Healthcare Worker Evaluation

Evaluation of an exposed healthcare worker should be done immediately after wound care or decontamination has been completed. The benefits and risks of post-exposure prophylaxis should be thoroughly discussed. If the source patient is known to have an HIV infection and the exposure is such that transmission of HIV is likely, post-exposure prophylaxis should be started within 1-2 hours of the exposure.8

Animal studies indicate that delaying administration of post-exposure prophylaxis decreases its effectiveness, and post-exposureprophylaxis should be started as soon as possible and ideally within 72 hours of the exposure.8 It is not known at what point after an exposure there would be no benefit from post-exposure prophylaxis. If the HIVstatus

of the source patient is unknown post-exposure prophylaxis should be started and if the result of the rapid testing is negative, treatment should be discontinued.8 The healthcare worker exposed to injury should not delay starting treatment while waiting for the test results.

Laboratory evidence and confirmation of an HIV infection can be delayed for up to 3 months after an exposure; this is commonly termed the “window period” of HIV infection. However, the U.S., Public Health Services Guidelines for post-exposure prophylaxis states that “… investigation of whether a source patient might be in the window period is unnecessary for determining whether HIV PEP [pre-exposure prophylaxis] is indicated unless acute retroviral syndrome is clinically suspected.”21 In most cases, rapid testing alone issufficient.

The affected healthcare worker should be tested for the presence of HIV and other blood-borne pathogens, if needed. The need for tetanus vaccination should also be considered.