This document discusses post exposure prophylaxis for blood borne diseases. It defines key terms like post exposure prophylaxis and blood borne diseases. It provides statistics on the risk of diseases like HIV and hepatitis B and C among healthcare workers. It describes the drug regimens, side effects, and follow up treatment for post exposure prophylaxis of HIV, hepatitis B, and hepatitis C. The goal of post exposure prophylaxis is to prevent infection and disease development by starting preventive medical treatment immediately after exposure to viruses like HIV or hepatitis.

1. Post exposure
prophylaxis

2. At the end of this module, you will be able to:
 Define the terms: post exposure prophylaxis, blood
borne disease.
 Explain statistical view of blood borne diseases among
the health care workers.
 Discuss the, post exposure prophylaxis of blood borne
diseases like HIV infection, hepatitis B,C and AIDS
 Discuss the drug regimen of Post exposure prophylaxis
for HIV, HEPATITIS B,C and AIDS
 Describe the side effects of drugs, follow up treatment
of post exposure prophylaxis.

3.  A blood borne infection or disease (sometimes referred
to as a blood borne virus or BBV) is one that can be
spread through contamination by blood and other body
fluids. The most common.
Example: HIV, Hepatitis B ,C, AIDS.

5. HIV:
 HIV infection is sharp injury is about 0.3% .CDC has
reported 57 documented cases and 140 possible case of HIV
transmission in US.
 India .estimated at 24 lakhs cases are identified in 2009
HIV health care workers.
 Hepatitis B :
National hepatitis surveillance data shows that 400
health workers are affected.
 OSHA surveillance data shows that 2100 cases of
clinical hepatitis, 400-440 hospitalization and
approximately 200 deaths in each year in health care
workers.

6. Hepatitis C:
 CDC reported Overall 54.5% dentist are reported hepatitis c
virus infection because of improper clinical practice .
 WHO estimated that in 66,000 hepatitis B and 16,000
hepatitis C and 1000 HIV infections were caused by needle
stick injuries in health care workers in past 5years.
 The central disease control estimates that there are
approximately 8,700 infections in health care workers in
occupational exposure to blood and other potentially
infection material in US in each year.
 The mortality rate from hepatitis b has been reported
10%
Cont…..

8. Exposed person is the person who is at risk of
acquiring HIV/HBV/HCV infection through
exposure to blood or body fluids .
Who is at Risk ? –
 - Dentists
 - Surgeons and operation theater staff
 - Nursing Staff
 - Emergency Care Providers
 - Labor & delivery room personnel
 - Lab Technicians
 - Health cleaning/ mortuary staff / Waste Handlers

9. - Handle with contamination of blood and other body fluids.
- Needle stick injury
- Lack of proper needle disposal technique
- Blood transfusion

10.  A needle stick injury is a percutaneous piercing wound
typically set by a needle point, but possibly also by
other sharp instruments or objects.
 Commonly encountered with people handling needles
in the medical settings like laboratory, casuality,etc.

11.  Used needles and other sharps are dangers to
people and pets if not disposed of safely because
they can injure people and spreads health
conditions.

12.  Blood borne pathogen transmission occurs
predominantly by percutaneous or mucosal
exposure of workers to the blood or body fluids
of infected patient.
 The risk for HIV transmission after a
percutaneous exposure is approximately 0.3%
the risk of HB V transmission 6 to 30% and the
risk of HCV transmission is approximately
1.8% .

13.  Both the patient and dental heath care personnel
can be exposed to pathogen.
 Contact with blood, oral and respiratory secretion.
 The blood born infection are:
- HIV
- HEPATITIS B
- AIDS
- HEPATITIS C

14. • Human: Infecting human beings.
• Immunodeficiency: Decrease or weakness in the
body’s ability to fight off infections and illnesses.
• Virus: A pathogen having the ability to replicate
only inside a living cell.

