BIOMEDICAL WASTE

MANAGEMENT
(Amendment) RULES, 2018

Dr. Aseem Tiwari

(Community Medicine Lecture Scheduled on 9th May, 2020)

Moderator - Dr. Rajesh Garg

(HOD, Department of Community Medicine, KCGMC)
 Bio-Medical Waste – DEFINITION

• “Bio-medical waste" means any waste, which is generated during

the diagnosis, treatment or immunization of human beings or
animals or research activities pertaining thereto or in the
production or testing of biological or in health camps.

• The Bio-medical Waste Management rules are applicable to all

persons who generate, collect, receive, store, transport, treat,
dispose, or handle bio medical waste in any form.
 BMW Rules – HISTORY

• Ministry of Environment, Forest and Climate change.

• The BMW 1998 rules were modified in the years – 2000,

2003, and 2011,2016,2018,2019.
 BMW Rules – SCOPE

BMW Rules apply to All who generate, collect, receive, store, transport, treat,
dispose, or handle bio medical waste :-

 Hospitals,  Clinical establishments

 Nursing homes  Research or educational institution
 Clinics  Health camps,
 Dispensaries,  Medical or surgical camps,
 Veterinary institutions  Vaccination camps,
 Animal houses,  Blood donation camps,
Pathological laboratories  First aid rooms of schools,
(irrespective of the size)  Forensic and research labs.
 Blood banks,  AYUSH hospitals,
 BMW Rules – SCHEDULES and ANNEXURES

18 Rules, 4 Schedules, and 5 Forms

 Schedule I - BMW color coding, collection, treatment and disposal
 Schedule II - Standards for treatment and disposal
 Schedule III - Prescribed Authorities and Responsibilities
 Schedule IV - Labels for BMW containers and Bags

 Form I - Accident Reporting

 Form II and III - Application and Authorization document
 Form IV - Annual Report
 Form IVA - Annual Report by SPCB or AFMS to CPBB
 Form V - Appeal
 BM WASTE CATEGORISATION

WASTE

Non Infectious Hazardous

Infectious 10-15% 5-15%
75-85%

In a large tertiary care hospital in India (AIIMS), the Bio medical waste generated is about
1.5kg/bed/day as against 2.8kg/bed/day from a similar sized hospital in USA.
 Why BMW is Important ?

• 80% non-infectious (kitchen waste, paper)

• 15% is infectious (dressings, anatomical wastes, blood
bags)
• 5% is non infectious but hazardous (chemicals, drugs
and mercury)
• When this 20% of the hospital infectious material is
mixed with 80%.

Then all the 100% waste becomes

hazardous and infectious, hence segregation should be at
source.
Health Hazards of Health Care Waste
Hazards from Infectious waste and Sharps

• Through puncture, abrasion or cut or through mucous membranes by

inhalation or by ingestion
• HIV , hepatitis B and C Infection.

Hazards from Chemical and Pharmaceutical waste

Acute or chronic exposure may cause intoxication, and injuries

such as burns
Disinfectants and other highly reactive chemicals are
hazardous
Health Hazards of Health Care Waste
Hazards from Genotoxic waste
• Exposure through inhalation of dust or aerosols, absorption through skin,
ingestion of food contaminated with cytotoxic drugs or wastes.
• Severity depends on extent and duration of exposure, and combination of
substance toxicity

Hazards from Radio-active waste

• Type of disease is determined by type and extent of exposure
• Headache, vomiting, dizziness etc and may affect genetic material

Public sensitivity
• Sensitive to visual impact
• Human anatomical waste if not managed appropriately may raise
social as well as religious concerns
 Treatment and Disposal technologies
for health care waste

Incineration

• High temperature dry oxidation process.

