The RI DOC health services has had a protocol for responding to potential bloodbourne pathogen exposure of staff and inmates since 1996. I'll treat the nurse using our guidelines…
1. After cleansing the site with soap and water, I evaluate the nature and severity of the exposure. A needle stick from a patient likely to be HIV positive represents a high-risk exposure. I ask the inmate patient for permission to evaluate him for HIV/HBV/HCV.
2. After counseling the nurse about the exposure's significance, I encourage HIV/HBV/HCV testing (at an outside facility to maintain confidentiality) to document baseline seronegative status, for workman's compensation, in the rare event of seroconversion. I encourage repeat testing at 6 weeks, 3 and 6 months post exposure. She should report any symptom of seroconversion to her outside provider. Until she has HIV infection ruled out, I recommend that she use barrier methods during sex and refrain from blood donation.
3. During initial evaluation, I give the first dose in my presence. I refer her for further management to an outside facility to maintain confidentiality at her worksite. 
Our guidelines take a 'one size fits all' approach. AZT, 3TC and Indinavir may not represent the best HIV prophylaxis. The sexual partner of the source patient could transmit a virus resistant to her AZT/3TC.
Tolerance of Indinavir may be less than Nelfinavir. However, RI DOC has made PEP uniform to maximize the number of potential candidates who take the first dose rapidly.
With the institution of the emergency packet system, health care workers, correctional officers and inmates have received PEP within one hour of potential exposure. Previously, staff went to local hospitals, which sometimes tarried before administering any medication. During follow-up with an HIV specialist, who will oversee a four-week regimen of PEP, individualization of further treatment (perhaps D4T and DDI as reverse transciptase inhibitors) can occur.

The clock is ticking!  The few animal data that actually demonstrate any effectiveness of post-exposure prophylaxis (PEP) following retroviral infection indicate that the earlier the administration of PEP(ideally within one hour) the greater the chance of aborting infection (1). 
First Aid, in this case, should consist of simply washing the wound with soap or and water.  Use of caustic agents such as bleach have no role in cleansing needlestick injuries.
Documentation of the exposure is required by OSHA and is essential if the health care worker seeks Workman's Compensation.  The confidentiality of the HCW and the source patient must be strictly respected.
Assess the risk.  The injury experienced in this case was substantial. To the nurse's credit, she was wearing gloves, which may have reduced the amount of blood carried by the needle. The source patient and HCW must be tested for HIV, hepatitis B (HBsAg) and hepatitis C.  The HCW must have baseline testing for HIV antibodies, hepatitis C and hepatitis B (anti-HBs IgG).  The HCW should be tested for pregnancy. Pregnancy status may influence her decision regarding initiation of PEP.  The lack of detectable HIV RNA by PCR in the plasma of the source patient does not rule out HIV infection, but probably lessens the risk of HIV transmission. 
PEP should be offered if the results of the source patient's HIV status will be unavailable within a few hours.  The US Public Health Service guidelines recommend that either 2 or 3 agents be administered as PEP based on the severity of exposure and the perceived infectiousness of the source. Many find this ambiguous.  When offering PEP, I try to provide the best chance of preventing infection with 2 nucleosides and a protease inhibitor.
Selection of PEP regimen in this case is clouded by the history of the source patient's partner's use of ZDV and 3TC, but it is wise to assume resistance to ZDV and 3TC is likely. I would offer d4T, ddI and nelfinavir (1,250 mg BID). This combination should be potent and unaffected by cross-resistance to ZDV and/or 3TC.  Nelfinavir's manageable major side effect of diarrhea should be considered. DDI must be taken on an empty stomach. I recommend a single dose of DDI be taken before bed. If DDI is not tolerated, 3TC could be substituted in its place,  recognizing the concern for resistance and its use with ZDV in treating HIV infected persons with previous ZDV experience
The HCW should be counseled to be alert to signs of acute seroconversion and safe sex and should have psychological support services available. All HCW receiving PEP should be registered with the PEP Registry (888-448-4911).