The management of occupational exposures to blood and body fluids: revised guidelines and new methods of implementation.

Emergency physicians should be aware of the following changes and shifts in emphasis that differentiate this set of guidelines from its predecessors. Changes related to the transmission of HIV: • The CDC is concerned with the unnecessary use of long courses of HIV postexposure prophylaxis (PEP) drug regimens in health care providers who are exposed to blood and/or body fluids from non–HIV-infected source patients. The new guidelines encourage the use of the rapid HIV test to determine the source’s HIV status in real time, thereby eliminating more than 1 dose of antiviral PEP to health care providers exposed to HIVnegative blood. The guidelines emphasize that when rapid HIV testing is not available, it is imperative that the health care provider be given a 48to 72-hour follow-up visit, at which time any prescribed PEP can be discontinued if the source’s HIV status is negative. • The CDC is also concerned that 3-drug therapy, with its higher incidence of complications, is being overused. Three-drug therapy is now limited to cases in which the skin is punctured with an object from a source known to be HIV positive. Decision tables have been revised and nomenclature changed to clarify which health care providers should be offered no PEP, 2-drug PEP, or 3-drug PEP. • At the same time, an emphasis is placed on the following: the consideration of the health care provider’s preexisting medical conditions and pregnancy status; the potential for drug interactions and side effects; and the potential for HIV drug resistance when Editor’s note: This article is part of a regular series on emerging infections from the Centers for Disease Control and Prevention (CDC) and the EMERGEncy ID NET, an emergency department–based and CDC-collaborative surveillance network. Important infectious disease public health information with relevance to emergency physicians is reported. The goal of this series is to advance knowledge about communicable diseases in emergency medicine and foster cooperation between the front line of clinical medicine and public health agencies.