(1)CDC standards for needlesticks? (2)regarding needlesticks, how can you get the needle apparatus fluid residue tested for HIV, hepatitis and any other suspected ID's?
Jan 13, 1997
I am a health care professional. Our hospital has a contridicting policy that states that after a needle stick from a patient, we and the patient are to be tested for HIV. If the patient is in fact HIV positive, then a viral load is to be done. Only when all the results are back, does the health care worker recieve a regimen of AZT. I read drug therapy is recommended 72 hours after exposure. The contridiction lies with the time it takes for all these tests to come back (a week and half in our area). Is it possible for a worker to start AZT before these results are reported out? Suppose the patient does not give his consent for testing? Is there a standardized policy from the CDC covering this situation and where can I find it? Thank you.
What rapid tests are there? What rapid tests are used on neonates?
Response from Mr. Sowadsky
Hi. Thank you for your questions.
Many of the guidelines for needlestick exposures to HIV have already been address in the question, "Are there rapid PCR, P24 antigen, viral culture or other rapid tests for suspicious needle sticks?", dated December 29, 1996. I will however add some additional information here.
If a person has had a significant occupational exposure to a KNOWN HIV positive person, it is recommended that treatment with AZT/3TC (and if indicated a protease inhibitor such as Crixivan) should be initiated promptly, preferably within 1-2 hours post-exposure. Animal studies suggest that prophylactic treatment is probably not effective when started later than 24-36 hours post-exposure. The interval after which there is no benefit for prophylactic treatment for humans is presently not known. However, we must therefore assume that post-exposure therapy is no longer effective after 24-36 hours. Initiating therapy after a longer interval (e.g., 1-2 weeks) may be considered for the highest risk exposures, but the benefits of starting treatment this late are not established. The length of time needed to stay on these drugs is still unknown, but the present recommendation is 4 weeks. These treatments are NOT designed to be used for suspected sexual or other non-occupational exposures.
In exposures to KNOWN HIV positive persons, viral load testing is irrelevant in terms of whether to treat the healthcare worker or not. This is for 2 reasons. First, since it's recommended that treatment begin 1-2 hours after exposure, it's impossible to get a viral load result that quickly. In addition, since a person's blood is still infectious regardless of viral load, treatment is still recommended, whether the viral load is high or low.
If a patient refuses to be tested (after a healthcare worker was exposed to their blood), we must assume that they may be infected with HIV, or other bloodborne diseases. Follow-up testing is still recommended if the patient refuses to be tested. If a patient does get tested and the results are negative, this doesn't necessarily mean the patient is not infected. This is because if they were infected for less than 6 months, their infection may not yet show positive on the test, but their blood would still be infectious. Therefore, regardless of a patients test results, testing the exposed healthcare worker for up to 6 months is still recommended, even if the patient tested negative. If the patient is already known to be positive at the time of the needlestick, then post-exposure prophylaxis should be considered.
For healthcare workers occupationally exposed to blood, symptoms consistent to Acute Viral Syndrome, needs to be reported if they appear. Acute Viral Syndrome is NOT by itself diagnostic of HIV infection (or other bloodborne diseases), but in a case such as this, it may give some additional information whether the healthcare worker may be infected or not.
After a needlestick, having the needle tested for HIV and other infectious diseases is rarely feasible. We therefore ask the patient to consent to be tested after a healthcare worker is exposed to their blood. This is a much more feasible and realistic approach at determining the healthcare workers risk of infection.
For more information on guidelines for post-exposure prophylaxis for HIV, please read the following publication:
Morbidity and Mortality Weekly Report
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