• Reduces organic and combustible waste to inorganic incombustible
matter.
• For wastes that cannot be recycled, reused and disposed off in a land fill
site.
• No pretreatment required.
 Incineration
Suitable for incineration Not Suitable for incineration
Low heating volume – above 2000 kcal/kg Pressurized gas containers, ampules
for single chamber incinerators containing heavy metals

Combustible matter content > 60% Large amount of reactive chemical waste

Non-combustible solid content < 5% Silver salts and photographic or radiographic

waste

Moisture content < 30% Halogenated plastics such as PVC

Content of non-combustible fines < 20% High mercury or cadmium content waste,
such as broken thermometer, used batteries
Types of Incinerators

1. Double chamber pyrolytic incinerators, designed to burn infectious

health care waste.

2. Single chamber furnaces with static grate.

3. Rotary kilns operating at high temperature, decomposes genotoxic

substances and heat resistant chemicals.
Chemical Disinfection

• Kills/ inactivates pathogens

• Disinfection rather than sterilization

• Most suitable for liquid waste – blood, urine, stools, hospital sewage

• Solid wastes can be disinfected with certain limitations

(microbiological cultures, sharps)
Wet and Dry Thermal Treatment

Wet Thermal treatment

• Shredded waste exposed to high temperature, high pressure steam
• Inappropriate for anatomical waste and animal carcasses
• Inefficient for chemical and pharmaceutical waste

Screw-Feed technology
• Non-burn, dry thermal disinfection
• Shredded and heated in a rotating auger
• Waste reduction by 80% in volume and 20-35% in weight
• Suitable for treating infectious waste and sharps
• Inappropriate for pathological, cytotoxic or radioactive
Microwave Irradiation

• Microwave frequency of about 2450 MHz and wavelength of 12.24 nm.

• Efficiency should be regularly checked through bacteriological and

virological tests.
Land Disposal

• Municipal disposal sites : Open dumps and Sanitary landfills

• Healthcare waste should not be deposited on open dumps.

• Advantages of Sanitary landfills over open dumps

• Geological isolation of waste from environment

• Appropriate engineering preparation
• On site staff
• Organized deposit and daily waste coverage
Inertization

• Mixing waste with cement and other substances before disposal to

minimize risk of toxic substance to ground or surface water.

• 65% pharmaceutical waste, 15% lime, 15% cement and 5% water.

• Homogeneous mass cubes or pellets formed are then transported to

storage sites.
DEFINITIONS COMMONLY USED IN BMW

OCCUPIER means a person having administrative control over the institution and the
premises generating bio-medical waste, which includes a hospital, nursing home, clinic,
dispensary, veterinary institution, animal house, pathological laboratory, blood bank,
health care facility and clinical establishment, irrespective of their system of medicine
and by whatever name they are;

OPERATOR of a common bio-medical waste treatment facility" means a person who

owns or controls a Common Bio-medical Waste Treatment Facility (CBMWTF) for the
collection, reception, storage, transport, treatment, disposal or any other form of
handling of bio- medical waste;
PROCESS FLOW OF BMW

Generation Segregation

Collection Storage

Treatment &
Transportation
Disposal
 Human Glassware:
anatomical Broken or
waste, Chemo Contaminated Waste discarded
drugs, Soiled Plastic Waste sharps and
General waste Expired contaminated
(Recyclable) including
waste or Discarded Metals glass including
Medicines, medicine vials
soiled linen and ampoules
 YELLOW CATEGORY
SOILED WASTE
(a)Human Anatomical Waste: Human tissues, organs,
body parts and fetus
(b)Animal Anatomical Waste :
(c)Soiled Waste: Items contaminated with blood, body
fluids like dressings, plaster casts, cotton swabs and
bags containing residual or discarded blood

Incineration or Plasma Pyrolysis or deep burial

 (d) Expired or (d) CYTOTOXICDRUGS:
Discarded Medicines
YELLOW CATEGORY Including all items
including antibiotics Contaminated with
cytotoxic drugs along
with glass or plastic
DRUGS ampoules, vials etc.

