🩺"Surgical Protocols & HIV: A Clinical Guide to Safety and Post-Exposure Measures for Surgeons"

 

🩺"Surgical Protocols & HIV: A Clinical Guide to Safety and Post-Exposure Measures for Surgeons"

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🔷 Introduction

Operating on HIV-positive patients requires enhanced vigilance. This blog provides an in-depth medical framework — pre-op, intra-op, and post-op — for infection control, exposure management, and medico-legal safety, ensuring both patient care and surgeon safety.

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🛡️ 1. Pre-Surgical Precautions

✅ a. Universal Precaution

• Treat all patients as potentially infectious.

• Use double gloves, face shields, and impermeable gowns.

• Prepare surgical staff about HIV transmission risks (0.3% per needlestick).

💊 b. Medication for High-Risk Exposure Anticipation (Optional)

• If patient is known HIV+ with high viral load, some high-risk centers begin PrEP for surgical team prior to high-risk exposure.

• Tenofovir Alafenamide 25mg + Emtricitabine 200mg  (1 tab before one day of procedure, 2 tab that day procedure done , 1 tab third day of procedure ) may be considered for continuous high-risk professionals. 

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🔪 2. During Surgery

🧷 a. Instrument Handling

• Use blunt suture needles, needle holders, and no-touch technique.

• Never pass sharps hand-to-hand — use a tray.

🩸 b. Team Management

• Limit personnel in the OT.

• Assign a trained assistant to watch for protocol breaches.

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🚨 3. What If An Accident Happens? (Exposure Response)

🩻 a. Types of Exposures

• Percutaneous Injury (Needlestick)

• Mucosal Contact (Eye, Mouth)

• Non-intact skin exposure

⏱️ b. Immediate First Aid

• Needlestick: Let it bleed, wash with soap and water.

• Mucosa: Rinse with saline.

• Skin: Wash area thoroughly.

💊 c. Start PEP Within 2 Hours

• Recommended 28-day PEP regimen:

  • Tenofovir DF (300 mg) + Emtricitabine (200 mg) + Dolutegravir (50mg)  – once daily for 28 day

  •                                                               OR 

  • Tenofovir AF (25 mg) + Lamivudine (300 mg) + Dolutegravir (50mg)  – once daily for 28 day

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🧪 4. Follow-Up Protocol

• Baseline HIV, HBsAg, HCV testing

• Follow-up HIV tests at 6 weeks, 3 months, and 6 months

• Monitor for PEP side effects (nausea, liver enzymes, renal function)

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📁 5. Documentation & Reporting

• File incident report immediately.

• Document time, type of exposure, patient status, and PEP initiation.

• Notify hospital infection control committee.

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⚕️ 6. Legal and Ethical Responsibility

• Maintain confidentiality of both patient and surgeon.

• Inform surgeon about right to PEP and counseling.

• Record consent and disclosure where required.

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🧠 Conclusion: Safety Is Systematic, Not Situational

Treat every surgery as a potential exposure. Use universal precautions, stay prepared for exposure, and act quickly in emergencies. PEP is most effective within 2 hours — do not delay.

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🏷️ medicine require helpline number 9637531539 and 9421704106

 

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🩺 Pre-Exposure and Post-Exposure Prophylaxis (PrEP & PEP): Complete Guide for Healthcare and High-Risk Settings

Author: BJ (Health Blogger)
Category: Medical Awareness | Infectious Diseases
Published on: 28 June 2025

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🧬 Introduction

In a world where healthcare workers, lab technicians, and even the general public face risk of exposure to serious infections like HIV, Hepatitis B/C, and other blood-borne or sexually transmitted diseases — preventive care becomes critically important.

That's where Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) come into play.

These are preventive medical strategies used before or after potential exposure to an infection to reduce the risk of acquiring that infection.

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📌 What is Pre-Exposure Prophylaxis (PrEP)?

PrEP stands for Pre-Exposure Prophylaxis — it is a method where a person takes medication before being exposed to a virus, especially HIV, to prevent infection.

🧪 Used For:

• Preventing HIV infection in high-risk individuals.

• Preventing Hepatitis B in non-immune persons.

👥 Who Should Use PrEP?

• People with a partner who is HIV positive.

• Health care workers at high risk.

• Individuals with multiple sexual partners.

• Injection drug users.

• People who engage in unprotected sex.

💊 Common Medicines for PrEP (for HIV):

Medicine Name	Drug Combination	Notes
Tab. Tavin-EM	Tenofovir disoproxil + Emtricitabine	Once daily oral pill
Tab. Emtaf	Tenofovir alafenamide + Emtricitabine	Not approved for vaginal sex

Effectiveness: PrEP reduces the risk of getting HIV from sex by 99% and from injection drug use by 74%when taken daily.

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📌 What is Post-Exposure Prophylaxis (PEP)?

PEP stands for Post-Exposure Prophylaxis — taking medication after potential exposure to prevent infection from viruses like HIV, Hepatitis B/C.

💉 Used For:

• Healthcare workers after needle-stick injuries.

• Accidental exposure to HIV-infected blood.

• Unprotected sex with someone who may be HIV-positive.

• Sexual assault victims.

• Shared needles.

🕒 Timing is Critical:

• Must be started within 72 hours of exposure.

• The sooner, the better — ideally within 2 hours.

💊 Common PEP Regimen (for HIV):

Duration	Medicine Name	Combination brand name
28 days	Tenofovir alafenamide 25mg + Emtricitabine 200mg+ Dolutegravir 50mg	Tab Spegra
28 days	Tenofovir disoproxil 300mg + Lamivudine 300mg + Dolutegravir 50mg	Tab Viropil

Important: Complete 28-day course even if tests are negative.

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🩻 PEP for Hepatitis B

Situation	Action
Source is HBsAg positive, person not vaccinated	Administer HBIG + Start full HBV vaccine series immediately
Source unknown or low risk	Start vaccine series if unvaccinated
Person vaccinated but non-responder	Give HBIG x2 doses, or HBIG + revaccinate

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🔬 PEP for Hepatitis C (HCV)

• No effective PEP currently available.

• Close follow-up and monitoring is recommended.

• Direct-acting antivirals (DAAs) are used after diagnosis, not as prophylaxis.

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💡 Practical Examples:

Situation	Prophylaxis Used	When to Start
Doctor gets needle prick from HIV+ patient	PEP for HIV	Within 2 hours
Nurse exposed to hepatitis B-infected blood	HBIG + HBV vaccine	Immediately
Person in high-risk sexual relationship	PrEP for HIV	Daily, before exposure
Healthcare student assisting in surgeries	PrEP (optional)	Continuous during risk

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⚠️ Side Effects and Monitoring

Common Side Effects:

• Nausea, fatigue, headache

• Mild liver or kidney function changes

Monitoring Required:

• HIV test before starting PrEP or PEP

• Kidney function (Creatinine)

• Hepatitis B/C testing

• Pregnancy test (in females of childbearing age)

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✅ Summary Checklist

Topic	PrEP	PEP
Use	Before exposure	After exposure
Time	Daily	Within 72 hours
Duration	Ongoing	28 days
Target	High-risk people	Emergency exposure cases
Effectiveness	99% (HIV)	High if started early

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📢 Final Note

PrEP and PEP are powerful tools in protecting healthcare workers, lab technicians, and the general public from potentially life-threatening infections.

Every doctor, surgeon, nurse, and even informed citizen should know:

• When to use it,

• What to take,

• And how to act fast in emergency situations.

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🙋 Need for medicine help line number 9637531539 and 9421704106