Download MUSC Occupational Bloodborne Pathogen Protocol

MUSC Occupational Bloodborne Pathogen Protocol
Off Campus Procedure Packet
MUSC has established these protocols in accordance with the OSHA Bloodborne Pathogen Standard and Center for
Disease Control recommendations for Occupational Blood and Body Fluid exposure. CDC strongly recommends HIV
prophylaxis start as soon as possible (ASAP) in the event of occupational bloodborne exposure, please perform the
following emergency medical care:
Instructions for Employees/Students:
Know or carry your Hepatitis B (HBV) vaccination information and your HBV antibody results
In the event of a blood or body fluid exposure:
1.
Wash the site immediately with soap and water. Splashes to the eye should be flushed
for 15 minutes with water or a Liter of Lactated Ringers.
2.
Go to the nearest Emergency Facility immediately, preferably to a Hospital Emergency
Department.
3.
Report the BBP exposure immediately by calling the Employee Health Services (EHS) at
(843) 792-2991 Monday – Friday 7:30am – 4:00pm.
Students report by calling Student Health Services (SHS) at (843) 792-3664 Monday – Friday
8:00 am – 4:30 pm.
After hours contact the MUSC Medical Center Hospital Supervisor by calling the operator at
(843) 792-2123. For general instructions on BBP, call the BBP Hotline 24 hours a day at
(843) 792-4422.
Leave the following information on the recording:
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4.
Employee/Student name and phone number
Date and time of exposure
Name of the BBP Source, medical record #
Name of facility, ER, MD who will treat you for BBP exposure
Name and phone number of health care worker to contact for lab follow up
Immediately complete the online ACORD form (Worker’s Compensation First Report
of Injury Form). Employee/Student results and source results must be submitted to
Worker’s Compensation and EHS/SHS.
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Instructions for Care of MUSC Employee/Student with BBP exposure
Please complete the following medical evaluation for our Employee/Student. If outside South Carolina,
refer to the appropriate state law.
Responsible Area
Medical Provider
Billing Manager
Reporting
Instruction
1. Identify and obtain blood from BBP Source.
Perform labs. Draw STAT HIV, HbsAG, HCV
AB if available. 1 Gold Serum Separator blood
tubes-no microtainers
2. Evaluate employee/student for Hep B exposure
risk. See Hep B chart. Provide care as indicated.
Hep B surface antibody (for unknown titer only.)
3. Counsel the employee/student on HIV exposure.
4. Offer Post Exposure Prophylaxis (PEP) as per
CDC recommendation.
5. If the employee/student elects PEP have them sign
the consent form and report to EHS/SHS
immediately or the next business day (if after hours
or holiday) for baseline lab draw.
Provide wound care as indicated. Tdap booster as
indicated.
For Billing or Worker’s Compensation questions
contact the following:
1. Elise Giles (843) 792-7554 (MUSC)
2. Brandy Atkins (843) 852-3127 (MUSC-P)
3. Kathryn Singleton (843) 792-3226 (Students)
Please forward all documentation to:
MUSC Employee Health Services
57 Bee Street
Charleston, SC 29403
(843) 792-2991 (phone)/(843) 792-1200 (fax)
MUSC Student Health Provider
30 Bee Street
Charleston, SC 29403
(843) 792-3664 (phone)/(843) 792-2318 (fax)
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Hepatitis B Prophylaxis Following Blood Exposure
Hepatitis C (HCV) Exposure:
1. HCV Negative Source – No treatment is indicated.
2. HCV Positive Source – Instruct the Employee/Student to contact their Employee/Student Health
provider for follow up. There is currently no prophylaxis for HCV exposure.
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BLOODBORNE PATHOGEN EXPOSURE:
GUIDELINES AND RISKS
This data is from the Updated U.S. Public Health services guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV
Recommendations for Post exposure Prophylaxis; CDC MMRW Recommendations & Reports, June 29, 2001 / 50 (RR11); 1-42
Exposure that may place a health care provider at risk for contracting Hepatitis B (HBV), Hepatitis C (HCV), or Human
Immunodeficiency Virus (HIV) infection is defined as a percutaneous injury (example, a needlestick or cut with a sharp objet)
or contact of mucous membrane / non-intact skin (example, exposed skin that is chapped, abraded, or afflicted with dermatitis)
with blood, tissue, or other body fluids that are potentially infectious.
Blood
Amniotic fluid
Cerebral spinal fluid
Synovial fluid
Pleural fluid
Peritoneal fluid
Pericardial fluid
Body fluids with visible blood
Semen & Vaginal secretion
Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus are not considered potentially infected unless they contain
blood.
Any direct contact (example, contact without barrier protection) to concentrated virus in a research
Laboratory is considered an exposure that requires clinical evaluation.
