Download A. See appendix A Bloodborne Pathogens (HBV,HCV, HIV)

FLORIDA DEPARTMENT OF CORRECTIONS
OFFICE OF HEALTH SERVICES
TECHNICAL INSTRUCTION NO. 15.03.43
Page 1 of 7
SUBJECT: MANAGEMENT OF BLOODBORNE PATHOGEN EXPOSURES
EFFECTIVE DATE: 9/10/02
I.
PURPOSE:
The purpose of this technical instruction (TI) is to assure that all employees and inmate
patients who have had significant exposure to blood or other potentially infectious
materials (OPIM) will be managed according to appropriate guidelines.
II.
III.
DEFINITIONS:
A.
Significant exposure is defined in appendix A Bloodborne Pathogens (HBV,
HCV, HIV—Significant Exposures and Risk of Infection.
B.
Bloodborne pathogens—For the purposes of this technical instruction,
bloodborne pathogens are considered to include hepatitis B virus (HBV),
hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Other
pathogens such as syphilis or the viruses of hemorrhagic fevers might also be
present in blood or OPIM.
GENERAL COMMENTS:
A.
Unless specified otherwise, instructions apply to employees and inmates.
B.
Institutional health services staff will a maintain packet of forms and steps for
follow-up to provide guidance for the nurse on duty at the time that a bloodborne
pathogen exposure occurs. The list of materials to be included in the packet are:
1.
Detail of the steps to follow in assessing the exposed employee.
2.
CDC appendix on postexposure drugs
3.
Postexposure prophylaxis for bloodborne pathogens algorithm
4.
DC4-798 Bloodborne Pathogens Exposure/Screening Incident Report (risk
management form).
5.
Emergency forms:
a.
b.
DC4-701C Emergency Room Record
DC4-708 Diagram of Injury
TECHNICAL INSTRUCTION NO. 15.03.43
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SUBJECT: MANAGEMENT OF BLOODBORNE PATHOGEN EXPOSURES
IV.
6.
Form for refusal of follow-up care (DC4-792B Informed Consent
[section B])
7.
Workers’ compensation paperwork/forms (for use with health services
personnel exposures)
C.
An outline of the steps to be followed (brief checklist) will be posted in the
emergency room (see appendix B Bloodborne Pathogen Exposure Brief
Checklist). The complete description of steps (see appendix C Bloodborne
Pathogen Exposure Checklist) to be taken based on this outline will be a part of
the packet.
D.
If an injury is so severe that immediate transport is needed, the receiving
institution will be notified that a bloodborne pathogens exposure is part of the
injury. Documentation of the circumstances of this exposure will be completed
on the same forms as any other bloodborne exposure.
E.
The supervisor of the exposed employee will complete the necessary workers’
compensation paperwork.
F.
The environmental health and safety officer (EHSO) will coordinate the process
of workers’ compensation and bloodborne pathogen exposures.
IMMEDIATE RESPONSE:
A.
B.
The employee shall take first aid precautions as soon as possible.
1.
Blood on skin areas should be washed off with soap and water.
2.
Clothing splashed with blood: the clothing should be removed and other
employees should be requested to assist with locating other clothing for
the worker to wear.
3.
Do NOT use chlorine bleach as an antiseptic in an attempt to kill HIV. It
cannot kill virus that has already gotten into the blood stream and it will be
damaging to skin. Attempts to squeeze out blood in an attempt to remove
any virus are also not helpful if virus has entered the blood stream and has
gotten beyond the local area already. Use the time to follow the remainder
of this procedure and obtain the appropriate medical attention.
The exposed employee will report the exposure incident to their supervisor as
soon as possible.
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SUBJECT: MANAGEMENT OF BLOODBORNE PATHOGEN EXPOSURES
V.
VI.
C.
The supervisor will arrange for relief for the employee from job responsibilities as
soon as possible.
D.
The exposed individual will be assessed in the institutional health services unit.
EVALUATION OF EXPOSURES FOR SIGNIFICANCE:
A.
See appendix A Bloodborne Pathogens (HBV,HCV, HIV)—Significant Exposures
and Risk of Infection and appendix C Bloodborne Pathogen Exposure Checklist.
