Download Sharps injury and exposure to body fluids procedure

Document name:
Sharps Injury and Exposure to Body
Fluids Procedure
Document type:
Procedure
What does this policy
replace?
New procedure
Staff group to whom it
applies:
All staff within the Trusts
Distribution:
The whole of the Trusts
How to access:
Intranet
Issue date:
July 2014
Next review:
July 2016
Approved by:
Trust Wide Clinical Policies and
Procedures Advisory Group
Developed by:
Occupational Health
Director leads:
Alan Davies, Director of HR
Contact for advice:
Occupational Health
01977 605585
Page 1 of 8
Approved - July 2014
Review Date - July 2016
OCCUPATIONAL HEALTH PROCEDURE
SHARPS INJURY AND EXPOSURE TO BODY FLUIDS
PROCEDURE
This document outlines the procedure to follow if an
employee sustains an exposure to a patient’s blood or
other high risk bodily fluid. It outlines the actions to take
following exposure and provides useful forms to assist
and guide you in the process.
Issued – 10 April 2014
Review date – 10 April 2016
Page 2 of 8
Approved - July 2014
Review Date - July 2016
SHARPS INJURY & EXPOSURE TO BODY FLUIDS PROCEDURE



Exposure incident occurs
YOUR ACTION IS NEEDED URGENTLY
Contamination with blood or body fluid from:
a puncture to the skin caused by a needle or other sharp object or a bite,
splash to the eye or mouth
broken skin, eczema, cuts or abrasions
First Aid – Encourage wound to bleed by gentle squeezing – do not suck
Wash affected area with soap and tap water – do not scrub
Cover with a waterproof plaster
Rinse eyes, nose and mouth if affected with copious amounts of water
Report and assess injury
Senior person completes Form 1 - If significant exposure has occurred contact the source
patient’s medical team/clinician (see page 8*)
Source patient’s medical team/clinician (see page 8*), but not affected staff member to
assess the patient for blood-borne viruses – Complete Form 2
If the source patient’s HIV/HBV/HCV status is not known, the source patient’s medical team/clinician
should whenever possible approach the source patient and ask for their informed consent to BBV
testing.
See Consent form (Form 3) and Information for source patient (Form 4).
More information is provided in Appendix 1 regarding informed consent.
If significant exposure is confirmed
During normal working hours – (Monday to Friday 0830 – 16.30) inform OH by telephone. This
should be done immediately for high risk contamination injuries. Bring completed Forms 1 & 2 if
attending department
Outside normal working hours - If high risk contamination injury. Attend A & E immediately with
Forms 1 & 2 to enable an assessment of whether HIV Prophylaxis (PEP) is required
In all cases – staff must contact OHD when next open on 01977 605585
Barnsley BDU staff can also contact Barnsley Hospital OH on 01226 434939
York and North Yorkshire staff can also contact York OH on 01904 725099
Complete Datix/Incident form at earliest opportunity
Taken from ‘Occupational Health Sharps Injury & Exposure to Body Fluids Procedure’. See
Trust Intranet and links on Occupational Health or Infection Control pages for full document
and forms.
See also the Trusts policy – ‘Prevention and Management of Occupational Exposure to Blood
Page 3 of 8
Approved - July 2014
Borne Viruses and Post Exposure Prophylaxis (needlestick)’ on the intranet
Review Date - July 2016
FORM 1
INITIAL ASSESSMENT OF POTENTIAL BLOOD EXPOSURE INCIDENT
This form should be completed by the Manager / Supervisor / person in charge of the area where the
incident occurred. It identifies whether or not a significant incident has occurred.
Initial Risk Assessment
NAME OF EMPLOYEE: ………………………………………………………………………….
D.O.B. ……………………………… JOB ………………………………………………………..
LOCATION ………………………………………………………………………………………..
DATE AND TIME INJURY OCCURRED ………………………………………………………
Has the employee sustained the following :



A puncture to the skin caused by a contaminated needle or other sharp
object or a bite (percutaneous injury).
Splash to the eye or mouth (mucocutaneous exposure).
Contamination to broken skin, eczema, cuts or abrasions.
Yes
No






If the answers to all the questions above are ‘NO’, a significant exposure has not occurred. You will still
need to complete a Datix/Incident form, eg for a clean sharps injury.
If the answer to any of the three boxes above is ‘YES’, continue with this assessment.
For needlestick or sharps injury, was the object contaminated with either:Blood or material visibly contaminated with blood or any of the high
risk body fluids in the box below
























For splashes or contamination to the eye, mouth or broken skin
Body fluids which may pose a risk of transmission of blood borne
viruses if significant occupational exposure occurs are:Blood
Cerebrospinal fluid
Amniotic fluid
Semen
Vaginal secretions
Pericardial fluid
Pleural fluid
Saliva in association with dentistry (even if not visibly blood stained)
Synovial fluid
Unfixed human tissues and organs
Exudative or other tissue fluid from burns or skin lesions
If the answer to any of the above is ‘YES’ a significant exposure has occurred. You need to contact the
clinician responsible for the source patient’s care who will complete Form 2 and obtain a blood sample
from the source patient if appropriate.
If the source patient is not identified the circumstances of the exposure should be discussed with OH.
MANAGER / SUPERVISOR’S SIGNATURE ……………………………………………………………
NAME (Block Capitals) …………………………………………………………………………………….
DATE …………………………………………… TIME …………………………………………………..
Page 4 of 8
Approved - July 2014
Review Date - July 2016
FORM 2
ASSESSMENT OF SOURCE PATIENT
To be completed by the Senior Qualified Professional on duty who has responsibility for the care
of the source patient (see page 8*).
RETAIN A COPY OF THIS FORM IN THE PATIENT’S NOTES AND A COPY TO BE TAKEN TO
OH/A&E IF ATTENDING IN PERSON OR SENT TO OCCUPATIONAL HEALTH IF DEALT WITH BY
TELEPHONE
D.O.B. …………………………… CONSULTANT …………………………………..
Rio/Paris/Hospital number* (*delete as appropriate)……………………………………
Date of incident: ……………………………………. Time of incident: ………………………….
Is the source patient known to be: (documented blood test):-
 HIV Positive
 HCV Positive
 HBV Positive
Is the source patient strongly suspected of having HIV or AIDS?
Has the source patient been clinically diagnosed as having HIV or AIDS?
 Yes
 Yes
 No
 No
Does the source patient have any risk factors for HIV/HCV/HBV?

Blood transfusion or use of blood products before 1985

Blood transfusion in another country

A man who has sex with another man

A sexually active man or woman from areas of the world where these infections are more
common, eg sub-Saharan Africa, SE Asia, parts of Eastern Europe.

Injecting drug user

Sexual partner of any of the above

Neonate of mother in any of the high risk groups
DO ANY OF THE ABOVE POINTS APPLY TO THE SOURCE PATIENT?
 Yes
 No
Taking into account the risk identified in this information about the source patient and the risk
assessment of the incident, does this incident pose a significant risk of:HIV seroconversion
 Yes
 No – if Yes, refer immediately to OH / A& E for PEP
HCV seroconversion
 Yes
 No – if No, contact OH at next opening time
Signed ………………………………………………. Print Name …………………………………………
Doctor / Clinician (please circle) Grade ……………………………………………………………………..
Page 5 of 8
Approved - July 2014
Review Date - July 2016
FORM 3
CONSENT FOR SCREENING FOR BLOOD BORNE VIRUSES
FOLLOWING A BLOOD EXPOSURE TO A HEALTH CARE WORKER
TO BE RETAINED IN PATIENT’S RECORD
SOURCE PATIENT’S NAME ………………………………………………………….. …………………………..….……
ADDRESS
…………………………………………………………………………………..…….……..
D.O.B.
…………………………………………………………..
RIO / PARIS / HOSPITAL NUMBER * (* delete as appropriate)
(YOU MAY FIX A HOSPITAL LABEL IF AVAILABLE)
A Health Care Worker involved in your care has sustained an exposure to your blood or body fluids,
which may in turn put them at risk if you are infected with Hepatitis B, Hepatitis C or HIV. In order to
ensure that the Health Care Worker receives appropriate treatment, we need to test your blood to
find out if you are infected with these viruses.
If you have any reason to believe you may be infected with Hepatitis B, Hepatitis C or HIV, or wish
to discuss the implications of having your blood tested for these conditions please ask the
doctor/clinician before signing this form.
The medical staff responsible for your care will discuss the risks in confidence with you, if you wish.
The results of these blood tests will be given to you by the team responsible for your care. The
results will also be given to our Occupational Health Service to help them care for the Health Care
Worker. The Health Care Worker will already be aware of your identity.
Your care will be unaffected whether you agree or refuse to undergo this test.
I understand that I am being asked to undergo blood testing for Hepatitis B, Hepatitis C and HIV.
I understand the results of this test will be given to me and will remain confidential to my medical records and to the
Occupational Health Service.
I consent to my blood being tested for Hepatitis B, Hepatitis C and HIV
SIGNED:
………………………………………………………………………
NAME IN CAPITALS: …………………………………………… DATE: ………………………….
Name of Doctor/Clinician requesting consent (block capitals):
…………………………………………………………………………………………………………………
SIGNED: …………………………………………………………… DATE: ……………………………….
Unable to consent or lacks mental capacity (see appendix one)
Comments …………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………….
Page 6 of 8
Approved - July 2014
Review Date - July 2016
FORM 4
MANAGEMENT OF BLOOD EXPOSURE INCIDENTS
INFORMATION FOR SOURCE PATIENT
A Health Care Worker involved in your care has been accidentally exposed to your blood or
body fluids in a way, which would pose a risk to their health if you are infected with Hepatitis B,
Hepatitis C or HIV. In order to protect the Health Care Worker from this risk, we need to test
your blood to see if you are infected with these viruses. We will need a blood sample to do this
test.
It is possible to be infected with Hepatitis B, Hepatitis C and HIV without knowing or being ill. If
you are infected with these viruses it is important for you to know this, as there are treatments
available for these conditions.
These viruses are transmitted by exposure to blood and some body fluids, most commonly by
sexual contact with an infected person, or by the sharing of needles between injecting drug
users. People who are at higher risk of being infected are:




