1. Treat site of exposure (i.e., clean wound, flush mucous membrane).
2. Obtain information regarding the exposure incident. Examples:
- Was the exposure from a needle, sexual contact, bite or other agent?
- What is known about the person who caused the exposure (hepatitis C/HIV status)?
- Was there visible blood in needle/syringe (fresh/dried)?
3. Obtain information regarding the health status of the patient, including height, weight, general health, allergies, ability to take tablets versus liquid and status of hepatitis B vaccination.
4. Consult the UMass Memorial pediatric infectious disease physician on call (call 508-334-1000 and ask for the physician to be paged). The pediatric infectious disease specialist will assist in making decisions:
- Whether or not to offer PEP
- Medication treatment (dosing schedule for antiretroviral drug attached)
- Whether hepatitis B prophylaxis is indicated (hepatitis B immune globulin)
5. If the patient is seen between 9 am and 5 pm, Monday through Friday, the pediatric infectious disease physician will contact the pediatric HIV nurse for appropriate follow-up care.
6. Obtain the following blood labs:
- HIV antibody (requires signed consent)
- Hepatitis B antibody to core and surface antigen
- CBC with differential
- Hepatitis C antibody
- SGOT, SGPT
Please note: If at all possible, test the person whose blood or fluids were the agent of exposure as well.
7. If it is decided that PEP is needed, administer the first dose of antiretroviral drugs to the patient in the Emergency Room. PEP is most effective when started within hours of the exposure.
8. Provide the patient with:
- Patient information sheet for PEP
- Medication information sheet
- Prescription for PEP medications; direct the family to fill the prescriptions as soon as possible and confirm the next time medication is to be administered
- Hepatitis B immune globulin and hepatitis B vaccine if the patient has not received hepatitis B vaccine
9. Upon consulting with a pediatric infectious disease specialist, if necessary, provide the patient/family with the telephone number for the Division of Pediatric Infectious Disease 508-856-3947. Ask them to contact the office the following weekday and speak with one of the pediatric HIV nurses. A follow-up appointment in the Pediatric Infectious Disease Clinic will be scheduled at that time.
10. Emphasize to the patient that side effects may occur from PEP treatment, but they should call us before stopping treatment.