Emergency prophylaxis following needle-stick injuries and sexual exposures: results from a survey comparing New York Emergency Department practitioners with their national colleagues.
Merchant RC, Keshavarz R. Mt Sinai J Med. 2003 Oct; 70(5): 338-43.Department of Emergency Medicine, Mount Sinai School of Medicine

BACKGROUND: Emergency prophylaxis following needle-stick and sexual exposures includes HIV post-exposure prophylaxis, hepatitis B prophylaxis and emergency contraception. The Centers for Disease Control and Prevention endorse HIV post-exposure and hepatitis B prophylaxis for health care workers, and hepatitis B prophylaxis and emergency contraception after sexual assault. The New York State Department of Health advocates HIV post-exposure prophylaxis after sexual assault. This study compares emergency department practitioners in New York State (NYS) with those from other states in their willingness to offer emergency prophylaxis after needle-stick and sexual exposures, and their self-reported history of prescribing and using HIV post-exposure prophylaxis.

METHODS: The authors surveyed emergency department practitioners from across the US at the American College of Emergency Physicians 2000 Scientific Assembly. The questionnaire included clinical scenarios describing different patients who present to the emergency department within one hour of a needle-stick injury, sexual assault or consensual sexual encounter, and had questions on the practitioners self-reported prescribing and usage of HIV post-exposure prophylaxis. For each scenario the practitioners were asked to indicate if they would offer emergency prophylaxis to different patients at varied HIV risk levels.

RESULTS: Of the 600 respondents, 100 were from NYS. In the clinical scenarios, NYS practitioners were more likely than other US practitioners to offer HIV post-exposure prophylaxis for exposures to unknown and low HIV risk sources (p<0.05) and to offer hepatitis B prophylaxis in most of the sexual exposure scenarios (p<0.01). All practitioners offered HIV post-exposure and hepatitis B prophylaxis less often after consensual sexual encounters than after sexual assault and needle-stick injuries. In most cases, NYS practitioners were more willing to offer emergency contraception after sexual assault and consensual sexual encounters than were other practitioners (p<0.05). In terms of self-reported prescribing of HIV post-exposure prophylaxis, NYS practitioners had prescribed HIV post-exposure prophylaxis after sexual assault (p<0.001) and non-health-care-worker needle-stick injuries (p<0.05) much more often than did other practitioners.

CONCLUSIONS: Compared to their national colleagues, NYS emergency department practitioners were generally more willing to offer all forms of emergency prophylaxis after sexual assault. They also reported having had more experience than other practitioners in prescribing HIV post-exposure prophylaxis. Although most practitioners were clearly willing to offer HIV post-exposure prophylaxis for nonoccupational exposures, NYS practitioners were less willing to offer emergency prophylaxis following consensual sex than after sexual assault. These findings suggest that the NYS guidelines for HIV post-exposure prophylaxis after sexual assault may have influenced emergency practitioners willingness to offer and prescribe prophylaxis.