Occupational Hazards Of HIV And Its Prophylaxis

M. Mittal, Prateek Khanna, B. Yadav, Vidhi Dhakray
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Transmission is evidently rare in the industrialized nations and can be significantly reduced or prevented by the use of standard infection control measures, appropriate clinical and instrument-handling procedures, and the use of safety equipment and safety needles. Viruses can be transmitted in health-care settings including dentistry, albeit rarely, where standard infection control measures are not implemented. The epidemic of Acquired Immune Deficiency Syndrome (AIDS) has been recognized for about 25 years, and concern about the transmission of human immunodeficiency viruses (HIV) is therefore not new. The human immunodeficiency virus (HIV) is transmitted from person to person via the following routes: Most dental HCPs appear to be careful to try to avoid injury during intra-oral procedures, but it is during extra-oral procedures—laboratory work, operatory clean up, and instrument preparation for sterilization—that most percutaneous injuries occur. WHAT IS AN OCCUPATIONAL EXPOSURE? According to the ILO/WHO guidelines “An occupational exposure is defined as a percutaneous, mucous membrane or non-intact skin exposure to blood or body fluids that occurs during the course of an individual’s employment. This applies to health care workers (HCW) and to non-health workers.” The risks for occupational transmission of HIV vary with the type and severity of exposure: A percutaneous injury refers to an injury resulting from a needle prick, or a cut with a sharp object. The risk after percutaneous exposure is estimated to be about 0.3% i.e. 3 out of a thousand needle pricks may result in HIV infection. The risk after a mucous membrane exposure is estimated to be lower; about 0.09%. This includes contact with the mucous membranes of the eyes, nose and mouth, or contact with chapped, abraded or inflamed skin. Episodes of HIV transmission have also been documented after non-intact skin exposure. Although the average risk for transmission by this route has not been precisely quantified, it is estimated to be much less than the risk for mucous membrane exposures. Various factors increase the risk of acquiring HIV infection. These include: POTENTIALLY INFECTIOUS BODY FLUIDS The most frequent areas of contact are the hands, eye or mucous membrane contacts may occur in cases where there is splattering of blood. POST EXPOSURE PROPHYLAXIS Post-exposure prophylaxis (PEP) refers to treatment of occupational exposures using antiretroviral therapy. The rationale is that antiretroviral treatment which is started immediately after exposure to HIV may prevent HIV infection. Protocol for post-exposure prophylaxis (PEP) of percutaneous injury with known HIV-contaminated blood Occupational Hazards Of HIV And Its Prophylaxis 2 of 4 has been modified relatively recently. This change has been supported by the Canadian Medical Association and other agencies concerned with infection control and aseptic procedures in health care settings. The PEP protocol is altered from time to time following review of prospective, case-controlled studies of HIV seroconversion in health care workers after percutaneous exposure to HIV-contaminated blood. These studies are commonly known as the CDC Needlestick Study. Although the possibility of seroconversion following an HIV-contaminated percutaneous injury in a dental setting appears to be extremely unlikely, contaminated percutaneous injuries in dentistry do, unfortunately, occur. There are several preventive measures to reduce the risk of HIV transmission. These include: What immediate measures should be taken after an occupational exposure? 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引用次数: 0

