Emergency Triage Engine: This algorithm simultaneously evaluates the risk for HIV, Hepatitis B (HBV), and Hepatitis C (HCV) to generate a unified Post-Exposure Prophylaxis (PEP) and baseline testing protocol.
1. Exposure Details
2. Source Patient Serology
If the source is unknown (e.g., a needle found in the laundry), select "Unknown" for the respective fields. Do not delay PEP waiting for lab results if the exposure is high-risk.
3. Exposed Person (HCW) Status
HIV PEP Indication
-
-
HBV HBIG / Vax
-
-
1. HIV Action Plan
2. Hepatitis B Action Plan
3. Hepatitis C Action Plan
Academic Pearls & Clinical Pathophysiology
1. Mnemonic for Immediate First Aid: "WASH"
W - Wash the area thoroughly with soap and flowing water.
A - Avoid squeezing or milking the wound. Do NOT apply bleach or caustic agents.
S - Source testing (Draw blood from the source patient for HBsAg, HIV, Anti-HCV immediately).
H - HIV PEP & HBIG evaluation within the critical 72-hour window.
Clinical Pitfall (The "Squeeze"): Panicked healthcare workers routinely squeeze the punctured finger to bleed it out. Pathophysiology: Squeezing creates intermittent negative pressure in the capillary bed, which acts as a vacuum, actively drawing viral particles deeper into the tissue. Furthermore, applying alcohol or bleach causes tissue necrosis, creating micro-tears that facilitate viral entry. Wash gently with soap and water only.
2. Pathophysiology: Why HBIG + Vaccine?
In a high-risk exposure (Unvaccinated HCW + Positive Source), administering the Hepatitis B vaccine alone is too slow; the virus will replicate before active immunity develops. We must use Post-Exposure Prophylaxis Bridging:
HBIG (Hepatitis B Immune Globulin): Provides immediate, passive neutralising antibodies that bind to the HBsAg on the viral envelope, preventing hepatocyte entry. This protection fades in a few weeks.
HBV Vaccine: Initiates the endogenous T-cell and memory B-cell response for long-term active immunity.
Administration Rule: If giving both, they MUST be administered in different limbs (e.g., Left Deltoid and Right Deltoid). If given in the same site, the passive HBIG antibodies will bind to and neutralise the vaccine antigen, rendering the vaccine useless.
3. Illness Script: The "Rule of 3s" for Needlestick Risk
When counselling a colleague after an untreated hollow-bore needlestick from a positive source, use the classic baseline transmission probabilities:
Pathogen
Untreated Transmission Risk
Post-Exposure Efficacy
Hepatitis B (HBV)
~30% (Highest Risk)
HBIG + Vax is >95% effective if given within 24-72 hours (HBIG viable up to 7 days).
Hepatitis C (HCV)
~3%
No active PEP available. Monitor HCV RNA; treat with Direct-Acting Antivirals (DAAs) if infection occurs (Cure rate >95%).
HIV
~0.3%
Triple-therapy ART PEP for 28 days reduces risk by >80% if started within 72 hours.
4. NACO India Guidelines: HIV PEP Regimen
The National AIDS Control Organisation (NACO) standard for adult PEP is a 28-day course of a three-drug regimen. The preferred regimen is Tenofovir (TDF) 300mg + Lamivudine (3TC) 300mg + Dolutegravir (DTG) 50mg once daily.
Pregnancy: NACO and WHO have updated guidelines to strongly recommend Dolutegravir-based regimens for pregnant women, as the previously suspected neural tube defect risk was found to be statistically insignificant.
Renal Impairment: Tenofovir Disoproxil Fumarate (TDF) is nephrotoxic. If eGFR is < 50 mL/min, TDF must be dose-adjusted or substituted with Zidovudine (AZT) or Abacavir (ABC) per specialist advice.
Abbreviations: PEP (Post-Exposure Prophylaxis) · HBIG (Hepatitis B Immune Globulin) · HCW (Healthcare Worker) · HBsAg (Hepatitis B Surface Antigen) · anti-HBs (Hepatitis B Surface Antibody) · HIV (Human Immunodeficiency Virus) · HCV (Hepatitis C Virus) · NACO (National AIDS Control Organisation) · ART (Antiretroviral Therapy) · TDF (Tenofovir) · 3TC (Lamivudine) · DTG (Dolutegravir)
Algorithm References & Evidence Base
National AIDS Control Organisation (NACO), Ministry of Health and Family Welfare, Government of India. National Guidelines for HIV Care and Treatment. 2021.
Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the ACIP. MMWR Recomm Rep. 2018;67(1):1-31.
Kuhar DT, Henderson DK, Struble KA, et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013;34(9):875-892.
Singh A, Kumar H, Tandon N. Guidelines for vaccination in normal adults in India. J Assoc Physicians India. 2016;64(Suppl):S1-S5.
How to Cite This Tool
AMA Style:
Umakanth S. Occupational Exposure & Needlestick PEP Pathway. MEDiscuss. Published 2026. Accessed .
Vancouver Style:
Umakanth S. Occupational Exposure & Needlestick PEP Pathway [Internet]. MEDiscuss.org; 2026 [cited ]. Available from:
