Portsmouth has 24 hour hotline staffed by nurse specialists

EDITOR—Easterbrook and Ippolito discuss prophylaxis after occupational exposure to HIV.1 Ignorance about this problem among the medical profession is still considerable. Although the risk of occupational exposure to HIV is rare, every hospital should have a written policy on how to manage healthcare workers after needlestick injury or exposure to body fluids.

In Portsmouth, many years ago, a healthcare worker acquired HIV infection after a needlestick injury despite receiving zidovudine. Since then the department of genitourinary medicine has developed an efficient service, providing a 24 hour hotline for all healthcare workers employed by the trust and community and also for members of the general public who have sustained needlestick injuries. The hotline is staffed by nurse specialists experienced in HIV infection, who are overseen by the genitourinary physicians. This enables the person who sustained the injury to access care immediately and to discuss with experienced counsellors not only HIV infection but also infection with hepatitis B and hepatitis C viruses, in a confidential manner. Appropriate treatment can also be started by the nurse specialist without delay. Since all patients with HIV infection in Portsmouth are treated by the genitourinary physicians, the nurse specialists are fully aware of their antiretroviral treatment and the stage of their disease. The consultants hold weekly updates about all the patients and also discuss all new developments in the field of HIV infection with the nurse specialists.

This model of care is superior to the one described in the editorial, which suggests that the assessment and treatment should be initiated in the accident and emergency department. There is a rapid turnover of junior medical staff in accident and emergency departments, who will find it difficult to keep up to date with all the advances in antiretroviral treatment. Though a written protocol gives an overall prescription …