Transcript HIV, Hep C - Prolonged Field Care

Actions to take for exposure to bloodborne pathogens
(HIV, Hep C)
EXPOSURES with increased risk:
Needle Stick, Contact with infected or
suspected person's fluids, OR
contact with assailant body fluid via mucous
membrane, non-intact skin or bite; OR
unknown exposure (e.g, drug assisted)
[AFRICA is considered High Risk]
Is Contact
Source
HIV
Negative?
IMMEDIATELY:
NO RISK EXPOSURES:
Exposures where skin remains intact
where there is no anal, vaginal, or oral
penetration; no contact with source body
fluids via mucous membrane,
•Begin Soldier Treatment PEP:
Delay of PEP administration greater than 48
hours significantly diminishes efficacy of
treatment regime.
•Begin Coordinating for EVAC to
Landstuhl:
Is Source
available
for RDT
No /UNK
HIV Post Exposure
Prophylaxis Regimen
Due to limited PEP supply on hand,
evacuation should be completed within 72
hours.
No
(Rapid
Diagnostic
Test)?
Yes
Conduct RDT (Rapid Diagnostic Test) on Source: 1
each, HIV, Hep B, Hep C
[do not use saliva, use blood]
Yes
Is Source
RDT
Positive?
Submit additional blood sample from potential
source to a laboratory for verification.
Yes
No
DSN: 314-421-3339 COMM: +49 (0)711-729-3339
SVOIP: (80) 304-436-2035
NIPR: [email protected]
SIPR: [email protected]
•SOCAFRICA JOC:
Sample will travel with Soldier during EVAC to
Germany and shipped via FedEx using account
or be shipped DHL to WRAIR
Do you still
suspect
source HIV
positive?
No
DRAFT
HIV
Points of Contact:
-LTC Lynch, SOCAF Surgeon (all MEDEVACs)
Blot a sample of Blood onto filter-paper and
seal in plastic bag (See Blood Collection and
Shipping Instructions)
Educate Soldier and unit
on Risk Factors and
Avoidance
Use Triple Drug Therapy, currently the
best combination:
•Dolutegravir x 1 tab per day, plus
•Truvada (two drug combo) X1 Tab per
day
•Pre-treat w/Zofran or Phenergan to
offset nausea/vomiting from meds
Yes
- DSN 421-3340/3370; 0711-729-3340/3370
- RED: 304-436-2100
- [email protected]
•[email protected]
•[email protected]
•AFRICOM ID consultant
Note: Continued Treatment and
consultation required, Testing will be
required at 1, 3, 6 and 12 months
HIV PEP Kit Contents
•
Sealable rugged container: Otter/Pelican approx 5W"x7W"x3D"
–
Labeled on Outside,
•
•
•
•
Drugs (should medics fill separate in case of expiration date?
–
–
•
Include extra lancet for blood sample
Ensure each kit has pipette if applicable (some RDTs have pipets separate)
SOP/Flow Chart/shipping instructions - 5x7 laminated printout
Blood Sample Kit
–
–
–
–
–
–
–
–
–
–
•
•
•
Dolutegravir
Truvada
Rapid Test - HIV RDT, (verify no special handling instructions or expiration)
–
–
•
•
HIV Exposure Kit
Kit Contents with pertinent expiration date
Last inspection date and initials
FTA Micro Card (x2)
alcohol wipe
sterile lancet
adhesive bandage
gloves,
Multi-Barrier Pouch (strong ziplock to hold the blood sample)
mailing envelope
tamper-proof tape for the mailing envelope,
Desiccant
clear outer bag (labeled with code number and expiration date
Gloves
Pre-Printed labels
Desicant bag - keep moisture out
Blood Sample Kit
•
•
•
•
•
•
•
•
•
•
•
Blood Sample Collection Instructions 5x7 laminated
FTA Micro Card (x2)
alcohol wipe
sterile lancet
adhesive bandage
gloves,
Multi-Barrier Pouch (strong ziplock to hold the blood sample)
mailing envelope
tamper-proof tape for the mailing envelope,
Desiccant
clear outer bag (labeled with code number and expiration date
HIV Post Exposure
Prophylaxis Regimen
Actions to take for exposure to bloodborne pathogens
(HIV, Hep C)
HIGH RISK EXPOSURES:
Needle Stick, Contact with infected or
suspected person's fluids, OR
contact with assailant body fluid via mucous
membrane, non-intact skin or bite; OR
unknown exposure (e.g,, drug assisted)
[AFRICA]
Is Contact
Source HIV
Negative?
NO RISK EXPOSURES:
No anal, vaginal, or oral penetration; No
contact with assailant body fluid via
mucous membrane, non-intact skin
or bite Contact with fluids of non-infected
person
Is Source
available
for RDT?
No /UNK
No
Always submit additional blood
sample from the potential source to a
laboratory for verification.
Blot a sample of Blood onto filterpaper and seal in plastic bag
Sample will travel with Soldier during
EVAC and turned into lab
Yes
Conduct RDT on
Source
Is Source
RDT
Positive?
Yes
Yes
No
Do you still
suspect
source HIV
positive?
Delay of PEP administration greater than
48 hours significantly diminished efficacy
of treatment regime.
•Begin Coordinating for EVAC to
Landstuhl:
Due to limited PEP supply on hand,
evacuation should be completed within
72 hours.
Use Triple Drug Therapy, currently
the best combination:
•Daltegravir x 1 tab per day, plus
•Truvada (two drug combo) X1 Tab
per day
•Pre-treat w/Zofran or Phenergan to
offset nausea/vomiting from meds
HIV
Points of Contact:
-LTC Lynch, SOCAF Surgeon (all
MEDEVACs) DSN: 314-421-3339
COMM: +49 (0)711-729-3339
SVOIP: (80) 304-436-2035
NIPR: [email protected]
SIPR: [email protected]
No
Educate Soldier and unit
on Risk Factors and
Avoidance
IMMEDIATELY:
•Begin Soldier Treatment PEP:
Yes
•[email protected]
•AFRICOM ID consultant
Note: Continued Treatment and
consultation required, Testing will
be required at 1, 3, 6 and 12
months