Missed Opportunities for HIV Prophylaxis Among Emergency Department Patients With Occupational and Nonoccupational Body Fluid Exposures

O’Donnell, Shannon; Bhate, Tahara D.; Grafstein, Eric; Lau, William; Stenstrom, Robert; Scheuermeyer, Frank

doi:10.1016/j.annemergmed.2016.03.027

Cited by 11 publications

(5 citation statements)

References 26 publications

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“…Un estudio realizado por O' Donnell, luego de la administración de la profilaxis a los profesionales de la salud, procedió a realizar el seguimiento control por pruebas de laboratorio dentro de los 6 meses, de estos, no se encontró seroconversión para los profesionales expuestos a accidentes de pacientes con riesgo alto por HIV. 19 Pudiéndose establecer, que la rápida administración de medicamentos profilácticos evita una seroconversión.…”

Section: Resultsunclassified

Caracterización del riesgo biológico por accidentes laborales en el personal de salud de un centro ambulatorio en Guayaquil-Ecuador

Icaza

2021

Rev Colomb Salud Ocup

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Introducción: Los accidentes ocupacionales por riesgo biológico son tan habituales, que para su prevención se han diseñado estrategias nacionales e internacionales de registros para documentar y responder a las eventualidades de carácter biológico; más de 20 agentes patógenos pueden diseminarse por vía hemática a través de los fluidos corporales y la sangre, siendo los más relevantes para identificación y seguimiento hospitalario, los virus de hepatitis B, C, virus del VIH. Objetivo: Caracterizar los accidentes biológicos de los profesionales de la salud del Centro Ambulatorio en Guayaquil; Métodos: Estudio de tipo descriptivo con diseño retrospectivo y cohorte transversal; la muestra correspondió a 250 trabajadores de la salud en el periodo 2017-2018. La información fue adquirida del sistema de vigilancia ocupacional de la institución, del formulario estandarizado nacional. Las variables evaluadas fueron exposición a sangre y fluidos corporales a través de pinchazos, laceraciones, raspaduras, cortes, también en mucosas o piel no incólume (salpicadura), en el lapso de la actividad laboral. Resultados: La tasa de prevalencia por riesgos biológicos fue de 6 por cada 100 trabajadores, La edad media 36.06 años, 80% de los casos fueron mujeres; el accidente con mayor prevalencia fue el pinchazo percutáneo por aguja hueca contaminada (60%). El corte con bisturí y la aguja no hueca fue 13.3 % y 6.7% a salpicadura a la mucosa ocular. Conclusiones: la punción percutánea presentó la mayor incidencia para accidentes en esta categoría, a pesar que el 94% de los trabajadores accidentados reportó el uso de los guantes de látex como elementos de protección personal.

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Section: Resultsunclassified

Caracterización del riesgo biológico por accidentes laborales en el personal de salud de un centro ambulatorio en Guayaquil-Ecuador

Icaza

2021

Rev Colomb Salud Ocup

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“…In this retrospective study of potential HIV exposures over 2 years, the majority of patients presented after occupational exposure (81.5%), higher than centres in the United States (68.9%). 11 Possible factors may include ease of access and higher awareness of PEP amongst healthcare employees. This notion is further supported by Merchant et al who reported that over 90% of ED physicians had indicated experience in managing occupational exposure cases, while less than 50% indicated experience in treating non-occupational HIV exposure cases.…”

Section: Discussionmentioning

confidence: 99%

“…If this were to be 'unknown', the indication for PEP would be correspondingly unclear. 11 Contributing factors to poor documentation may include a comparatively lower volume of post-exposure HIV cases compared to other ED conditions causing a lack of familiarity, the lack of an institutional protocol specific to HIV encounters, or a gap in knowledge.…”

Section: Discussionmentioning

confidence: 99%

“…The ED is a port of call for individuals after potential HIV exposure, due to its ability to provide round-the-clock time-sensitive evaluation and management of body fluid exposures. 11,17 Emergency practitioners should be familiar with the nature of presentation of such patients to the ED, and the guidelines used for assessment and management of exposures. In the interest of evidence-guided best practices for patient care, adherence to such guidelines is of paramount importance.…”

Section: Discussionmentioning

confidence: 99%

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HIV post-exposure prophylaxis in the Emergency Department: a perspective from Singapore

Wong

Fua

Pek

2019

Proceedings of Singapore Healthcare

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Background: Exposures to human immunodeficiency virus (HIV) commonly arrive at the Emergency Department (ED) for evaluation of transmission risk and the necessity for post-exposure prophylaxis (PEP). PEP aims to prevent HIV after exposure. International recommendations exist to guide eligibility assessment and standardise prescribing practices. Objective: The primary objective was to describe the patient cohort receiving HIV PEP at the ED. The secondary objective was to assess the ED physicians’ adherence to the 2005 guidelines provided by US Centers for Disease Control and Prevention for HIV PEP. Methods: This retrospective study identified patients prescribed with PEP after presenting with potential HIV exposure to a tertiary hospital ED in Singapore over 2 years. The exposure type and characteristics, source patient characteristics, indications for PEP, HIV status on presentation and on follow-up were assessed. Institutional guidelines recommended tenofovir/emtricitabine (Truvada) and raltegravir as HIV PEP. Results: Twenty-seven patients received HIV PEP during the study period. The majority (81.5%) presented after occupational exposure, with fresh needlestick injury (44.4%) being the most common cause. Amongst all recipients, PEP was indicated in 22.2% and not in 18.5%. Conclusions: With international guidelines simplifying eligibility assessment and prescribing practices, accurate and evidence-based PEP provision should be implemented at the frontline in the ED. These may be encouraged by enforcement of specific workflows and physician education.

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“…1 Despite having nPEP guidelines in place for years, emergency physicians frequently fail to provide nPEP when indicated. 2 For US EDs that routinely prescribe nPEP to patients meeting established criteria, patient adherence to nPEP regimens remains abysmal. In a recent systematic review and meta-analysis of HIV postexposure prophylaxis studies, the overall rate of completion for a standard 28-day course was 40.2% after sexual assault and 65.6% for other nonoccupational exposures.…”

Section: Commentarymentioning

confidence: 99%

Commentary

Liang

Adalja

2016

Annals of Emergency Medicine

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Missed Opportunities for HIV Prophylaxis Among Emergency Department Patients With Occupational and Nonoccupational Body Fluid Exposures

Cited by 11 publications

References 26 publications

Caracterización del riesgo biológico por accidentes laborales en el personal de salud de un centro ambulatorio en Guayaquil-Ecuador

Caracterización del riesgo biológico por accidentes laborales en el personal de salud de un centro ambulatorio en Guayaquil-Ecuador

HIV post-exposure prophylaxis in the Emergency Department: a perspective from Singapore

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