In Case of Needle Stick Injury

1. Wash and clean injury/flush mucous membranes immediately.
2. Assess risk
   1. Characterize exposure
   2. Evaluate exposure by medical history (see attached questionnaire)
   3. Evaluate and test exposed individuals
3. Perform Quick HIV test - this test is usually available at your nearest hospital ER. The rapid HIV test should be performed on the Source Patient.
4. Decide whether or not HIV post-exposure prophylaxis is needed with your healthcare provider
5. F/u with a healthcare worker for any pending labs, unknown source patient lab results, or any further questions. Appointments can be made at the LSU Campus Clinic, 478 S. Johnson St, 504-412-1995 or 504-412-1517 

Blood Monitoring Schedule

Initial Draw:

• If PEP: Baseline CBC , CMP, pregnancy test for women. Ideally, initiate medication within 30-90 minutes of exposure, and at least within 72 hours
• If PEP: Follow up with healthcare provider within 72 hours. Call the LSU Campus Clinic, 478 S. Johnson St, 504-412-1995 or 504-412-1517 for an appointment
• If PEP: Recheck kidney and liver functions in 2 weeks.
• Treatment duration is 28 days

• HIV Post-Exposure:
• If 4^th generation combination HIV p24 ag/ab testing being used, follow up lab testing at 6 weeks, then 16 weeks is sufficient
• If 4th generation combination HIV p24 ag/ab testing not available, perform HIV antibody testing for at least 6 month as follows:
  • At 6 weeks: HIV antibody
    At 3 months: HIV antibody
    At 6 months: HIV antibody
    At 1 year: HIV Antibody (recommended if source patient was co-infected with Hepatitis C)

• HCV Post-Exposure: If HCV RNA test available, a s early as 3 Weeks Post-Exposure:
  • HCV RNA. If negative, no further testing needed
  • If HCV RNA test not available, test for Hep C Ab w/reflex to HCV RNA as early as 4-6 months post-exposure

• HBV Post-Exposure

 If source patient tests negative for HBV, no follow-up HBV testing is necessary for the healthcare worker.
• Follow-up testing is necessary for exposed persons who do not have hepatitis B immunity (defined as a positive response to a complete HBV vaccine series, with a post-vaccination HBsAb titer ≥10 mIU/mL)
• For those who do not have HBV immunity, a test for Hep B core Ab (total) is drawn, followed by administration of HBIG x 1 and the first Hep B vaccine (the first of three shots administered over six months) for postexposure prophylaxis. For persons who do not respond to HepB vaccine (Hep B non-responders), a Hep B core Ab should be ordered. HBIG is administered at time of exposure then again one month later. The standard adult dose of HBIG is 0.06 mL/kg administered intramuscularly. HBIG can be administered simultaneously with HepB vaccine but at a different injection site.

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6210a1.htm

It is YOUR responsibility to come for testing.

PEP Meds -- Isentress 400 mg twice daily and Truvada once daily for 28 days

Pregnant Women: Combivir and Kaletra

Source Risk Assessment Questionnaire

Have you ever tested positive for HIV? Yes No
Have you ever tested positive for Hepatitis B or Hepatitis C? Yes No
Have you ever had a sexually transmitted disease? Yes No
Did you receive a blood transfusion or blood products between 1978 and 1985 Yes No
Have you ever used needles to inject street drugs? Yes No
Have you ever shared needles to inject street drugs? Yes No
Have you ever had sex with another person with HIV and AIDS? Yes No
Are you a male who has had sex with male partners? Yes No
Have you had sex with a person who injects street drugs? Yes No
Have you ever traded sex for money, drugs, food or housing? Yes No
Have you had unprotected sex (of any kind) within the last 10 years with someone other than your spouse? Yes No
Have you ever been sexually assaulted? Yes No
Have you had occupational exposure to blood or body fluids such as a needle stick within the last 10 years? Yes No
Do you have a sex partner with any of the above risks for HIV? Yes No
Are you or may you be pregnant? Yes No

Comments:

Signature: ___________________________________________

Date: ___________________________________________

Reviewed By: ___________________________________________

Obtain anti-retroviral meds from:

Walgreens Pharmacy, 900 Canal Street, (504) 568-1271

Blue Cross Blue Shield of Louisiana Insurance Company
Louisiana State University Needle Stick Standalone Benefit Summary

Coverage is provided for eligible students for testing and prophylactic treatment of blood-borne diseases following at-risk contact with blood or other body fluids from human or animal sources. This contact may include but is not limited to needle sticks. This benefit is not subject to any co-payment or annual deductible requirement.

Services must be received at: Louisiana State University Health Sciences Center Student Health Center (LSUHSC Student Health Center), Children's Hospital New Orleans, Our Lady of the Lake, Baton Rouge General Hospital, Women's Hospital in Baton Rouge, Ochsner Hospital, Ochsner Baptist, Baton Rouge General Occupational Health, LabCorp, Our Lady of Lourdes Rapides Medical Center,University Medical Center New Orleans, Lafayette General in Lafayette, Walter Moss Medical Center, Leonard Chabert Medical Center, Lallie Kemp Medical Center, Bogalusa Medical Center, Touro Infirmary, East Jefferson General Hospital, and West Jefferson Medical Center. Any services provided outside of these providers are excluded from coverage.