🩺"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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