Current Recommendations on the Workup and Post-exposure Prophylaxis for HIV, HBV, and HCV in Healthcare Workers

Hepatitis B, hepatitis C, and HIV are the most commonly acquired infections related to occupational exposure in the health care setting. Measures to reduce the risk of transmission in health care workers (HCW) include primary prevention and post-exposure prophylaxis (PEP). Primary prevention essentially includes the adoption of standard precautions to avoid percutaneous or mucocutaneous injuries and hepatitis B vaccination. PEP varies according to both the source patient and HCW serologic status. So far PEP is not approved for hepatitis C. The post-exposure management for hepatitis B will depend on the vaccination and immune status of the HCW. Immune HCW do not need prophylaxis. For non-immune HCW, prophylaxis includes hepatitis B vaccination and immune globulin within 7 days of the exposure. HIV-exposed HCW should initiate prophylaxis as soon as possible, using three drugs regardless of the type of exposure risk. New regimens including integrase inhibitors and protease inhibitors have improved HCW adherence to PEP. Timely reporting any exposure remains a challenge and is a priority for an adequate work up and management. HCW frequently do not recognize high-risk exposures and do not seek post exposure prophylactic management. Multidisciplinary efforts are still needed to improve HCW awareness and adherence to PEP.