Common bio-medical waste

treatment facility: Incineration
 LABORATORY WASTES AND LINEN

Microbiology, Biotechnology
and other clinical
laboratory waste:
Laboratory cultures,
stocks or specimens of
microorganisms
Pre-treat to sterilize with LINEN: linen, mattresses,
nonchlorinated contaminated with
chemicals on-site as blood or body fluid.
per NACO or World
Health Organization
 YELLOW CATEGORY

CHEMICAL & LIQUID WASTES

(g) Chemical Waste: Yellow coloured Disposed of by incineration
Discarded disinfectants containers or or
non- Plasma Pyrolysis or
chlorinated Encapsulation in
plastic bags hazardous waste
treatment, storage and
disposal facility.

(h) Chemical Liquid Separate

Waste :discarded Collection
Formalin, liquid from system leading
laboratories and floor to effluent
washings, cleaning, treatment
etc. system
 Chemical waste

Pre-Treatment
Chemical treatment using at least 1% Sodium Hypochlorite having 30% residual
chlorine for twenty minutes

Final Treatment

Effluent treatment system

AUTOMATED LIQUID WASTE TREATMENT SYSTEM FOR PRE-TREATMENT
 RED CATEGORY - PLASTICS RECYCLABLE WASTE

(a) Wastes generated from

tubing, bottles,
intravenous tubes and
sets, catheters, urine
bags, syringes (without
needles and fixed needle
syringes) and gloves

catheters, urine bags,

syringes (without
needles and fixed
needle syringes) and
gloves

Autoclaving or micro-waving/hydroclaving
followed by shredding or mutilation
 SHARPS - WHITE CONTAINER
Puncture Proof, Leak Proof, Tamper Proof, Translucent Container

Waste sharps
Including
Metals:
Needles, syringes with fixed
needles, needles from needle
tip cutter or burner, scalpels,
blades,
This includes both used,
discarded and
contaminated metal
sharps

Handed over to Waste Agency… when 2/3

full. Autoclaving or Dry Heat Sterilization
followed by shredding or mutilation
 BLUE CARDBOARD BOXES WITH BLUE COLORED MARKING

Glassware:
Broken or discarded and
contaminated glass
including medicine vials
and ampoules except
those contaminated with
cytotoxic wastes &
Metallic Body
Implants

Disinfection (by soaking the

washed glass waste after
cleaning with detergent and
Sodium Hypochlorite treatment)
or through autoclaving or
microwaving or hydro claving and
then sent for recycling.
GENERAL WASTE IN BLACK
 General Waste
All the waste other than bio-medical waste and which has not been
in contact with any hazardous or infectious, chemical or biological
secretions and does not includes any waste sharps.

This waste consists of mainly:

(i) News paper, paper and card boxes (dry waste)
(ii) Plastic water bottles (dry waste)
(iii) Aluminum cans of soft drinks (dry waste)
(iv) Packaging materials (dry waste)
(v) Food Containers after emptying residual food (dry waste)
(vi) Organic / Bio-degradable waste - mostly food waste (wet waste)
(vii) Construction and Demolition wastes
 General Waste
• General waste is further classified as :

Dry Wastes
Wet Wastes

• collected separately

• Such waste is required to be handled as per Solid Waste Management

Rules, 2016 and Construction & Demolition Waste Management Rules,
2016, as applicable

**Other Wastes : used electronic wastes (E- Waste), used batteries, and
radio-active wastes which are not covered under biomedical wastes but
have to be disposed as and when such wastes are generated as per the
provisions laid down under E-Waste (Management) Rules, 2016, Batteries
(Management & Handling) Rules, 2001, and Rules/guidelines under
Atomic Energy Act, 1962 respectively.
 Biomedical Waste - Accidents and
Management
Accident:

• Any Spill of BMW whether liquid or solid and incidents of needle

stick injury (NSI)

• Reported to prescribed authority i.e. CPCC in Form I with the annual

report,

• Management

• Prevention of their recurrence.

