In each country that we serve, there are unique situations that can arise. Overall, consideration of each team member’s health and safety is very important. All universal precautions should be followed to include PPE (personal protection equipment) standards. The potentially grave consequences of exposure to body fluids from people infected with HIV, Hepatitis (A/B/C), and Syphilis have prompted development of policies and procedures designed to reduce the risk in healthcare personnel (HCP). LEAP medical volunteers will follow these procedures after possible exposure to blood borne pathogens,

All team members must agree to become familiar with these guidelines and to abide by them. The team medical leader is responsible for ensuring procedures are followed as outlined.

PROCEDURES WHEN POSSIBLE EXPOSURE OCCURS

Immediately:

1. Remain calm and tell the nearest team member you have had a possible exposure.
2. The nearest team member should instruct the source patient to remain in the room and immediately inform the medical team lead and a member of LEAP staff.
3. The exposed person should immediately cleanse the exposed site (wound, mucous membrane, etc.). For skin exposure (needlestick or cut), wash well with soap and running water for at least 5 minutes and follow with alcohol-based hand sanitizer. For eye, nose, or mouth exposure, flush the affected area with plenty of clean water, saline, or sterile irrigants for 15 minutes. If the eye was splashed, roll eyes left to right and up and down during the flushing process. Remove contact lenses during the flushing process.

The team medical lead will:

Consider the type of exposure and risk of transmission. Factors to think about include type of wound, instrument involved, risk of the patient involved, type of body fluid, and extent of exposure, if mucous membrane involved.

Test both the patient and the exposed person for HIV, Hepatitis (A/B/C), and  Syphilis. A patient may already have been tested. If so, review lab work and when it was done. If no recent testing is available (<15 days), the patient will be tested in accordance to host hospital guidelines. Consent to test for HIV, Hepatitis (A/B/C), and Syphilis will be governed by LEAP’s Disclosure and Consent Form.

Decide if you need to consider post-exposure prophylaxis (PEP).

If deemed a significant exposure and significant risk of HIV, Hepatitis (A/B/C) or Syphilis  then a discussion with the exposed volunteer and medical team lead should involve treatment options.

1. HIV PEP (antiretroviral) oral medication is chosen by the exposed volunteer. It should begin as soon as possible, preferably within one hour of being exposed with a maximum of 72 hours. It is generally a 28-day course of treatment. The medication will come from the host hospital’s pharmacy.
2. If Hepatitis A PEP is chosen, it is a series of two inactivated HA vaccines given 6-12 months apart. It is recommended that this PEP be started as soon as possible, ideally within 2 weeks of exposure. There can also be consideration of IG (immune globulin) and should be managed with your PCP’s guidance upon returning home.
3. If the exposed volunteer has written documentation of completed Hepatitis B vaccine series, no further treatment is recommended. If they are not fully vaccinated, the exposed person should receive the first Hepatitis B vaccine as soon as possible, preferably within 24 hours. The vaccine series should be completed in accordance with the CDC guidelines.
4. Although there is now treatment for Hepatitis C infection, we are not recommending post-exposure prophylaxis for Hepatitis C. If the patient is found to be positive for Hepatitis C, it is important for the exposed person to be tested at regular intervals after exposure. This should be addressed with the exposed person’s health care provider upon returning home.
5. Syphilis transmission via needlestick is very rare, but can happen. Because of this, PEP is not standard practice for Syphilis after needlestick. If the exposed person chooses PEP, the recommendation is a single dose of Benzathine Penicillin IM.

GENERAL INFORMATION

• The exposed person should follow up with their own health care provider upon arrival home to complete treatment, if initiated.
• The medications are very well tolerated, and taking PEP for HIV exposure does not necessarily mean that one has to stop working or change one’s role on the trip. However, if the volunteer is concerned, he/she has the option of returning home.
• Any local staff working with our team that suffers a possible exposure should be evaluated and treated according to local guidelines/policies. If none exist, then LEAP policies will be substituted.
• Click below for a more detailed explanation of potential exposure and the recommendations for post-exposure management.

HIV  https://hivinfo.nih.gov/understanding-hiv/fact-sheets/post-exposure-prophylaxis-pep

HEP A https://www.cdc.gov/hepatitis-a/hcp/clinical-care/index.html

HEP B https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a3.htm

HEP C  https://www.cdc.gov/hepatitis-c/hcp/infection-control/index.html

Syphilis https://www.cdc.gov/mmwr/volumes/73/rr/rr7302a1.htm