I agree with you, it feels off to me to do so as well for the very reasons you describe.

Rachel Leibu, MD, MBA, MS, FACOEM

Medical Director Occupational Medicine Services

Atlantic Health System

Clinical Assistant Professor, Sidney Kimmel Medical College

at Thomas Jefferson University

Office 973-829-4277

Cell 973-886-6708

From: MCOH-EH <mcoh-eh-bounces+rachel.leibu=atlantichealth.org@mylist.net> On Behalf Of Swift, Melanie D., M.D., MPH via MCOH-EH
Sent: Tuesday, October 24, 2023 4:48 PM
To: MCOH-EH <mcoh-eh@mylist.net>
Cc: Swift, Melanie D., M.D., MPH <Swift.Melanie@mayo.edu>
Subject: Re: [MCOH-EH] BBPE PEP Declination Form

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Hi Rachel, if I understand the question, you mean if they've had an exposure for which PEP is strongly recommended (like a deep puncture with a hollow bore device from a known positive HIV source) and the exposed worker declines it - does anyone have them sign a formal declination?

Interesting question. I suspect you have a case in mind, yes? I've never asked for a signed PEP declination, but people with those higher risk exposures generally accept PEP anyway. I’d be focused on trying to understand their reasons, so I could help them feel comfortable taking it.

I’d certainly do all I could to convince them and then document carefully.

I can’t quite put my finger on it, but asking them to sign a declination feels “off” in this situation, almost adversarial somehow. What would be the purpose? Usually a signed declination serves to prove it was strongly recommended (not necessary if you document carefully), to reinforce education (but I’m not letting a high risk exposure go until I am convinced they really understand) and to inform them that they can always get it if they change their mind later (not applicable for HIV or HBV PEP, at least not much later.)

Just my two cents. Would be interested if anyone does this and if they’ve found it helpful.

Melanie

From: MCOH-EH <mcoh-eh-bounces@mylist.net> on behalf of Leibu, Rachel <Rachel.Leibu@atlantichealth.org>
Sent: Tuesday, October 24, 2023 3:48:21 PM
To: MCOH/EH <mcoh-eh@mylist.net>
Subject: [EXTERNAL] [MCOH-EH] BBPE PEP Declination Form

Hi,

Does anyone ask an employee who has had a bloodborne pathogen to decline HIV PEP if offered and they do not want to take it?

Rachel Leibu, MD, MBA, MS, FACOEM

Medical Director Occupational Medicine Services

Atlantic Health System

Clinical Assistant Professor, Sidney Kimmel Medical College

at Thomas Jefferson University

Office 973-829-4277

Cell 973-886-6708

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