 Liquid Spill Management
• PPE : Wear Personal Protection Equipment (PPE) - gloves and mask. If
there is risk of splash, protective eye-shield and gown should also be
worn.

• Limit : Put some absorbent material over the spilled liquid like tissue
paper or old newspaper or gauze piece so that excess of the spilled liquid
gets absorbed onto the absorbent material.

• Disinfect/neutralize: If spilled liquid is potentially infectious like

blood etc., pour a disinfectant solution like 1% sodium hypochlorite
solution over the spilled liquid and absorbent material and leave for 30
minutes. For acid spills, sodium bicarbonate and for alkaline spills, citric
acid powder may be used for neutralization.
 Liquid Spill Management

•Collect: Thereafter, the spilled liquid along with the

disinfectant/neutralizing agent may be mopped up/wiped. The
absorbent material should never be turned during this process, because
this will spread the contamination. The mopping should be carried out
by working from the least to the most contaminated part.

• Mopping cloth should not be reused, but should be put into appropriate
waste container for final disposal. After mopping, cleaning may be done
with detergent and water.
 BMW Management in COViD-19
Special Focus
• Individuals/staff dealing with soiled bedding, towels and
clothes from patients with COVID-19 should:
• Wear appropriate PPE –heavy duty gloves, mask, eye
protection (goggles/face shield), long-sleeved gown,
apron (if gown is not fluid resistant), and boots or closed
shoes
• Never carry soiled linen against body; place soiled linen in
a leak-proof bag or bucket
• Perform hand hygiene after blood/body fluid exposure and
after PPE removal
 BMW Management in COViD-19
Special Focus
• Soiled linen should be placed in clearly labelled, leak-proof
bags or containers, carefully removing any solid excrement
and putting in covered bucket to dispose of in the toilet or
latrine
• Washing machine Used
• Wash at 60-90°C with laundry detergent followed by soaking
in 0.1% chlorine for approximately 30 minutes and dried
• Machine washing Not Used
• Soaked in hot water with soap/detergent in a large drum
• Use a stick to stir and avoid splashing
• Empty the drum and soak linen in 0.1% chlorine for approx.
30 minutes
• Rinse with clean water and let linens dry fully in the sunlight
 Spill Management in COViD-19

• Worker assigned to clean the spill should wear gloves

and other personal protective equipment

• Most of the organic matter of the spill to be removed with

absorbent material

• Surface to be cleaned to remove residual organic matter

• Use disinfectant: hypochlorite

• 1% for small spills

• 10% for large spills
TIMELINES FOR NEW REQUIREMENTS
New Requirements Timeline for Remarks
implementation

Pre-treatment of laboratory waste, *Immediate effect.

microbiology waste, blood samples before
giving to disposal

Phase out chlorinated bags, gloves, Within 2 years from date of

blood bags issue for Principle BMW 2016
now extended to 27th March
2019

Training Health care workers about *Immediate effect Details of training to

handling of Biomedical waste be submitted along
with Annual report

Immunization of Health care *Immediate effect Records of

workers for Hepatitis B and Tetanus vaccination to be
maintained.
 TIMELINES FOR NEW REQUIREMENTS
New Requirements Timeline for implementation Remarks
Barcode system for bags or Within 1 year from date of issue
containers containing Biomedical of Principle rules BMW 2016
waste now extended to 27th March
2019

Health check up of Health care *Immediate effect Records to be

workers during induction and maintained
annually there after.

