COMMENTARY

HIV Prophylaxis Following Occupational Exposure: Guideline and Commentary

Barry S. Zingman, MD

Disclosures

January 30, 2013

In This Article

Responsibilities of Employers

Recommendations:

As part of a comprehensive plan to prevent the transmission of bloodborne pathogens, employers should implement the use of safety devices and educate workers about how to prevent needlestick injuries. (AIII)

Antiretroviral medications for PEP should be readily available to exposed workers who sustain a potential occupational exposure to HIV. (AIII) When establishing plans for providing PEP, employers should determine the following:

   - who will perform the post-exposure evaluation

   - who will provide counseling to the exposed worker regarding the exposure and indications for PEP (for off-hour exposures as well)

   - how PEP will be made available within 2 hours of an exposure

   - how a 3- to 5-day supply of PEP will be made available for urgent use

   - who will be given authority for releasing drugs for this purpose

   - how the exposed worker will obtain a continuous supply of PEP drugs to complete the 28-day regimen

Employers should determine who will pay for PEP and establish policies for submitting claims to their Workers' Compensation plan. Exposed workers should not be expected to pay out-of-pocket for PEP, even if it is reimbursed at a later date.

Federal law requires covered employers to ensure that all medical evaluations and procedures, vaccines, and post-exposure prophylaxis are made available to the employee within a reasonable time and at a reasonable location and are made available at no cost to the employee (OSHA, 29 CFR, Part 1910.1030, CPL 2-02.069, 11/27/01, Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens).

As part of the employer's plan to prevent transmission of bloodborne pathogens, the following measures can be taken to avoid injuries:

elimination of unnecessary use of needles or other sharps

use of devices with safety features

verification of compliance with safety features

avoidance of recapping of needles

planning before beginning any procedure using needles or other sharps for safe handling and prompt disposal in sharps disposal containers

promotion of education and safe work practices for handling needles and other sharps

For more information about prevention of needlestick injuries, refer to the NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings.[12]

Even when effective prevention measures are implemented, exposures to blood and bodily fluid still occur. Employers of personnel covered by the Bloodborne Pathogen Standard are obligated to provide post-exposure care, including prophylaxis, at no cost to the employee. The employer may subsequently attempt to obtain reimbursement from Workers' Compensation. Appendix C provides further information regarding employer responsibilities.

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