Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) POST-EXPOSURE PROPHYLAXIS Health care workers may be accidentally exposed to blood and other body fluids that are potentially infected with HIV, hepatitis virus or other bloodborne pathogens. Occupational exposure may occur through direct contact of non-intact skin with potentially infected blood or body fluids, from splashes into the eyes or mouth, or through injury with a used needle or sharp instrument. Post-exposure prophylaxis (PEP) can help prevent the transmission of pathogens after such a potential exposure. Managing occupational exposure to hepatitis B, hepatitis C and HIV The immediate response to exposure to blood or other fluids that are potentially infected with hepatitis B virus (HBV), hepatitis C virus (HCV) or HIV is as follows. Step 1. Provide immediate first aid care to the exposure site: • If a splash or a spill occurs on the skin, wash the area immediately with soap and water. Do not use caustic agents, alcohol or bleach, because they will irritate the skin and may increase the risk of infection. Do not apply a dressing. • If a splash or a spill occurs in the eyes, the nose, the mouth, or on any mucous membrane, rinse the area with clean water for at least 10 minutes. • If an injury has been caused by a potentially contaminated sharp, wash the area with soapy water, and allow the wound to bleed freely for a few minutes if possible. Then give normal first aid. Step 2. Evaluate the risk by determining the type of fluid (blood, visibly bloody fluid, or other potentially infectious fluid), the severity and type of exposure (percutaneous or needle stick, mucous membranes, intact or non-intact skin), and the source of infection. Step 3: If the source person is identified, it is important to try to obtain information on his or her hepatitis and HIV serostatus and, if positive, an evaluation of the clinical status and treatment history. • Assess the risk of infection, using available information. • The source person may be tested only with his or her informed consent. • Do not test discarded needles or syringes for virus contamination. Management of exposure to hepatitis B The medical response to exposure to hepatitis B virus (HBV) depends on the patient's immune status, as determined by the history of hepatitis B vaccination and vaccine response, and whether the exposure poses a risk of infection. Transmission of HBV may occur Prevention of Infection Chapter 8-16
Male circumcision under local anaesthesia Version 3.1 (Dec09) following percutaneous injury, or contamination of mucous membranes or non-intact skin. The virus does not cross intact skin. HBV post-exposure prophylaxis is safe for pregnant and breastfeeding women. Table 8.2. Recommendations for HBV post-exposure prophylaxis, according to immune status of exposed person HBV immune status Unvaccinated Previously vaccinated, known responder (anti-hepatitis B surface antigen positive) Previously vaccinated, known non-responder Antibody response unknown Post-exposure prophylaxis HBV vaccination and HB immunoglobulin (HB Ig) None HBV vaccination and HB Ig Test. If antibody response is poor, give HB vaccination and HB Ig People who receive hepatitis B vaccine should be tested for antihepatitis B surface antigen 1–2 months after the last dose. Note that the anti-hepatitis B surface antigen response to vaccine cannot be ascertained if the person was given HB Ig in the previous 3–4 months. Management of exposure to hepatitis C • There is no post-exposure prophylaxis regimen for hepatitis C virus (HCV). • Evaluate the person who has been exposed to hepatitis C virus by performing a baseline test for anti-HCV antibodies and alanine aminotransferase (ALAT). • Perform follow-up testing for anti-HCV antibodies and ALAT 4–6 months after exposure. • Repeatedly reactive anti-HCV enzyme immunoassays should be confirmed with supplemental tests. • Any person who is found to have HCV antibodies should be referred to a specialist for care. Prevention of Infection Chapter 8-17
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Manual for Male Circumcision under Local Anaesthesia

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