Maintain and update biomedical Within 2 years from date of On Compliance

waste management register and issue of Principle rule BMW- Portal in ESS
monthly report on website 2016 rules i.e. within 28th March
2018

Major accidents to be reported Should be documented and

along with annual report reported
Maintain records of autoclaving, *Immediate effect
Microwaving etc for a period of five
years
TIMELINES FOR NEW REQUIREMENTS

New Requirements Timeline for implementation Remarks

Annual report on Within 2 years from date of

website issue of Principle Rules 2016
now extended to 16th March
2020.
Setup BMW *Immediate effect
management
committee, and
meetings be done bi-
annually. Minutes
submitted in annual
report.
 Duties of Occupier
Rule 4
• To ensure that waste is handled without any adverse effect to human
health and the environment.
• Provision of a Final Storage Room.
• Pre-treatment of Lab waste, microbiology waste, blood bags etc.
• Phase-out use of chlorinated plastic bags, gloves and blood bags
• Providing training to healthcare workers & keep record.
• Immunize Health workers with Tetanus and Hepatitis-B vaccine
• Establish bar-code based software system.
• Pre-treatment of liquid chemical waste before mixing it with domestic
liquid waste.
• Appropriate and adequate use of PPEs.
• Conduct health-checkup of health workers and keep record.
 Duties of Occupier

• Display waste management monthly record on the HCFs website.

• Report Major Accidents in Form-I within 24 hrs.

• Untreated human anatomical waste, animal anatomical waste, soiled

waste and, biotechnology waste shall not be stored beyond 48 hrs.

• Report to PPCB in case of irregular visit of CBWTF.

• Forming a BMW Management committee and hold atleast bi-annual

meetings.

• The containers shall be properly labelled.

 Duties of Occupier - Annual report

• Every occupier shall submit an annual report to the

prescribed authority in Form-IV, on or before the 30th June
of every year, display Annual Report of the waste on the
HCE’s website and make own website within 2 years.
 Duties of Occupier - Maintenance of
Records
• Every authorised person shall maintain records related to the
generation, collection, reception, storage, transportation,
treatment, disposal or any other form of handling of bio-
medical waste, for a period of 5 years.

• Daily record log book maintenance at waste generation source

tabulated as :
Waste Category Weight or Volume Date of generation Disposal Details

Yellow

Red

White

Blue

General Municipal
Waste
BMW Management at Healthcare Facilities

• No HCF shall establish on-site BMW treatment and disposal facility if the
provision of CBMWTF is present at a distance of 75 Km.

• If no CBMWTF is available, the occupier shall set up requisite BMW

treatment facility such as incinerator, autoclave or microwave, shredder
after taking prior authorization from the prescribed authority. E.g. For
Haryana - (Haryana State Pollution Control Board) at Panchkula.

• After confirming treatment of plastics and glassware by autoclaving or

microwaving followed by mutilation/shredding, these recyclables should
be given to authorized recyclers
 Non Compliance of Rules

• The occupier is liable for penalty for contravention of the

provisions of the Act and the Rules, orders and directions as
specified in Rule 15. of the E(P)Act,1986 which states that

“whosoever fails to comply or contravenes any of the

provisions of the Act and the Rules, orders and directions be
punishable with imprisonment for a term which may extend to
five years or with fine which may extend to one lakhs rupees
or both”
 Newer Innovations in BMW Management

• Barcoding and GPS (global positioning system) to be established for

handling of BMW within 1 year.
TAKE HOME MESSAGE….

YELLOW has blood, drugs and tissues dead,

Plastics; tubes and syringe go in RED,
Sharps in Containers lockable & white,
Black is for garbage; BMW not by right,
Card boards shall carry bottles and Glasses,
All we need, are a few more classes!!
Bad vs Good Practices
GOOD WASTE HANDLING PRACTICES
Labelling of BMW bags

Label should be non-washable and

prominently visible
 NEEDLE STICK INJURIES

Infectious Disease/Agent Risk of Transmission

HBV • up to 30%
(if source patient is HBs Ag as well as HBe Ag +ve)

• 1 to 6%
(if source patient is only HBs Ag +ve)

HCV 0 to 7%

HIV 0.2 to 0.5%

• An injection needle used on a HBV or HCV positive patient may retain live
virus for approximately 7 days.

