13- Accidental HIV Exposure of Workers

In a dying HIV patients' ward that has poor organization, no social security for workers, tired and scarce workers, and numerous other problems, the main responsibility in drug ordering must be to MINIMIZE injectable drugs!

Sources of danger:

Skin punctured by needles or other infected instruments, exposure of broken skin, cuts or wounds contaminated by body fluids from patient, splashes onto mucous membranes...

Policy:

1. Try to clean any blood from the wound.  You can suck blood out if really necessary if no mouth wounds.
2. Take immediately (AZT (-zidovudine-) 300 mg) + (3tc (-lamivudine-) 150 mg) + (indinavir 800mg if available), and try not to think too much about what has happened!
3. In writing describe in detail the accident (time + description of injury + description of patient's health condition + description of worker: menstruation? tired?  Good general condition?)
4. Telephone a medical center with good HIV experience and use your description to help them understand the full situation before following their suggestions.  If impossible to contact (night, no telephone available…) take drugs till you can contact them.  Normally we use: (AZT 300mg 2x/day) + (3TC 150 mg 2x/day) + (indinavir on empty stomach 800mg 3x/day if available) for 28 days.
5. Rest a lot to help body's ability to fight off infection.

This policy means:

1. You must always have a few bottles of AZT and 3TC and indinavir available in the hospice!
2. You must know the telephone number of a good medical center.
3. In a dying HIV patients' ward that has poor organization, no social security for workers, tired and scarce workers, and a plethora of other problems, the main responsibility in drug ordering must be to minimize injectable drugs!