Reports on HIV/AIDS: 1990

JANUARY 26, 1990, MMWR, Vol. 39, RR-1: [inclusive page numbers]
PHS RECOMMENDATIONS FOR MANAGEMENT OF PERSONS
AFTER OCCUPATIONAL EXPOSURES THAT MAY PLACE
THEM AT RISK OF ACQUIRING HIV INFECTION
Employers should make available to workers a system for promptly initiating
evaluation, counseling, and follow-up after a reported occupational exposure that
may place the worker at risk of acquiring HIV infection. Workers should be educated
to report exposures immediately after they 6ccur, because certain interventions that
may be appropriate, e.g., prophylaxis against hepatitis B, must be initiated promptly
to be effective (3,8,9). Workers who might reasonably be considered at risk of
occupational exposure to HIV should be familiarized with the principles of postexposure management as part of job orientation and ongoing job training.
If an exposure occurs, the circumstances should be recorded in the worker's
confidential medical record. Relevant information includes the following:
* date and time of exposure
* job duty being performed by worker at time of exposure
* details of exposure, including amount of fluid or material, type of fluid or
material, and severity of exposure (e.g., for a percutaneous exposure, depth of
injury and whether fluid was injected; for a skin or mucous-membrane exposure, the extent and duration of contact and the condition of the skin, e.g.,
chapped, abraded, intact)
* description of source of exposure-including, if known, whether the source
material contained HIV or HBV
* details about counseling, postexposure management, and follow-up
After an occupational exposure, both the exposed worker and the source individual should be evaluated to determine the possible need for the exposed worker to
receive prophylaxis against hepatitis B according to previously published CDC
recommendations (3,8,9). Because of the potentially severe consequences of hepatitis B virus infection, hepatitis B vaccine, which is both safe and highly effective (10),
should be offered to any susceptible health-care worker who has an occupational
exposure and has not previously been vaccinated with hepatitis B vaccine. Hepatitis
B immune globulin may also be indicated, particularily if the source patient or
material is found to be positive for hepatitis B surface antigen (HBsAg) (3,8,9).
In addition, the source individual should be informed of the incident and, if consent
is obtained, tested for serologic evidence of HIV infection. If consent cannot be
obtained (e.g., patient is unconscious), policies should be developed for testing
source individuals in compliance with applicable state and local laws. Confidentiality/
of the source individual should be maintained at all times.
If the source individual has AIDS, is known to be HIV-seropositive, or refuses
testing, the worker should be evaluated clinically and serologically for evidence of HIV
infection as soon as possible after the exposure (baseline) and if seronegative, should
be retested periodically for a minimum of 6 months after exposure (e.g., 6 weeks, 12
weeks, and 6 months after exposure) to determine whether HIV infection has
occurred. The worker should be advised to report and seek medical evaluation for any
acute illness that occurs during the follow-up period. Such illness, particularly if
characterized by fever, rash, myalgia, fatigue, malaise, or lymphadenopathy, may be
indicative of acute HIV infection, drug reaction, or another medical condition. During