• Survival of HIV in a hypodermic needle is for approximately 3 days.

 NEEDLE STICK INJURIES
• All HCWs and waste handlers must get complete course of vaccination
against HBV and tetanus.

• For prophylactic purposes, 3 doses of HBV vaccine are given at 0, 1 and 6

months interval.

• After 2 months of the 3rd dose, anti HBs titre is estimated. The protective
level of anti-HBS Titre is ≥ 10 m IU/ml. If the titre is less, the course of
vaccination should be repeated. There is no need for booster dose.

• 4 doses of Tetanus Toxoid are given, 1 dose each at 0, 2, 12 months and 5

years.
 NEEDLE STICK INJURIES MANAGEMENT
Immediate
For Injury : Wash with soap and running water.
For Non intact Skin Exposure : Wash with soap and water.
For Mucosal Exposure : Wash thoroughly.
Reporting
All sharps injury and mucosal exposure MUST be reported to the immediate
supervisor, and to the Casualty Medical Officer to evaluate the injury. Details of the
needle-stick injury should be filled by the supervisor and handed over to the HIC
nurse for further follow-up.
Management
Management is on a case to case basis.
Follow-Up
Follow-up and statistics of needle-stick injury are done by the HIC nurse on a weekly
basis. This information is presented at the HICC meeting and preventive actions to
avoid needle-stick injuries, if any, are recorded.
 NEEDLE STICK INJURIES MANAGEMENT
POST-HIV EXPOSURE MANAGEMENT / PROPHYLAXIS (PEP)

Occupational exposure:
Occupational exposure refers to exposure to potential blood-borne infections
(HIV, HBV and HCV) that occurs during performance of job duties.

“Exposure” which may place an HCP at risk of blood-borne infection is defined

as:
a percutaneous injury (e.g. needle-stick or cut with a sharp instrument),
contact with the mucous membranes of the eye or mouth,
contact with non-intact skin (particularly when the exposed skin is chapped,
abraded, or afflicted with dermatitis), or
contact with intact skin when the duration of contact is prolonged (e.g. several
minutes or more) with blood or other potentially infectious body fluids.
HIV - Infection Risk
 NEEDLE STICK INJURIES MANAGEMENT

It is necessary to determine the status of the exposure and the HIV status of
the exposure source before starting post exposure prophylaxis (PEP).

Step 1: Immediate measures

For skin — if the skin is broken after a needle-stick or sharp instrument:

· Immediately wash the wound and surrounding skin with water and soap,
and rinse. Do not scrub.
· Do not use antiseptics or skin washes (bleach, chlorine, alcohol, betadine).
After a splash of blood or body fluids on unbroken skin:
· Wash the area immediately
· Do not use antiseptics
 NEEDLE STICK INJURIES MANAGEMENT
For the eye:

· Irrigate exposed eye immediately with water or normal saline. Sit in a chair, tilt
head back and ask a colleague to gently pour water or normal saline over the
eye.
· If wearing contact lens, leave them in place while irrigating, as they form a
barrier over the eye and will help protect it. Once the eye is cleaned, remove the
contact lens and clean them in the normal manner. This will make them safe to
wear again
· Do not use soap or disinfectant on the eye.

For mouth:

· Spit fluid out immediately

· Rinse the mouth thoroughly, using water or saline and spit again. Repeat this
process several times
· Do not use soap or disinfectant in the mouth
· Consult the designated physician of the institution for management of the
exposure immediately.
NEEDLE STICK INJURIES MANAGEMENT
HIV

Don’ts

· Do not panic

· Do not put pricked finger in mouth

· Do not squeeze wound to bleed it

· Do not use bleach, chlorine, alcohol, betadine, iodine or any antiseptic

or detergent
 NEEDLE STICK INJURIES MANAGEMENT
Step II: Prompt reporting :
a) All needle-stick/sharp injuries should be reported to the immediate
supervisor, and then to the Casualty Medical Officer.
b) An entry is made in the Needle-Stick Injury Register in the Casualty.

