What is the post-exposure prophylaxis (PEP) regimen for a needle stick injury?

From the Guidelines

The post-exposure prophylaxis (PEP) regimen for a needle stick injury typically involves immediate reporting, washing of the affected area, and initiation of antiretroviral medications as soon as possible, ideally within 24 hours, for a duration of 28 days.

Key Steps in PEP Regimen

• Immediate action: Wash the needle-stick site or cut with soap and water, and report the incident to a supervisor and seek medical treatment immediately 1.
• Hepatitis B prophylaxis: If the exposed person is unimmunized against hepatitis B and the source is HBsAg-positive, administer HBIG (0.06 mL/kg; maximum dose: 5 mL) intramuscularly and begin the hepatitis B vaccine series 1.
• HIV prophylaxis: Consider prophylaxis against HIV, with a basic regimen of a 4-week course of 2 anti-HIV drugs, or an expanded regimen containing 3 anti-HIV drugs for exposures with an increased risk of transmission 1.
• Follow-up: Ensure follow-up for the potentially exposed employee, including repeat serologic testing for hepatitis C and HIV at 6 months after potential exposure 1.

Important Considerations

• Timing of PEP: PEP should be initiated as soon as possible, preferably within 24 hours of exposure, and continued for 28 days 1.
• Source patient testing: If possible, test the source patient for HIV, hepatitis B, and hepatitis C to determine the likelihood of transmission 1.
• Employee education: Use this opportunity to educate the exposed person regarding risks of exposure, safe handling of sharps, immunization, standard precautions, and safe work habits 1.

From the Research

Post-Exposure Prophylaxis (PEP) Regimen for Needle Stick Injury

• The PEP regimen for a needle stick injury is not explicitly stated in the provided studies, but it is mentioned that timely post-exposure prophylaxis, after needlestick exposure to high-risk body fluids, is believed to reduce the risk of seroconversion to HIV 2.
• A study from 2010 reports that for healthcare workers who sustained injuries from HIV positive sources, antiretroviral therapy was started as part of the PEP regimen 3.
• Another study from 2000 mentions that the regimens used for PEP varied, but zidovudine, lamivudine, and indinavir or nelfinavir were prescribed for patients after needle stick injuries or sexual assault 4.
• It is also noted that PEP should be administered within 1 hour of injury, but only 15% of anaesthetists were aware of this in a study from 2000 2.
• A scoping review from 2024 identified factors influencing healthcare workers' use of PEP after occupational exposure, including awareness, acceptability, availability, uptake, and adherence, but does not provide a specific PEP regimen for needle stick injuries 5.

Administration and Follow-up

• Follow-up is done after three and six months of exposure to monitor for seroconversion 3.
• Completion of the full course of antiretroviral therapy is crucial, but may be influenced by factors such as financial concerns, side effects, and parental involvement in the case of children and adolescents 4.
• A coordinated effort at the initial presentation to the health care system and at follow-up is necessary for effective PEP management 4.

Special Considerations

• For healthcare workers who sustained injuries from sources that are HbsAg positive, a hepatitis B immunization booster, hepatitis B immunoglobulin (HBIG), and hepatitis B vaccine may be administered as part of the PEP regimen 3.
• HIV PEP in the non-occupational setting for children and adolescents presents a medical and management challenge, and requires careful consideration of the difficulties that may be encountered 4.