15.  HIV 1
 Most common in sub-Saharan Africa and
throughout the world
 Groups M, N, and O
 Pandemic dominated by Group M
Group M comprised of subtypes A - J
 HIV 2
 Most often found in West Central Africa,
parts of Europe and India
15

16.  Sexual transmission, presence of STD
increases likelihood of transmission.
 Exposure to infected blood or blood products.
 Use of contaminated clotting factors by
hemophiliacs.
 Sharing contaminated needles (IV drug users).
 Transplantation of infected tissues or organs.
 Mother to fetus, perinatal transmission
variable, dependent on viral load and mother’s
CD 4 count.

17.  A serious liver infections caused by the hepatitis B
virus that's easily preventable by a vaccine.
 The virus is found in the blood body fluids of an
infected person.

18. SEXUAL CONTACT:
You may become infected if you have
unprotected sex with an infected partner whose
blood, saliva, semen or vaginal secretions enter your
body.
SHARING OF NEEDLES:
HBV is easily transmitted through needles
and syringes contaminated with infected blood.
Sharing intravenous (IV) drug paraphernalia puts
you at high risk of hepatitis B.

19. Contaminated instruments - In haemodialysis,
reuse of contaminated instruments in oral
surgeries, acupuncture needles.
Direct contact - Contact without barrier
protection with concentrated virus in a clinical
practice.
 Body fluids, like saliva,blood,pus,urine,etc..,
 Blood transfusion-contaminated blood
transfusion.

20.  The hepatitis C transmitted by other routes breast
feeding, Hugging , Kissing or Holding hands,
coughing, sneezing.
 Sexual transmission.
 Sharing razors and toothbrushes .
 Tattooing.

22. POST EXPOSURE PROPHYLAXIS(PEP):
Post Exposure Prophylaxis refers to the
preventive medical treatment started immediately after
exposure to diseases causing virus such as HIV, Hepatitis
B, Hepatitis C to prevent infection by these virus and
development of diseases.

23. 1st step: Management of exposed site - First Aid
 Skin: Do not squeeze the wound to bleed it, do not put
the pricked finger in mouth. Wash with soap & water,
don’t scrub, no antiseptics or skin washes (bleach,
chlorine, alcohol, betadine).
 Eye: wash with water/ normal saline/ don’t remove
contact lens immediately if wearing, no soap or
disinfectant.
 Mouth: spit fluid immediately, repeatedly rinse the
mouth with water and spit / no soap/ disinfectant.

24.  Evaluation must be made rapidly so as to start
treatment as soon as possible-ideally within 2hours
but certainly within 72 hours of exposure.
However all exposed cases don’t require
prophylactic treatment.
Factors determining the requirement of
PEP-
 Nature/Severity of exposure and risk of
transmission.
 HIV status of the source of exposure.
 HIV status of the exposed individual.

25. There are 2 types of regimen:
 Basic - 2 drug combination
 Expanded regimen - 3 drug combination
Drug 2 drug regimen 3 drug regimen
Zidovudine(AZT)
Or
Stavudine (d4T)
+
Lamivudine
(3TC)
Protease inhibitors
If Protease
inhibitors is not
available
300 mg twice a day
or
30 mg twice a day
+
150 mg twice a day
Nil
Nil
300 mg twice a day
or
30 mg twice a day
+
150 mg twice a day
+
1st choice: Lopinavir/
ritonavir
400mg/100mg twice a day
or
2nd choice: Nelfinavir
1250 mg twice a day
Efavirenz (EFV) 600 mg once
a day
3rd step – Prescribe PEP:

26. Drug Stock at the Healthcare facility:
 PEP kit comprises of 2 drug regimen:
Zidovudine(AZT) 300mg + Lamivudine (3TC) 150
mg as a fixed dose combination.
 3rd Drug (PI) can be purchased from chemist near RML
Hospital, Lok Nayak Hospital or AIIMS & amount will
be reimbursed by DSACS.