Step III: Post exposure treatment :

The decision to start PEP is made on the basis of degree of exposure to
HIV and the HIV status of the source from where the
exposure/infection has occurred.

More so, it should begin as soon as possible preferably within two

hours, and is not recommended after 72 hours.
 NEEDLE STICK INJURIES MANAGEMENT
PEP is not needed for all types of exposures :

The HIV seroconversion rate of 0.3% after an AEB (accidental exposure to

blood) (for percutaneous exposure) is an average rate.
The risk of infection transmission is proportional to the amount of HIV
transmitted, which depends on the nature of exposure and the status of
the source patient.
A baseline rapid HIV testing of exposed and source person must be done
for PEP.
However, initiation of PEP should not be delayed while waiting for the
results of HIV testing of the source of exposure.
Informed consent should be obtained before testing of the source as per
national HIV testing guidelines.
 NEEDLE STICK INJURIES MANAGEMENT

First PEP dose within 72 hours

A designated person/trained doctor must assess the risk of HIV and HBV
transmission following an AEB.
This evaluation must be quick so as to start treatment without any delay, ideally
within two hours but certainly within 72 hours; PEP is not effective when given
more than 72 hours after exposure.
The first dose of PEP should be administered within the first 72 hours of
exposure. If the risk is insignificant, PEP could be discontinued, if already
commenced.

Step IV: Counselling for PEP

Exposed persons (clients) should receive appropriate information about what
PEP is about and the risk and benefits of PEP in order to provide informed
consent for taking PEP. It should be clear that PEP is not mandatory.
 NEEDLE STICK INJURIES MANAGEMENT

Step V: Psychological support

Many people feel anxious after exposure. Every exposed person needs to
be informed about the risks, and the measures that can be taken. This will
help to relieve part of the anxiety. Some clients may require further
specialised psychological support.

Step VI: Documentation of exposure

Documentation of exposureis essential. Special leave from work should be
considered initially for a period of two weeks. Subsequently, it can be
extended based on the assessment of the exposed person’s mental state,
side effects and requirements.
 NEEDLE STICK INJURIES MANAGEMENT
IMPORTANT: Seek expert opinion in case of :

· Delay in reporting exposure (> 72 hours).

· Unknown source
· Known or suspected pregnancy, but initiate PEP
· Breastfeeding mothers, but initiate PEP
· Source patient is on ART
· Major toxicity of PEP regimen.
 NEEDLE STICK INJURIES MANAGEMENT

Step VII: Follow-up of an exposed person

Whether or not post-exposure prophylaxis is started, a follow up is
needed to monitor for possible infections and to provide psychological
support.

Clinical follow-up
In the weeks following an AEB, the exposed person must be monitored for
the eventual appearance of signs indicating an HIV seroconversion :
acute fever, generalized lymphadenopathy, cutaneous eruption,
pharyngitis, non-specific flu symptoms and ulcers of the mouth or genital
area.
These symptoms appear in 50%-70% of individuals with an HIV primary
(acute) infection and almost always within 3 to 6 weeks after exposure.
When a primary (acute) infection is suspected, referral to an ART centre
or for expert opinion should be arranged rapidly.
 NEEDLE STICK INJURIES MANAGEMENT

An exposed person should be advised to use precautions (e.g., avoid

blood or tissue donations, breastfeeding, unprotected sexual relations
or pregnancy) to prevent secondary transmission, especially during the
first 6–12 weeks following exposure.
Condom use is essential.
Drug adherence and side effect counselling should be provided and
reinforced at every follow-up visit.
Psychological support and mental health counselling is often required.

Laboratory follow-up
Exposed persons should have post-PEP HIV tests. HIV-test at 3 months
and again at 6 months is recommended. If the test at 6 months is
negative, no further testing is recommended.