Harbor:Non-Occupational Exposure: Difference between revisions
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*CDC Information: http://stacks.cdc.gov/view/cdc/38856.
*CDC Information: http://stacks.cdc.gov/view/cdc/38856.


==Harbor ED Policy <ref>Email from Dr. Lewis on 1/23/18</ref>==
==Harbor ED Policy==
* Harbor Sexual Assault algorithm and resources
* Harbor Sexual Assault algorithm and resources
** Harbor - How to for SART Team:  https://www.wikem.org/wiki/File:SART_ED_Protocol_Recommendations.pdf
** Harbor - Detailed "How to" for SART Team:  https://www.wikem.org/wiki/File:SART_ED_Protocol_Recommendations.pdf
*** Preserve all evidence (skin, urine, clothing) and protect chain of custody;  address any life-threatening emergencies as appropriate!
*** Limit detailed documentation of described events to avoid future discrepancies
*** Closest SART Center is in San Pedro
*** Forensic Nurse Specialist (SART Staff) available 24/7 at (562) 497-0147
** LA County Public Health HIV PEP Recommendations:  https://www.wikem.org/wiki/File:SART_-_Public_Health_HIV_PEP.pdf
*** High-risk HIV exposure:  sharing needles with a known HIV-positive partner or a partner of unknown status or unprotected (or failed condom) vaginal intercourse or anal sex
** Los Angeles SART Centers:  https://www.wikem.org/wiki/File:SART_Centers.pdf
** Los Angeles SART Centers:  https://www.wikem.org/wiki/File:SART_Centers.pdf
** LA COunty Public Health HIV PEP Recommendations:  https://www.wikem.org/wiki/File:SART_-_Public_Health_HIV_PEP.pdf
** https://emedharbor.labiomed.org/private/Contact%20Info/ED%20Documents/Sexual%20Assault%20Protocol.pdf




*Pre-exposure prophylaxis to sexual exposure has been studied as part of a preventive public health strategy and is effective in some well-controlled, very limited circumstances.  This is rarely an emergency medicine issue.
** OLD Policy https://emedharbor.labiomed.org/private/Contact%20Info/ED%20Documents/Sexual%20Assault%20Protocol.pdf
 
***Pre-exposure prophylaxis to sexual exposure has been studied as part of a preventive public health strategy and is effective in some well-controlled, very limited circumstances.  This is rarely an emergency medicine issue.
*The possible exception would be the case of exceptionally high risk exposure (partner or assailant in the case of sexual assault is known or highly likely to be HIV positive with a high viral load and the sexual activity was associated with a high risk of transmission, e.g., receptive anal intercourse, sexual assault with vaginal trauma), occurring within the prior 72 hours.  Sexual assault victims should be referred immediately to a RAPE center where PEP may be offered as part of the overall care plan.
***The possible exception would be the case of exceptionally high risk exposure (partner or assailant in the case of sexual assault is known or highly likely to be HIV positive with a high viral load and the sexual activity was associated with a high risk of transmission, e.g., receptive anal intercourse, sexual assault with vaginal trauma), occurring within the prior 72 hours.  Sexual assault victims should be referred immediately to a RAPE center where PEP may be offered as part of the overall care plan.
 
***For the vast majority of cases in which a patient seeks post-sexual-exposure HIV prophylaxis, the patient should simply be referred to the Los Angeles LGBT Center.  The LA LGBT Gay and Lesbian Center has a program for post-exposure prophylaxis in a number of specific circumstances; patients can be referred within 72 hours of an exposure.  Their hours are Mon-Friday 11am-6pm (telephone number is 323-860-5855, and their website is https://lalgbtcenter.org/post-exposure-prophylaxis).  The emergency department is generally not the place to start post-sexual-exposure prophylaxis because it ideally is part of an ongoing risk reduction strategy.
*For the vast majority of cases in which a patient seeks post-sexual-exposure HIV prophylaxis, the patient should simply be referred to the Los Angeles LGBT Center.  The LA LGBT Gay and Lesbian Center has a program for post-exposure prophylaxis in a number of specific circumstances; patients can be referred within 72 hours of an exposure.  Their hours are Mon-Friday 11am-6pm (telephone number is 323-860-5855, and their website is https://lalgbtcenter.org/post-exposure-prophylaxis).  The emergency department is generally not the place to start post-sexual-exposure prophylaxis because it ideally is part of an ongoing risk reduction strategy.
***If you happen to see a patient who meets the criteria above, then a baseline rapid HIV should be sent to make sure the patient is not already infected.  If the baseline rapid HIV test is negative and if the end of the 72 hour window is near, or it is a Friday night or a weekend, then the HIV service may be consulted, as they may choose to offer a few doses of post-exposure prophylaxis for the patient to take prior to being seen at the LA LGBT Center. Please remember that the HIV fellows and attendings are on call for weeks at a time, so middle of the night calls should be reserved for emergencies.<ref>Email from Dr. Lewis on 1/23/18</ref>
 
*If you happen to see a patient who meets the criteria above, then a baseline rapid HIV should be sent to make sure the patient is not already infected.  If the baseline rapid HIV test is negative and if the end of the 72 hour window is near, or it is a Friday night or a weekend, then the HIV service may be consulted, as they may choose to offer a few doses of post-exposure prophylaxis for the patient to take prior to being seen at the LA LGBT Center. Please remember that the HIV fellows and attendings are on call for weeks at a time, so middle of the night calls should be reserved for emergencies.


==See Also==
==See Also==

Revision as of 22:37, 12 June 2019

General Guidelines

Harbor ED Policy


    • OLD Policy https://emedharbor.labiomed.org/private/Contact%20Info/ED%20Documents/Sexual%20Assault%20Protocol.pdf
      • Pre-exposure prophylaxis to sexual exposure has been studied as part of a preventive public health strategy and is effective in some well-controlled, very limited circumstances. This is rarely an emergency medicine issue.
      • The possible exception would be the case of exceptionally high risk exposure (partner or assailant in the case of sexual assault is known or highly likely to be HIV positive with a high viral load and the sexual activity was associated with a high risk of transmission, e.g., receptive anal intercourse, sexual assault with vaginal trauma), occurring within the prior 72 hours. Sexual assault victims should be referred immediately to a RAPE center where PEP may be offered as part of the overall care plan.
      • For the vast majority of cases in which a patient seeks post-sexual-exposure HIV prophylaxis, the patient should simply be referred to the Los Angeles LGBT Center. The LA LGBT Gay and Lesbian Center has a program for post-exposure prophylaxis in a number of specific circumstances; patients can be referred within 72 hours of an exposure. Their hours are Mon-Friday 11am-6pm (telephone number is 323-860-5855, and their website is https://lalgbtcenter.org/post-exposure-prophylaxis). The emergency department is generally not the place to start post-sexual-exposure prophylaxis because it ideally is part of an ongoing risk reduction strategy.
      • If you happen to see a patient who meets the criteria above, then a baseline rapid HIV should be sent to make sure the patient is not already infected. If the baseline rapid HIV test is negative and if the end of the 72 hour window is near, or it is a Friday night or a weekend, then the HIV service may be consulted, as they may choose to offer a few doses of post-exposure prophylaxis for the patient to take prior to being seen at the LA LGBT Center. Please remember that the HIV fellows and attendings are on call for weeks at a time, so middle of the night calls should be reserved for emergencies.[1]

See Also

References

  1. ↑ Email from Dr. Lewis on 1/23/18
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