Mumbai: Doctor living with the fear of AIDS

[Guest guest]

[Editors note and a list of PEP resources follows the text of the message]

Doc living with the fear of AIDS

Friday, August01, 2008 After an accidental jab, Nair hospital resident in search

of a miracle drug

MUMBAI: It was just a jab of the needle, but it’s going to haunt this

28-year-old doctor for months, years and, perhaps, the rest of his life.

Four days ago, resident doctor Anil Patil (name changed) was trying to inject an

Aids patient when he accidentally jabbed himself.

Unfortunately, the incident occurred while Patil was trying to locate a vein and

the needle had already pricked the woman a few times. Since then the resident

doctor of BMC-run BYL Nair Hospital has been running from one hospital to

another in search of a miracle drug that can protect him from the deadly virus.

Though they treat scores of HIV positive patients every day, Patil and his

colleagues got extremely jittery after Monday’s incident and began making

frantic calls to senior doctors. That’s because the patient is suffering from

multiple ailments like meningitis and tuberculosis and, most importantly, she

has not been responding to any Hiv/Aids drugs of late.

She is suffering from the resistant type of the virus and we got really worried

that Patil would contract the virus, said one of the resident doctors from the

medicine department.

A first-year post-graduate student of medicine, Patil immediately rushed to the

anti-retroviral therapy (ART) centre of the JJ Hospital where he was put on the

first line of HIV drugs. He has to continue with the regimen that is known for

its horrific side-effects for at least a month

http://www.dnaindia.com/report.asp?newsid=1181052

_______________________

Editors note: It is unfortunate that BMC-run BYL Nair Hospital staff are not

aware of the protocol to be followed, if Occupational exposure to HIV happened

and the Post Exposure Prophylaxis (PEP). The PEP Protocol is available on the

NACO webpage.

This incident is yet another example of the consequences of not having a

National comprehensive advocacy, education and support for PEP in Occupational

and non Occupations settings.

“Occupational exposure refers to exposure to potential blood-borne infections

(HIV, HBV and HCV) that may occur in healthcare settings during performance of

job duties. Post exposure prophylaxis (PEP) refers to comprehensive medical

management to minimise the risk of infection among Health Care Personnel (HCP)

following potential exposure to blood-borne pathogens (HIV, HBV, HCV). This

includes counselling, risk assessment, relevant laboratory investigations based

on informed consent of the source and exposed person, first aid and depending on

the risk assessment, the provision of short term (four weeks) of antiretroviral

drugs, with follow up and support”(NACO)

One of the best article on this subject in India is from Armed Forces Medical

College, Pune

“Post-exposure Prophylaxis : What Every Health Care Worker Should Know” by Col K

Kapila*, Col RM Gupta, Brig GS Chopra, SM,VSM. MJAFI 2008; 64 : 250-253.

A pdf copy of this article is available on the following url.

http://medind.nic.in/maa/t08/i3/maat08i3p250.pdf

http://www.nacoonline.org/National_AIDS_Control_Program/Services_for_Prevention/\

PEP/

PEP Resources from SHIC E-mail Update No. 98, June 16-30, 2008

(shic@...)

Occupational HIV post exposure prophylaxis (PEP) is an accepted form of

secondary HIV prevention for health care workers exposed to HIV during the

course of their role in caring for patients. There is growing international

interest in the use of these drugs to prevent HIV transmission following sexual

and other non-occupational exposures. In contrast to occupational HIV PEP,

currently there are no national guidelines for non-occupational HIV PEP.