Men who have sex with men
Injecting drug users
People who have had a blood transfusion abroad or before 1985 in the UK
Sexually active men and women from areas of the world where these
infections are more common, in particular, sub-Saharan Africa, S.E. Asia, and parts of
Eastern Europe.
People who have sexual partners from any of the above categories
If none of these risks groups apply to you, the risk of you being found to be infected with
Hepatitis B, Hepatitis C or HIV is very low. If one or more of these risk groups apply, you may
have a higher chance of being found to be positive in testing.
If you know that you are infected with Hepatitis B, Hepatitis C or HIV, please tell us as we may
need to act quickly to protect the Health Care Worker. You do not have to tell us which group
applies to you.
If you would like further information about the risk of being infected with Hepatitis B,
Hepatitis C or HIV please ask the Clinician who is seeking your consent for a blood test.
YOUR CARE WILL BE UNAFFECTED WHETHER YOU AGREE OR REFUSE TO UNDERGO
THIS TEST
If you agree to a test for Hepatitis B, Hepatitis C and HIV, the results will be given to you, your
consultant and to our Occupational Health Service (without disclosing your identity), who are
responsible for the care of the Health Care Worker. The result will be given to you by your
medical team. If it should show that you are infected with one of these viruses, appropriate
investigation and treatment will be organised for you.
Page 7 of 8
Approved - July 2014
Review Date - July 2016
APPENDIX 1
Further information on consent -
If you or another Health Care Worker has suffered a sharps injury or other occupational
exposure to blood or bodily fluids and source patient testing for a serious communicable
disease is indicated, the patient consent should be obtained before the test is undertaken. The
GMC Guidance – Consent: patients and doctors making decisions together (2008), highlights
that consent should be written if there may be significant consequences for the patient’s social
or personal life (p.21). The guidance also states that you must respect a patient’s decision to
refuse an investigation and pressure must not be put upon them to accept your advice.
If the patient is unconscious when the injury occurs, consent should be sought once the patient
has regained full consciousness.
If the patient refuses testing, is deemed to lack the mental capacity to consent following a
capacity assessment (as per the Mental Capacity Act), withholds consent or does not regain full
consciousness within 48 hours, the severity of the risk to the Health Care Worker should be
reassessed by revisiting Form 2 and discussing with Occupational Health. You should not
arrange testing against the patient’s wishes or without consent and it is not permissible to test
an existing sample in such circumstances (see Section 1 (1) (f) of the Human Tissue Act, 2004
for more information).
To assist with the consent process please see the following documents Form 3 – Consent form to be completed by source patient
And
Form 4 – information for source patient prior to testing
*It would normally be expected that the Patient’s Medical Team, Clinician or Senior Qualified
Professional would assess the person’s known medical information in relation to risks for blood
borne viruses and complete form 2. Should this not be possible in circumstances where there
is a lack of medical history known e.g. dental surgeries or other community settings, if
appropriate, the source patient should be approached to ascertain any known history and
verbal consent gained to discuss this further with their GP. If there are no staff trained in
phlebotomy in these areas source testing could only be carried out via the source’s GP. In
children’s services gaining consent for testing or obtaining further information regarding risk is
likely to be difficult due to legal consent issues and in this instance it is recommended that
within normal working hours the general risk is discussed with Occupational Health or if out of
hours and there are concerns that the incident is high risk attend Accident and Emergency.
Please note that one full clotted sample is required for the testing and the following tests are
requested:


HIV antibody test
Hepatitis C antibody test
Hepatitis B surface antigen
Should you have any queries or require more information in relation to this document or
completion of the forms please contact the Occupational Health department on 01977 605585
between 08.30 -16.30 Monday to Friday.
Page 8 of 8
Approved - July 2014
Review Date - July 2016