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Summary This report updates U. Public Health Service recommendations for the management of health-care personnel HCP who have occupational exposure to blood and other body fluids that might contain human immunodeficiency virus HIV.
Although the principles of exposure management remain unchanged, recommended HIV postexposure prophylaxis PEP regimens have been changed. This report emphasizes adherence to HIV PEP when it is indicated for an exposure, expert consultation in management of exposures, follow-up of exposed workers to improve adherence to PEP, and monitoring for adverse events, including seroconversion.
To ensure timely postexposure management and administration of HIV PEP, clinicians should consider occupational exposures as urgent medical concerns. Introduction Although preventing exposures to blood and body fluids is the primary means of preventing occupationally acquired human immunodeficiency virus HIV infection, appropriate postexposure management is an important element of workplace safety.
Inthe first U. Since publication of the most recent guidelines innew antiretroviral agents have been approved by the Food and Drug Administration FDAand additional information has become available regarding the use and safety of HIV PEP.
On the basis of this discussion, the PHS working group decided that updated recommendations for the management of occupational exposure to HIV were warranted. This report modifies and expands the list of antiretroviral medications that can be considered for use as PEP.
This report also emphasizes prompt management of occupational exposures, selection of tolerable regimens, attention to potential drug interactions involving drugs that could be included in HIV PEP regimens and other medications, consultation with experts for postexposure management strategies especially determining whether an exposure has actually occurred and selection of HIV PEP regimens, use of HIV rapid testing, and counseling and follow-up of exposed personnel.
Recommendations on the management of occupational exposures to hepatitis B virus or hepatitis C virus have been published previously 3 and are not included in this report. Recommendations for nonoccupational e. Definition of Health-Care Personnel and Exposure The definitions of health-care personnel HCP and occupational exposures are unchanged from those used in 3.
The term HCP refers to all paid and unpaid persons working in health-care settings who have the potential for exposure to infectious materials e. HCP might include, but are not limited to, emergency medical service personnel, dental personnel, laboratory personnel, autopsy personnel, nurses, nursing assistants, physicians, technicians, therapists, pharmacists, students and trainees, contractual staff not employed by the health-care facility, and persons not directly involved in patient care but potentially exposed to blood and body fluids e.
The same principles of exposure management could be applied to other workers who have potential for occupational exposure to blood and body fluids in other settings. In addition to blood and visibly bloody body fluids, semen and vaginal secretions also are considered potentially infectious.
Although semen and vaginal secretions have been implicated in the sexual transmission of HIV, they have not been implicated in occupational transmission from patients to HCP.
The following fluids also are considered potentially infectious: The risk for transmission of HIV infection from these fluids is unknown; the potential risk to HCP from occupational exposures has not been assessed by epidemiologic studies in health-care settings.
Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus are not considered potentially infectious unless they are visibly bloody; the risk for transmission of HIV infection from these fluids and materials is low 7.
Any direct contact i. For human bites, clinical evaluation must include the possibility that both the person bitten and the person who inflicted the bite were exposed to bloodborne pathogens.
Transmission of HIV infection by this route has been reported rarely, but not after an occupational exposure Risk for Occupational Transmission of HIV The risks for occupational transmission of HIV have been described; risks vary with the type and severity of exposure 23 ,7.
Although episodes of HIV transmission after nonintact skin exposure have been documented, the average risk for transmission by this route has not been precisely quantified but is estimated to be less than the risk for mucous membrane exposures.
The risk for transmission after exposure to fluids or tissues other than HIV-infected blood also has not been quantified but is probably considerably lower than for blood exposures.
Epidemiologic and laboratory studies suggest that multiple factors might affect the risk for HIV transmission after an occupational exposure 3. In a retrospective case-control study of HCP who had percutaneous exposure to HIV, increased risk for HIV infection was associated with exposure to a larger quantity of blood from the source person as indicated by 1 a device e.
The risk also was increased for exposure to blood from source persons with terminal illness, possibly reflecting either the higher titer of HIV in blood late in the course of acquired immunodeficiency syndrome AIDS or other factors e.
A laboratory study that demonstrated that more blood is transferred by deeper injuries and hollow-bore needles lends further support for the observed variation in risk related to blood quantity 3.
The use of source-person viral load as a surrogate measure of viral titer for assessing transmission risk has not yet been established. Plasma viral load e.
Although a lower viral load e. The recommendations in this report provide guidance for two- or-more drug PEP regimens on the basis of the level of risk for HIV transmission represented by the exposure Tables 1 and 2 ; Appendix. Because all antiretroviral agents have been associated with side effects Table 3the toxicity profile of these agents, including the frequency, severity, duration, and reversibility of side effects, is an important consideration in selection of an HIV PEP regimen.
The majority of data concerning adverse events have been reported primarily for persons with established HIV infection receiving prolonged antiretroviral therapy and therefore might not reflect the experience of uninfected persons who take PEP.
Side effects have been reported frequently by persons taking antiretroviral agents as PEP In multiple instances, a substantial range: The symptom reported most frequently was nausea Because side effects are frequent and particularly because they are cited as a major reason for not completing PEP regimens as prescribed, the selection of regimens should be heavily influenced toward those that are tolerable for short-term use.
In addition, all approved antiretroviral agents might have potentially serious drug interactions when used with certain other drugs, requiring careful evaluation of concomitant medications, including over-the-counter medications and supplements e.
Information regarding potential drug interactions has been published 13, Additional information is included in the manufacturers' package inserts.1. Introduction. Polycyclic aromatic hydrocarbons (PAHs) are organic compounds that are mostly colorless, white, or pale yellow solids.
They are a ubiquitous group of several hundred chemically related compounds, environmentally persistent with various structures and varied toxicity. Access to online report from of a national and state-by-state profile of worker safety and health issues. Health forecasts and alternative future scenarios can influence long-term planning and investments.
The study shows that people’s health can improve, but such improvement demands attention, resources, action, and continued prioritization of these drivers of health.
Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press.
doi: / Health effects assessment for benzene. Cincinnati, OH: US Environmental Protection Agency, Office of Health and Environmental Assessment, For the patient in the case study, as .
Purpose. The purpose of these guidelines is to provide recommendations for prescribing HIV post-exposure prophylaxis (PEP) following occupational exposure.
Case-control studies have found strong associations between occupational exposure to asbestos fibres and the development of mesothelioma.
Malignant mesothelioma is an aggressive, usually fatal cancer arising from the mesothelial cells that form the lining of the pleural (lung), peritoneal (abdominal) and pericardial (heart) cavities.