RESOURCES

1. Post Exposure Prophylaxis: This web page article provides an overview of Post

Exposure Prophylaxis. http://www.who.int/hiv/topics/prophylaxis/en/

2. Antiretroviral Post-Exposure Prophylaxis (PEP) for Occupational HIV Exposure:

This Cochrane review evaluated the effects of antiretroviral PEP for preventing

HIV infection following occupational exposure.

http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002835/frame.html

3. Occupational Post Exposure Prophylaxis for HIV: Discussion paper prepared for

a WHO consultation examines issues associated with occupational exposure to HIV.

http://www.who.int/hiv/topics/arv/OccPEP2005.pdf

4. HIV Post Exposure Prophylaxis Following Non-Occupational Exposures: A

background document that summarizes the data supporting non-occupational PEP

use, describes the experience to date, outlines indications for PEP, and

considers PEP interventions. It also presents considerations for programme

development in resource-poor and resource-rich settings and summarizes existing

international, national, state, and provincial guidelines.

http://www.aidsportal.org/repos/kbr-07-02-07-roland.pdf

5. Occupational and Non-occupational Post exposure Prophylaxis for HIV Infection

(HIV-PEP): Summary report of a Joint ILO/WHO Technical Meeting for the

Development of Policy and Guidelines on Occupational and Non-occupational

Post-exposure Prophylaxis for HIV Infection (HIV-PEP).

http://www.who.int/hiv/topics/arv/HIV-PEPflyer081606.pdf

6. National Guidelines for Post-exposure Prophylaxis: These NACO guidelines

describe the risks of infection, the preventive measures and the procedures to

follow after occupational exposure.

http://www.whoindia.org/LinkFiles/HIV-AIDS_National_guidelines_PEP.pdf

7. UK Guideline for the Use of Post-Exposure Prophylaxis for HIV after Sexual

Exposure (PEPSE): This British Association for Sexual Health and HIV (BASHH)

document includes a review of the current data to support the use of PEPSE,

considers how to calculate the risks of HIV infection after a potential

exposure, and provides recommendations on when PEPSE would and would not be

considered. http://www.bashh.org/guidelines/2006/pepse_0206.pdf

8. Post Exposure Prophylaxis in Children and Adolescents for Non-Occupational

Exposure to Human Immunodeficiency Virus This clinical report reviews issues of

potential exposure of children and adolescents to HIV and gives recommendations

for PEP in those situations.

http://pediatrics.aappublications.org/cgi/reprint/111/6/1475

[Guest guest]

Friends,

/message/9111

Despite NACO having supplied the PEP medicines for Occpational exposure to all

districts in large quantity, the medicines are lying in stores and not reaching

service providers at places where they could be acessible round the clock. SOP

for PEP administration by NACO are avaiable on the website.

 

But we need another set of SOP on PEP accessibility- All hospitals should have a

clear writen policy on Injection safety and handling accidents.

The nodal person in each institution with whom PEP will be available should be

identified and his mobile number prominently displayed; so that s/he can be

contacted round the clock.  In case s/he is off duty/leave ther person having

custody of the medicines should also be notified.

Only then can we have the initiation of PEP within 2 hrs as is needed for

optimal response. The process needs to be monitored otherwise things dont move,

and even a circular within the institution on avaiability of PEP is missing

even after the PEP reaches the incharge of the institution.

Development and implementation of this SOP will save the affected service

provider having to run around and groping in the dark in panic after an

accident.

--

Dr RK Sood

FETP Scholar (NIE, Chennai)

drrksood@...

+91 9418064077, +91 9445157327

[Guest guest]

Dear all,

 

Re: /message/9111

Accidental occupational exposure to HIV is not an uncommon thing during medical

practice now a days and every health care provider should be trained how to face

it . Also every hospital has to have a protocol to deal with such situations.

Any way this case the doctor seem to have been started on first line ART

 

But will this suffice? the patient is supposed to have " extremely resistant

type " of virus. It means the virus is resistant to first line. is there any

point in giving first line drugs as PEP in this case? do we have a policy for

that? In case the patient gets infected who will pay him damages and treatment

expenses with costly drugs?

Yes, it is time to think about this.

 

Dr Ajith

 

--

Dr Ajithkumar.K

Asst Professor In Dermatology and Veneriology

Medical collge Chest Hospital

MG Kav,Trichur, Kerala ,India

Ph 04872333322 (res) 9447226012

e-mail: <ajisudha@...>