B.
The evaluation will consider at least hepatitis B, hepatitis C, and HIV. Other
bloodborne pathogens will be considered if there is reason to believe that those
pathogens might be involved in the particular exposure at hand.
C.
If a physician is not present, the on-call physician will be contacted immediately
and information about the exposure will be presented to him/her. If the
institutional on-call physician cannot be reached, the Regional Medical Executive
Director will be contacted for assistance.
D.
A decision will be made regarding immediate prophylactic medication and the
exposed employee will be counseled regarding the benefits and risks of taking this
medication.
E.
Employees will be referred to the workers’ compensation provider. The
institutional environmental health and safety officer is responsible for
coordination of this process. A toll-free telephone number is to be called to
access the workers’ compensation provider and request permission to send the
exposed employee to a site for medical follow-up. This toll-free number will be
posted in the emergency room so that the nurse in charge will have access to it in
a timely manner in the case of an exposure incident.
F.
If an exposed employee refuses follow-up for an exposure that is judged to be
significant, the employee will be required to sign DC4-792B Informed Refusal. If
an exposed inmate refuses follow-up for an exposure that is judged to be
significant, the inmate will be required to sign DC4-711A Refusal of Health Care
Services Affidavit.
PROVISION OF MEDICATIONS IF NEEDED:
A.
All institutions will have a prepackaged zidovudine (AZT), Lamivudine (3TC),
and Indinavir (IDV, Crixivan) available in the appropriate dosage made up and
packaged by the institutional pharmacy. This will have an appropriate warning
label indicating, at the least, that the medications contained within may cause
nausea, vomiting, diarrhea, allergy, and/or other side effects. This medication is
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SUBJECT: MANAGEMENT OF BLOODBORNE PATHOGEN EXPOSURES
to be taken only upon order of a physician. Its purpose is to reduce the chances of
contracting a dangerous disease.
1.
This dose pack is to be given by order of the contacted physician to any
person who has had a significant exposure and desires prophylactic
therapy.
2.
This therapy is consistent with the most currently available information
concerning the prophylaxis of HIV transmission.
B.
Before medication is given, the patient will be counseled concerning the reasons
for the medication and the possible side effects. See information on the
medications in appendix D HIV Postexposure Prophylaxis for Bloodborne
Pathogens, appendix E HIV Postexposure Prophylaxis—Basic and Expanded
Regimens, and DC4-792C Postexposure Prophylaxis HIV Counseling.
C.
An acknowledgment (DC4-792C) that this information was provided and the
medication was initiated will be signed by the injured patient. If the patient
declines to start medication this time, such shall be documented on the form.
D.
All institutions are authorized to administer this dose pack to employees, inmates,
or others on an emergency basis. Medication should be given within two hours of
exposure if at all possible.
E.
When an exposed employee demands preventive medication after a medical
decision is made that the exposure does not meet the guidelines to offer this
medication, further effort to educate the employee will be provided to explain the
decision. The education fact sheet (see attachment) regarding this situation will
be provided to the employee, and health care personnel will answer any questions.
F.
If a decision is made to give the initial dose of post exposure prophylactic
medications the exposed employee must be sent to a Worker’s comp site for
further evaluation.
G.
If for any reason the employee cannot be seen by the workers’ compensation
provider or cannot obtain an ongoing supply of this prophylactic medication from
a local pharmacy, the Department of Corrections will continue to supply the
medication until the medication is available from the local pharmacy.
1.
The medications in the pack are given on different schedules. The
exposed person will need additional education to understand when to take
each medication.
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SUBJECT: MANAGEMENT OF BLOODBORNE PATHOGEN EXPOSURES
VII.
2.
It is expected that the exposed person will be able to obtain medication
within a few days.
3.
Any delay will be reported to the Central Office Pharmacy Services
Director.
REPORTING OF BLOODBORNE PATHOGEN EXPOSURE:
A.
Telephone notification will be made to the Infection Control Coordinator or the
Director of Nursing Services during business hours. During nonbusiness hours:
the officer in charge will be notified who will then notify the Central Office
Emergency Reporting Center who will in turn notify the on-call Central Office
Health Services administrator to assure that the appropriate procedures have been
initiated.
