A 28-year-old medical resident sustains a deep percutaneous needle-stick injury to her hand while drawing blood from a patient in the emergency department. The source patient has a documented history of poorly controlled HIV with a high viral load. The hollow-bore needle was visibly contaminated with blood. What is the most appropriate chronological sequence of interventions for this occupational exposure?
- 1Wash the puncture site immediately with soap and water
- 2Obtain baseline serologic testing for HIV, HBV, and HCV from the resident
- 3Initiate a 28-day course of a three-drug antiretroviral regimen
- 4Perform serial follow-up HIV testing at 6 weeks, 12 weeks, and 6 months
Answer
The correct sequence begins with immediate local decontamination, followed by baseline serologic evaluation, rapid initiation of three-drug antiretroviral post-exposure prophylaxis, and finally serial follow-up testing.
The established protocol for occupational exposure to HIV involves a sequential and rapid response. First, basic first aid must be administered by vigorously washing the wound with soap and water to decrease the viral load at the entry site. Following local wound care, baseline bloodwork must be drawn from the exposed healthcare worker to document their pre-exposure HIV, HBV, and HCV status. Immediately following the blood draw (and without waiting for the laboratory results), a 28-day course of a three-drug antiretroviral post-exposure prophylaxis (PEP) regimen should be initiated, as its efficacy heavily depends on administration within 1-2 hours of the exposure. Finally, the worker must undergo longitudinal serologic monitoring at regular intervals (typically 6 weeks, 12 weeks, and 6 months) to definitively rule out delayed seroconversion.
Step-by-Step Solution
Key Concept
Management of occupational HIV exposure (Post-Exposure Prophylaxis)
Estimated Time:1m 0s