ADC Practice Question — Treating Patients with BBV

What determines whether post-exposure prophylaxis (PEP) for HIV is indicated, and what is the time-critical window?

Infection control in the ADC exam tests decision-making around exposure incidents, instrument classification, and decontamination protocols. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.

A dental nurse sustains a needlestick injury from a needle used on a patient with unknown HIV status. The injury is deep, with visible blood on the needle. What determines whether post-exposure prophylaxis (PEP) for HIV is indicated, and what is the time-critical window?

A. PEP is only indicated if the source patient is confirmed HIV-positive
B. PEP decision depends on risk assessment: (1) type of exposure (percutaneous with hollow bore needle = highest risk), (2) depth of injury (deep with visible blood = higher risk), (3) source patient risk factors (high-prevalence population, known risk behaviours, unknown status)
C. Needlestick HIV transmission risk is 30%
D. PEP can be started up to 2 weeks after exposure

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Sources cited

Therapeutic Guidelines v4 Odell's 3rd & 4th Ed IADT 2020 Code of Conduct CMS (Evans) Infection Control + more

Show the answer and cited explanation

Correct answer: B

PEP decision depends on risk assessment: (1) type of exposure (percutaneous with hollow bore needle = highest risk), (2) depth of injury (deep with visible blood = higher risk), (3) source patient risk factors (high-prevalence population, known risk behaviours, unknown status). For a deep hollow-bore needlestick with visible blood, PEP should be started as soon as possible — ideally within 1-2 hours, maximum 72 hours. PEP consists of a 28-day course of antiretroviral drugs (typically tenofovir/emtricitabine + raltegravir). Do NOT wait for source patient HIV test results if the exposure is high-risk — start PEP immediately and discontinue if the source tests negative. The occupational HIV seroconversion rate after needlestick is approximately 0.3%

Source: Odell 4th Ed, Case 31: A Sharps Injury

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Exam preparation FAQ

Should I memorise guidelines word-for-word for Treating Patients with BBV?

Focus on decision points — when the guideline says X vs Y. The exam tests application, not recitation.

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