virus in patient’s blood at time of exposure (viral load)
3. Failure to adhere to Post-exposure prophylaxis (PEP)
Risk of Transmission of Different Viruses Following
Accidental Needle Stick Injury
Below are the three most common infections associated with needlestick injuries:
Virus Risk
23–62%
HBV
0–7%
HCV
HIV 0.3–0.5%
From Prüss-Üstün A, Rapiti E, Hutin Y. Estimation of the Global Burden of Disease Attributable to
Contaminated Sharps Injuries Among Health-Care Workers. Am J Ind Med. 2005;48(6):482–490.
Effective Management of Occupational Exposure
Immediate Measures after Occupational Exposure:
Percutaneous injuries:
• Wash needle sticks and cuts with soap and water
Non-intact skin exposure:
• Wash with soap and water
Mucous membrane exposure
• Irrigate the nose, mouth, or skin with copious amount of water
• Irrigate eyes with clean water or sterile saline
Report to the immediate supervisor
Evaluation of Exposure and Source of Exposure
• Prompt reporting of the exposure
• Conduct evaluation of:
o Type of body substance
o Route and severity of exposure
• Perform baseline HIV and HBV test of the :
o source of exposure in case it’s traceable
o Exposed Health Care worker
Post-Exposure Prophylaxis (PEP)
Definition and Goal of PEP
PEP:
• A short-term use of antiretroviral treatment to reduce the likelihood of infection after
potential exposure
Goal of PEP:
• The ultimate goal of PEP is to maximally suppress viral (HIV) replication that may
occur and to shift the biological advantage of the host cellular immune system to
prevent or stop early infection
Institutional PEP Procedures
HAVE A PLAN for immediate provision of PEP
• Ensure access to the full course of PEP drugs to all HCWs
• A 3-day supply should be immediately available
• Ensure 24-hour/7-day availability of services
HAVE A PLAN for counseling HCWs.
• Protect client confidentiality about exposure, treatment, and test results
• Acknowledge and be prepared to address fears
• See the client again in 2–3 days to answer questions and clarify issues
Institutional PEP Procedures...
• Review medication frequently for possible toxicities / interactions and adherence
• Arrange for referral to comprehensive care clinics
• Provide contacts for questions
• Provide counseling about sexual and reproductive issues
• Discuss breastfeeding modalities for breastfeeding mothers
• Emphasize the need to avoid donation of blood, plasma, organs, tissue, or semen
Management and Follow-up of HCW
• Determination of PEP regimen will be based on eligibility criteria
• eligible client should be initiated on PEP preferably within 2 hours and up to 72 hours
post-exposure
• Provide counselling and PEP drugs for 14 days as per the guidelines
• Monitor for adherence and manage PEP toxicity 2 weeks after starting PEP, then give
additional dose or substitute the drug incase of any adverse event
• Perform HIV screening test at 6 weeks, 3 months, and 6 months.
Recommended ARVs for PEP
Age Weight Regimen Alternate
<15 years <30kgs ABC+3TC+DTC AZT+3TC+DTG
AZT+3TC and LPV/r may be
used as the third drug
>30kgs TDF+3TC/FTC+DTG AZT+3TC and ATV/r may
be used as alternative third
drug
>15 years Any weight TDF+3TC/FTC+DTG AZT+3TC and ATV/r may
be used as alternative third
drug
Source: Kenya Guidelines for preventing & treating infections 2022
Side Effects of PEP
What are the side
effects of PEP?
Common Side Effects of PEP
• Nausea
• Vomiting
• Liver injury
• Fatigue
• Skin rash
• Headache
• Loss of appetite
• Diarrhea
• Muscle pain
Tolerability of HIV PEP in HCWs is Affected by
these Side Effects
Incidence of Common Side Effects
100
90
80
70
60
50
40
30
20
10
0
Nausea Fatigue Headache Vomiting Diarrhea Myalgias
Experience of healthcare workers taking postexposure prophylaxis after occupational HIV exposures:
findings of the HIV Postexposure Prophylaxis Registry ; Wang SA. Infect Control Hosp Epidemiol.
2000;231:780– 785
Recommendations: Hepatitis B
All Health workers MUST be fully vaccinated against Hepatitis B
For the non-immunised, give:
• Prophylactic hepatitis B immunoglobulin (HBIg)
• Initiate the vaccine series i.e
o at least 4 weeks between doses 1 and 2 and at least 8 weeks between doses 2
and 3
o The minimum interval for the overall series from dose1 to final dose is 4
months(16 weeks)
Key Messages
• HCW are required to seek PEP intervention incase of an occupational injury, to prevent
infection with HIV
• Needle stick injuries are likely to occur, hence important for HCW to take precaution
• The availability of PEP should not preclude taking standard precautions.
• Adherence to PEP is key to preventing seroconversion
• All the Health workers SHOULD be fully vaccinated against Hepatitis B
The End
You have come to the end of this module. Kindly attempt Module 8
Quiz and aim to attain a pass mark of 70% before proceeding to
Module 9.