A 28-year-old surgical resident sustains a deep, bleeding puncture wound to her left index finger from a hollow-bore needle immediately after drawing arterial blood. The source patient is known to be HIV-positive with a high viral load and is concurrently infected with hepatitis C. The resident has previously received the complete hepatitis B vaccine series and has a documented positive surface antibody titer. Arrange the following steps in the most appropriate chronological order for managing this healthcare worker's occupational exposure.
- 1Perform immediate local wound decontamination with soap and water.
- 2Notify the occupational health department to activate the exposure protocol.
- 3Obtain baseline HIV and HCV serologic testing from the exposed resident.
- 4Initiate a three-drug antiretroviral post-exposure prophylaxis (PEP) regimen.
- 5Schedule follow-up HIV and HCV testing at established intervals.
Cevap
The correct chronological sequence is: 1) decontaminate the wound with soap and water, 2) report the incident to occupational health, 3) obtain baseline serologies from the resident, 4) initiate an antiretroviral PEP regimen, and 5) schedule longitudinal follow-up testing.
The management of an occupational needle-stick exposure follows a strict chronological protocol to maximize safety and prophylactic efficacy. Immediate local decontamination with soap and water is the critical first action. Once the wound is stabilized, notifying occupational health ensures access to rapid testing and medications. Baseline serologies must then be drawn from the exposed worker to document their pre-exposure status. Subsequently, empiric three-drug antiretroviral PEP is administered, which is most effective when started within 1 to 2 hours of the injury. Finally, a schedule for serial follow-up testing is established to monitor for delayed seroconversion.
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Anahtar Kavram
Management sequence for occupational needle-stick exposure to bloodborne pathogens.