Abstract

Doctors currently recommend a four-week preventive treatment with zidovudine and lamivudine for health professionals accidentally exposed to HIV-infected blood. Preliminary research has shown that the average risk for infection (0.3%) after an injury involving HIV-infected blood can be reduced by nearly 80% with preventive treatment. The risk may be higher for those repeatedly exposed to infected blood and if the virus level in the exposed blood is high. Treatment with indinavir may be advisable if the exposure is extensive or if the infected patient carries a virus resistant to treatment. INTRODUCTION HIV transmission in the health-care setting is of concern. Transmission is evidently rare in the industrialized nations and can be significantly reduced or prevented by the use of standard infection control measures, appropriate clinical and instrument-handling procedures, and the use of safety equipment and safety needles. Viruses can be transmitted in health-care settings including dentistry, albeit rarely, where standard infection control measures are not implemented. The epidemic of Acquired Immune Deficiency Syndrome (AIDS) has been recognized for about 25 years, and concern about the transmission of human immunodeficiency viruses (HIV) is therefore not new. The human immunodeficiency virus (HIV) is transmitted from person to person via the following routes: Most dental HCPs appear to be careful to try to avoid injury during intra-oral procedures, but it is during extra-oral procedures—laboratory work, operatory clean up, and instrument preparation for sterilization—that most percutaneous injuries occur. WHAT IS AN OCCUPATIONAL EXPOSURE? According to the ILO/WHO guidelines “An occupational exposure is defined as a percutaneous, mucous membrane or non-intact skin exposure to blood or body fluids that occurs during the course of an individual’s employment. This applies to health care workers (HCW) and to non-health workers.” The risks for occupational transmission of HIV vary with the type and severity of exposure: A percutaneous injury refers to an injury resulting from a needle prick, or a cut with a sharp object. The risk after percutaneous exposure is estimated to be about 0.3% i.e. 3 out of a thousand needle pricks may result in HIV infection. The risk after a mucous membrane exposure is estimated to be lower; about 0.09%. This includes contact with the mucous membranes of the eyes, nose and mouth, or contact with chapped, abraded or inflamed skin. Episodes of HIV transmission have also been documented after non-intact skin exposure. Although the average risk for transmission by this route has not been precisely quantified, it is estimated to be much less than the risk for mucous membrane exposures. Various factors increase the risk of acquiring HIV infection. These include: POTENTIALLY INFECTIOUS BODY FLUIDS The most frequent areas of contact are the hands, eye or mucous membrane contacts may occur in cases where there is splattering of blood. POST EXPOSURE PROPHYLAXIS Post-exposure prophylaxis (PEP) refers to treatment of occupational exposures using antiretroviral therapy. The rationale is that antiretroviral treatment which is started immediately after exposure to HIV may prevent HIV infection. Protocol for post-exposure prophylaxis (PEP) of percutaneous injury with known HIV-contaminated blood Occupational Hazards Of HIV And Its Prophylaxis 2 of 4 has been modified relatively recently. This change has been supported by the Canadian Medical Association and other agencies concerned with infection control and aseptic procedures in health care settings. The PEP protocol is altered from time to time following review of prospective, case-controlled studies of HIV seroconversion in health care workers after percutaneous exposure to HIV-contaminated blood. These studies are commonly known as the CDC Needlestick Study. Although the possibility of seroconversion following an HIV-contaminated percutaneous injury in a dental setting appears to be extremely unlikely, contaminated percutaneous injuries in dentistry do, unfortunately, occur. There are several preventive measures to reduce the risk of HIV transmission. These include: What immediate measures should be taken after an occupational exposure? Following exposure to HIV, there are currently only two known means to reduce the risk of developing HIV infection: post-exposure prophylaxis (PEP) and interventions to prevent mother-to-child transmission Currently recommended guidelines for pep state that: Therapy should be recommended after exposure Therapy should be initiated within one to two hours of exposure, for a period of 4 weeks 2and 3-drug PEP regimens that are based on the level of risk for HIV transmission represented by the exposure are recommended Reevaluation of the exposed person should be considered within 72 hours post-exposure, especially as additional information about the exposure or source person becomes available If the source patient's HIV status is unknown at the time of exposure, decide whether to give PEP on a case-to-case basis after considering the type of exposure and clinical/epidemiological likelihood of HIV infection in the source. If a source person is determined to be HIV-negative, PEP should be discontinued Basically, 2 types of regimens are recommended for PEP: a “basic” 2-drug regimen that should be appropriate for most HIV exposures and an “expanded” three-drug regimen that should be used for exposures that pose an increased risk for transmission TWO-DRUG ARV REGIMENS PREFERRED ZDV + 3TC (or FTC) ALTERNATIVES TDF + FTC (or 3TC)
HIV的职业危害及其预防
目前,医生建议意外接触hiv感染血液的卫生专业人员使用齐多夫定和拉米夫定进行为期四周的预防性治疗。初步研究表明,通过预防性治疗,涉及艾滋病毒感染血液的伤害后感染的平均风险(0.3%)可降低近80%。对于那些反复接触受感染血液的人,如果接触的血液中的病毒水平很高,风险可能更高。如果接触广泛或感染患者携带对治疗有抗性的病毒,则可取用英地那韦治疗。导言保健环境中的艾滋病毒传播令人关切。传播在工业化国家显然是罕见的,可以通过使用标准的感染控制措施、适当的临床和仪器处理程序以及使用安全设备和安全针头来大大减少或预防。病毒可在卫生保健环境中传播,包括在没有实施标准感染控制措施的牙科,尽管这种情况很少发生。获得性免疫缺陷综合征(AIDS)的流行已经被认识了大约25年,因此对人类免疫缺陷病毒(HIV)传播的关注并不新鲜。人类免疫缺陷病毒(HIV)通过以下途径在人与人之间传播:大多数牙科医护人员在口腔内手术过程中似乎都很小心,尽量避免受伤,但在口腔外手术过程中——实验室工作、手术清理和消毒器械准备——大多数经皮损伤发生。什么是职业暴露?根据国际劳工组织/世卫组织准则,“职业接触被定义为在个人就业期间发生的经皮、粘膜或非完整皮肤对血液或体液的接触。这适用于卫生保健工作者和非卫生工作者。”职业传播艾滋病毒的风险因接触的类型和严重程度而异:经皮损伤是指因针刺或尖锐物体割伤而造成的损伤。经皮接触后的风险估计约为0.3%,即千分之三的针扎可能导致艾滋病毒感染。据估计,粘膜暴露后的风险较低;约0.09%。这包括接触眼睛、鼻子和嘴巴的粘膜,或接触皲裂、擦伤或发炎的皮肤。在非完整皮肤暴露后也有艾滋病毒传播的记录。虽然通过这一途径传播的平均风险尚未精确量化,但据估计其风险远低于粘膜接触的风险。各种因素增加了感染艾滋病毒的风险。这些包括:潜在的传染性体液最常见的接触部位是手、眼睛或粘膜,在有血液飞溅的情况下可能发生接触。暴露后预防暴露后预防(PEP)是指使用抗逆转录病毒疗法对职业性暴露进行治疗。其理由是,在接触艾滋病毒后立即开始抗逆转录病毒治疗可以预防艾滋病毒感染。已知HIV污染血液经皮损伤暴露后预防方案(PEP)及其预防方案(2 / 4)是最近修订的。这一变化得到了加拿大医学协会和其他有关卫生保健机构感染控制和无菌程序的机构的支持。PEP方案不时地在对卫生保健工作者经皮接触受艾滋病毒污染的血液后艾滋病毒血清转化的前瞻性病例对照研究进行审查后进行修改。这些研究通常被称为疾控中心针刺研究。虽然在牙科环境中受艾滋病毒污染的经皮损伤后发生血清转化的可能性似乎极不可能,但不幸的是,牙科环境中受污染的经皮损伤确实会发生。有几种预防措施可以减少艾滋病毒传播的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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