27. 4th step - Laboratory Evaluation:
Reason for testing soon after exposure is to establish “baseline’
against which to compare future test results.
Timing In persons on
PEP
In persons not on
PEP
Baseline (with
in 8 days of
exposure)
HIV, anti- HCV,
Complete blood
counts
Transaminases.
HIV,HCV,HBV

28. LAB FOLLOW UP FOR HIV :
Timing In persons taking PEP
Weeks 2 & 4 Complete blood counts
Week 6 HIV-Ab
Month 3 HIV-Ab, anti - HCV,
Month 6 HIV-Ab, anti –HCV,
Exposed persons should have post PEP HIV test. Testing at
end of PEP may give indication of zero conversion. To diagnose
all persons who zero convert testing at 3 and 6 months is
recommended.

29. 5th step – Follow up:
Clinical –
 Monitoring for appearance of signs of HIV
zero conversion
 Use precautions to prevent secondary
transmission (Blood donation, Breast feeding
,Pregnancy, Unprotected Sexual relations
especially during 6-12 wks. following
exposure. Condom use is essential.
 Drug adherence
 Psychological support

30. Immediate care to the exposure site:
 Wash wounds and skin with soap and water.
 Flush mucous membranes with water.
Determine the risk of Exposure:
 Type of fluid – Body fluids saliva potentially
infectious fluids or tissue.
 Type of exposure – Percutaneous injury, mucous
membrane or non intact skin exposure.

31. HEPATITIS B VACCINE:
 Initiation of the hepatitis B vaccine within 12 to 24 hours
of an exposure.
 The vaccine should not be given later than 14 days post
exposure.
 The 3 doses of hepatitis B vaccine is given at 0,1 to 2
months, and 6 months.
 Hepatitis B antibodies should be obtained 1 to 2 month
after completion of the third dose of the vaccine.

32. Recommended PEP for Hepatitis B Virus:
Vaccination/Ag
response status of
exposed patient
Treatment when source patient is:
HBsAg positive HBsAg
negative
Source unknown or not available
for testing
Unvaccinated/
non-immune
HBIG ×1;
initiate HB
vaccine series
Initiate HB
vaccine series
Initiate HB vaccine series
Previously
vaccinated, known
responder
No treatment No treatment No treatment
Previously
vaccinated, known
non-responder
HBIG ×1 and
initiate
revaccination or
HBIG ×2
No treatment No treatment unless high-risk
source; if high-risk source, treat as if
source were HBsAg positive
Previously
vaccinated, response
unknown
Single vaccine
booster dose
No treatment No treatment unless high-risk
source; if high-risk source, treat as if
source were HBsAg positive
Still undergoing
vaccinated
HBIG ×1;
complete series
Complete
series
Complete series

33. LAB FOLLOW UP OF HEPATITIS B
VIRUS EXPOSED PERSON:
 Perform follow up anti HBs testing in persons who
receive hepatitis B vaccine.
 Test for protective surface antibodies for 1 to 2
months after last dose of vaccine.
 HBsAb responses to vaccine cannot be ascertained
if HBIG was received in the previous 3 to 4
months.

34.  No vaccine or treatment will prevent
infection
- Immune globulin not
recommended; does
not work.
 Early infection effectively treated
with Peg-interferon +/- ribavirin

36. 57
38
18
16
14
6
0 20 40 60 80 100
Percent
Nausea
Fatigue
Headache
Vomiting
Diarrhea
Myalgias
Adverse Effects of PEP Regimens

37. The health care worker (HCW) should wash the
site of injury by sharps with soap and water.
immediately report the incidents to the
infection control nurse (ICN).
ICN will take the health care worker to
emergency room for wound dressing and TT
injection .

38. ICN will take the venous blood sample from
the heath care worker and the patient from
whom the incident occurred and give the
sample to laboratory test for HIV, HBsAg anti-
HCV .
The ICN will collect the result and take health
care worker, medicine consultant and follow
the consultant instructions.
If the health care workers have positive for any
of the three tests.

39. started for the post exposure prophylaxis
drugs.

40.  So for we are discuss the blood borne
diseases, and its causes risk of infection
statistical report of blood borne diseases in
health care professional and post exposure
prophylaxis treatment of HIV, hepatitis B,C
and its follow up care.