Post Exposure Prophylaxis (PEP)

Section 1 - ADMINISTRATIVE POLICIES

1.19 POST EXPOSURE PROPHYLAXIS (PEP)

INDICATIONS: In the event of a significant exposure to a potentially HIV infected patient, the Seminole County EMS system will provide immediate time sensitive, within 1 hour, oral prophylactic antiretroviral medications to significantly decrease the possibility of the Emergency Responder becoming infected.

A significant HIV exposure is defined as a percutaneous injury (e.g., a needle stick or cut with a sharp object) or contact of mucous membrane or non-intact skin (e.g., exposed skin that is chapped, abraded, or interrupted by dermatitis) with blood, tissue, or other body fluids that are potentially infectious. In addition to blood and visibly bloody body fluids, semen and vaginal secretions also are considered potentially infectious but have not been implicated in occupational transmission from patients to responder. The following fluids also are considered potentially infectious: CSF, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid. Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomit are not considered potentially infectious unless they are visibly bloody; the risk for transmission of HIV from these fluids and materials is low.

PROCEDURE:

• Upon the realization that a significant exposure has occurred as a result of patient contact while on-duty, the exposed responder should:
  • Take immediate steps to flush or cleanse the exposed area with soap and water or an approved bactericidal / virucidal product. (First-aid treatment)
  • Contact the Seminole County Emergency Communications Center (SCECC) and request contact with the on call infectious disease physician.
  • The remaining crew should contact their immediate supervisor per department policy.

• The SCECC supervisor will:
  • Contact the on call ID physician specialist to directly call the exposed responder.
    • If no contact can be made with the ID physician in 15 minutes, contact the on–duty medical director.
  • Dispatch non-emergency the nearest available Battalion Chief (BC) with a PEP kit to the location of the exposed responder to dispense medication(s).

• The ID physician or his designee shall:
  • Contact the exposed responder within 15 minutes and discuss with the responder the specifics of the exposure and will:
    • Determine the significance of the exposure and the need for PEP
    • Determine the recommended PEP regimen
    • Discuss the risks and benefits of PEP
    • Discuss any required follow-up care
  • Review the plan with the employee and supervisor. When the responding BC arrives on scene, the ID physician will give the orders for medication administration, baseline labs to be drawn and any other pertinent information.

• The Battalion Chief shall:
  • Meet with exposed employee and confirm that they have, or will be consulting with the Infectious Disease Physician. If not, have the communication center make a call to the ID physician’s service.
  • Once the employee is counseled, confirm with the ID physician on the telephone the medications that are to be prescribed to the employee, dosage, frequency and time.
  • Locate the medication dispensing form on the blue case and complete it with the required information about the patient (employee) and the dispensing information to include the dosage of the medication, the frequency and time.
  • Take the prescribed medication bottle out of the case confirm the medication, dose and time with the patient.
  • Complete the enclosed lab form marking the specific labs requested by the ID physician. Have the employee proceed to the hospital to get baseline labs drawn. The lab reports must be routed back to the Infectious Disease Physician office.
  • When the exposed employee arrives at the hospital they need to notify the charge nurse that a significant exposure has occured.
  • The lab results for the source patient can only be given to the exposed employee. Some of the test results will only take 15-20 minutes to obtain.
  • Give the prescribed medication bottle(s) to the employee along with the prescription info envelope.
  • Have the employee complete all related Worker’s Compensation claim paperwork and any other required forms for the agency.
  • Secure the blue case with the dispensing form in your vehicle and turn it into the EMS Office to be restocked.
  • Once the labs and medication administration are completed, follow your agency’s protocol regarding Worker’s Compensation, relief from duty, etc.