B.
Following a bloodborne pathogen exposure, an appropriate DC6-210 Incident
Report will be completed. Other institutional forms will be completed as needed.
VIII. INSTITUTIONS WITHOUT 24-HOUR MEDICAL COVERAGE:
When medical personnel are present, bloodborne pathogens will be managed as directed
in this TI.
When medical personnel are not present, security staff will send the exposed person to a
workers’ compensation provider as quickly as possible. If there are any questions for
medical personnel, the officer in charge will contact the responsible major institution.
Information about the incident will be provided to medical personnel at the earliest
possible time after the exposure occurs.
Medical personnel will ensure that the appropriate security personnel know the procedure
concerning follow-up for bloodborne pathogen exposures.
IX.
HEPATITIS B VACCINATION:
A.
All departmental employees will be assessed for risk of exposure to blood and
other potentially infectious materials by reason of their job functions. See
Bloodborne Pathogens Exposure Control Plan (or appropriate departmental
document) for the list of at-risk job functions. This list is determined based on
duties involved in the job and the possibility of exposure to blood or other
potentially infectious materials
B.
Information about vaccine will be provided in the department and health care
employee education and in written form using the Centers for Disease Control and
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SUBJECT: MANAGEMENT OF BLOODBORNE PATHOGEN EXPOSURES
Prevention vaccine information statement for hepatitis B. This will be provided in
department education programs that will precede the vaccination program.
X.
C.
These employees at risk will be offered hepatitis B vaccine according to the
departmental exposure control plan. Consent for vaccination will be completed
using DC4-792A Hepatitis B Vaccine Informed Consent/Previous Vaccination
Documentation.
D.
Employees who have previously been vaccinated against hepatitis B may decline
vaccination using the same form (DC4-792A).
E.
Employees may refuse hepatitis B vaccine. The refusal will be documented on
DC4-792B Informed Refusal, section A. The employee may rescind this refusal at
any time and start the hepatitis vaccine series.
F.
Inmates who perform job functions that put them at risk of exposure to blood or
OPIM, will be provided bloodborne pathogens education and provided the
opportunity to receive hepatitis B vaccination. Consent for vaccination will be
recorded on DC4-710C Immunization Record Card and refusal of vaccination will
be documented on DC4-792B section A
HEALTH CARE EMPLOYEE EDUCATION:
A.
All Health Service employees will receive education on bloodborne pathogens
upon employment and on an annual basis.
B.
All topics, as listed in the OSHA standard 29 CFR Part 1910 Occupational
Exposure to Bloodborne Pathogens; Needlesticks and Other Sharps Injuries, will
be covered.
C.
A curriculum is attached to this TI (see appendix F—Bloodborne Pathogens for
Health Care Workers Curriculum).
D.
Reference materials will be provided to each institution by the Central Office
Infection Control Coordinator. Updated information will also be provided by the
Central Office Infection Control Coordinator to every institution for use in the
annual education program.
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SUBJECT: MANAGEMENT OF BLOODBORNE PATHOGEN EXPOSURES
XI.
REFERENCES:
A.
B.
C.
XII.
Departmental Exposure Control Plan
Florida Department of Corrections Safety Manual
Departmental procedure Management of Bloodborne Pathogen Exposures (to be
issued)
IMPLEMENTATION DATE:
Each institution will implement this technical instruction no later than 30 days after
signature.
Director of Health Services
Date
Attachment: Education Fact Sheet
Appendix A Bloodborne Pathogens (HBV,HCV, HIV)—Significant Exposures and Risk of
Infection
Appendix B Bloodborne Pathogen Exposure Brief Checklist
Appendix C Bloodborne Pathogen Exposure Checklist
Appendix D HIV Postexposure Prophylaxis for Bloodborne Pathogens
Appendix E HIV Postexposure Prophylaxis—Basic and Expanded Regimens
Appendix F Bloodborne Pathogens for Health Care Workers Curriculum
Section I
Bloodborne Infections
Section II Transmission
Section III Exposure Control
Section IV Work Practice Controls
Section V Postexposure Prophylaxis
This Technical Instruction Supersedes:
Section VIII of TI 15.03.22 dated 4/19/01