Tatalaksana

Post Exposure Prophylaxis

Ns. Sondang Sianturi, SKep., MSN

STIK Sint Carolus
 Introduction

• Health care workers (HCW) are normally

at a very low risk of acquiring HIV
infection during management of the
infected patient.

PEP / pajanan okupasional

 HCW

• Nurse 40%
• Resident 14%
• Attending physician 8%
• Surgery attendant 5%
• Non-lab. technologist 5%
 BIOSAFETY
• Importance - No vaccine
- Expensive treatment

• Practices - Universal Work Precautions

- Effective use of sterilisation and
disinfection
- Safe disposal of hospital waste
 UNIVERSAL PRECAUTIONS
• Barriers Protection
• Hand washing
• Safe techniques
• Safe handling of
– Sharp items
– Specimens
– Spill of blood / body fluids
• Use of Disposable / Sterile items
PEP FOR OCCUPATIONAL EXPOSURE

• Taken when someone working in a healthcare

setting is potentially exposed to material
infected with HIV.

– Prevention of blood exposure

– Appropriate Post Exposure Management
 PEP FOR NON- OCCUPATIONAL
EXPOSURE

• Taken when someone is potentially exposed to

HIV outside the workplace.
– Ex:
– From sexual assault,
– During episodes of unprotected sex,
– Needle-sharing injection drug use
 DATA ON PEP

1. Retrospective Case Control Study of

HCP
2. ZDV efficacy in preventing perinatal
transmission
3. Evidence in animal studies
 DEFINITIONS
HCP EXPOSURE

Any person whose May place a Health

activities involve
contact with
Care Person at risk
BLOOD/OTHER BODY for HIV infection and
FLUIDS from patients requires
in a health care or lab consideration of PEP
setting or public safety
setting
 Who needs PEP?
• Anyone who may have • Healthcare :
been exposed to HIV – Tertusuk jarum yang
during a single event dipakai untuk
mengambil darah pasien
dengan HIV

– Terkena darah atau

cairan tubuh dimana
pasien memiliki banyak
virus HIV pada mata dan
mulut, kulit.
RATIONALE FOR PEP CONSIDERATIONS

• Pathogenesis of HIV infection – time course of

early infection
• Use of antiretrovirals prevents infection
– Biological plausibility
– Evidences
• Risk and benefit of PEP to exposed HCP
 IMMEDIATE TREATMENT OF
EXPOSURE SITE

• Wash wound & skin site with soap and water

• Mucous membrane to be flushed with water
• Use of Antiseptic to be done ( no evidence)
• Expressing fluid by squeezing
• Application of caustic agents or injection of
antiseptics into wound not recommended
 TIME & DURATION OF PEP

• Immediate
• Within 72 hrs of exposure
• After 1 wk, initiate PEP if increased risk of
transmission
• Optimal duration 4 wks
 MONITORING & MANAGEMENT OF PEP
TOXICITY

Baseline and 2 wks after starting PEP

• Complete blood count
• Renal function test
• Hepatic function test
• Evidence of hyperglycemia, hematuria,
hemolytic anemia, hepatitis, crystalluria
 Hal-hal penting

• Waktu yang terbaik adalah diberikan sebelum 4

jam dan maksimal dalam 48-72 jam setelah
kejadian
•  Paduan yang dianjurkan adalah AZT + 3TC + EFV
atau AZT + 3TC + LPV/r (Lopinavir/Ritonavir)
•  Nevirapine (NVP) TIDAK digunakan untuk PPP
•  ARV untuk PEP diberikan selama 1 bulan
•  Perlu dilakukan tes HIV sebelum memulai PPP
• ARV TIDAK diberikan untuk tujuan PPP jika tes
HIV menunjukkan hasil reaktif (karena berarti
yang terpajan sudah HIV positif sebelum
kejadian)
• Perlu dilakukan pemantauan efek samping dari obat
ARV yang diminum
• Perlu dilakukan Tes HIV pada bulan ke 3 dan 6 setelah
pemberian PPP
• Pada kasus kecelakaan kerja pada petugas yang
menderita Hepatitis B maka PPP yang digunakan
sebaiknya mengandung TDF/3TC untuk mencegah
terjadinya hepatic flare.
Prevention is the main stay of
strategy to avoid occupational
exposure to the HIV
 1. Use of protective barriers

• Gloves & aprons:

• They protect one from splashes of blood or
body fluids e.g. during surgery/delivery
• One may wear a waterproof gown or a sterile
cloth with a plastic apron underneath.
• Protective eye wear may be used to prevent
transmission by splash of fluids to mucous
membrane.
 2. Safe handling of sharps

• Never pass used sharps from one person to

another directly.
• Use forceps instead of fingers for guiding
sutures.
• The sharps should be disposed off in a
puncture resistant container.
 Apa yang harus dilakukan setelah
terkena darah pasien?

Immediately following an exposure to blood:

• Needlestick injuries and cuts should be washed
with soap and water
• Splashes to the nose, mouth or skin, should be
flushed with water
• Eyes should be irrigated with clean water, saline,
or sterile irrigants
• Do not put the pricked finger in mouth reflexly.
 Exposure management

• Health care workers put themselves at risk in

their work.
• Prevention of exposures is critical.
• Appropriate treatment, including PEP, after
exposures reduces risk.
• Awareness of post-exposure options may allay
fears of caring for infected patients.
 Pengobatan

• Basic Regimen: Zidovudine 300 mg (2 kali

sehari) + Lamivudine 150 mg (tiga kali sehari)

• Expanded Regimen: Basic Regimen + Indinavir

800 mg (3 kali sehari) atau Efavirens 600 mg
(sehari sekali)
 Management PEP
1. Pertolongan pertama
- Mencuci dengan air dingin dan sabun mandi atau
cairan hipoklorit.

2. Penilaian resiko pajanan

- Melakukan tes
- Evaluasi keparahan pajanan, kedalaman luka,
lama pajanan, jenis instrumen, stadium penyakit,
resistensi terhadap ARV
 Summary
• PEP harus dilakukan dalam 24-72 jam
• Sering tanpa konseling atau inform consent

HCW
• Alur layanan pada management PEP:
– Pertolongan pertama
– Penilaian resiko pajanan
– Konseling profilaksis (inform consent)
– Konseling pra test
• source\Video HIV\Universal Precautions.mp4