A first-year surgical resident is assisting in the repair of a complex lower extremity laceration in the emergency department. The patient is known to have untreated HIV with a recent viral load of copies/mL. During the procedure, the resident accidentally sustains a deep percutaneous puncture wound to their left index finger with a hollow-bore needle that is visibly contaminated with the patient's blood. The resident immediately stops assisting and removes their surgical gloves.
Arrange the following steps in the most appropriate chronological sequence for the management of this occupational exposure.
- 1Wash the puncture site copiously with soap and water.
- 2Report the exposure to the institutional occupational health department.
- 3Draw baseline blood samples from the resident for bloodborne pathogen testing.
- 4Initiate a 28-day course of a three-drug antiretroviral prophylaxis regimen.
- 5Schedule follow-up serological testing at 6 weeks, 12 weeks, and 6 months.
Answer
The correct sequence for managing an occupational percutaneous HIV exposure is to first decontaminate the wound, followed by reporting to occupational health, obtaining baseline serologies, rapidly initiating a three-drug antiretroviral prophylaxis regimen, and finally conducting long-term serological follow-up.
This sequence strictly aligns with CDC guidelines for occupational exposure to bloodborne pathogens. Immediate local wound care (washing copiously with soap and water) is the absolute first priority to mechanically reduce the inoculum. Caustic agents or squeezing the wound to induce bleeding are not recommended. Next, reporting the incident allows occupational health to coordinate the formal exposure protocol. Baseline serologies must then be drawn from the healthcare worker to establish their pre-exposure serostatus. Crucially, a three-drug post-exposure prophylaxis (PEP) regimen must be initiated immediately after blood is drawn, ideally within 1-2 hours, without waiting for those baseline laboratory results to return. Finally, because PEP is not universally effective, the exposed worker requires serial follow-up testing at 6 weeks, 12 weeks, and 6 months to monitor for late seroconversion.
Step-by-Step Solution
Key Concept
Management of occupational HIV exposure follows a strict protocol: immediate local decontamination, reporting, baseline serological testing, rapid initiation of a 3-drug PEP regimen (ideally within 1-2 hours, without waiting for lab results), and longitudinal follow-up.
Estimated Time:1m 30s