For Human Bites, the clinical evaluation must include the possibility that both the person bitten and the person
who inflicted the bite was exposed to bloodborne pathogens if a bite results in blood exposure.
Healthcare providers should report occupational exposures immediately after they occur, particularly
Because HBIG and Hepatitis B vaccine (in addition to HIV post exposure prophylaxis) are most likely to be
effective if administered as soon after the exposure as possible.
Risk for Occupational Transmission
HBV
HBV infection is well recognized risk for healthcare providers.
HBV has been demonstrated to survive in dried blood for at least 1 week
The risk of HBV infection is primarily related to the degree of contact with blood & hepatitis B e antigen
(HbeAg) status of the source person
HCV
HCV is not transmitted efficiently through occupational exposure to blood. The average incidence of antiHCV seroconversion after accidental percutaneous exposure from an HCV +positive source is 1.8%.
Data is limited on survival of HCV in the environment.
HIV
The average risk of HIV transmission after a percutaneous exposure to HIV infected blood had been estimated
to approx. 0.3%; and after a mucous membrane exposure approx. 0.09%
4 week post exposure prophylaxis with positive HIV exposure noting that the initiation of antiviral therapy be
administered as soon after the exposure as possible
Introduction
Exposure to another person’s blood or body fluids by needlestick, splash, or other exposure may place a worker at risk for exposure
to HIV, Hepatitis B, Hepatitis C, or other infectious agents. Medication is available that may reduce a worker’s risk of HIV
transmission. A vaccine is available for Hepatitis B. There is currently no vaccine available for Hepatitis C or recommendation for
Post exposure chemoprophylaxis.
Risk of Work Related Bloodborne Infection
Actual transmission of HIV in the workplace is rare. Studies of healthcare workers show that even the greatest risk of HIV
infection due to injury with a hollow needlestick with HIV position blood into the skin is 0.3%. That means that even with the
highest risk, the chances of getting HIV from one such exposure is 1 in 300. The risk of HIV for splashes to the face and eyes is 1
in 900. Risk factors for hepatitis infection depend on illness in the source, the type of hepatitis virus, and previous vaccination
status. Workers should always seek medical care immediately for any bloodborne exposure.
Management of Work Related HIV Exposure
Treatment for blood or body fluid exposure is based on recommendations by the CDC (Center for Disease Control). Only workers
with the highest risk of HIV exposure should receive post exposure combination therapy.
Follow Up When you are seen for a blood or body fluid exposure, you will be given a follow-up appointment. Further follow-up
depends upon these results. Exposure management decisions are made by Employee Health Services (EHS).
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INFORMATION FOR HUMAN IMMUNODEFICIENCY VIRUS (HIV) TESTING
HIV INFORMATION: HIV is spread through contact with certain body fluids from an infected person.
This can occur during sexual intercourse, receiving infected blood products, exposure to blood and
infectious body fluids, during the birth process, or by sharing needles for intravenous drug use. HIV is not
known to be spread by other contact, and infection can be prevented by avoiding the contact described
above.
OCCUPATIONAL HIV EXPOSURE: The body fluids to which Universal Precautions apply have been
defined by the CDC as blood, semen, vaginal secretions, and spinal, synovial, pleural, peritoneal,
pericardial, and amniotic fluids, but not urine, feces, sweat, saliva, or tears, unless they contain visible
blood. All but four of the published accounts of occupational HIV transmission have arisen from puncture
wounds from sharp instruments freshly contaminated with HIV-infected blood or blood containing body
fluids. In persons sustaining percutaneous exposure to blood from a known HIV positive individual, the
risk of transmission is about 4 in 1000.
TEST INFORMATION: The test is done on a sample of your blood. The purpose is to look for the
presence of antibodies to HIV. Antibodies are produced in the blood in response to infection. Most people
will develop antibodies to HIV within six months of infection.
CONFIDENTIALITY: The HIV test results will be considered confidential and released only to the
health professionals who have responsibility for your care, and to the S.C. Department of Health and
Environmental Control (DHEC), as required by state law. Information about this may not be released to
any other persons without your written approval, except by a valid court order or subpoena. Due to the
highly confidential nature of the test, results will be given only in person to the employee being tested.
Therefore, it will be the responsibility of the employee to schedule a brief follow-up visit a week later to
receive their results.
NEGATIVE TEST RESULTS: A negative result means that no antibodies were detected. On rare
occasions, this can occur if you are infected but have not yet developed antibodies to HIV.
POSITIVE TEST RESULTS: A positive test result means you are infected with HIV. A positive test does
not mean you have already developed AIDS. Your physician will discuss with you the need for further
testing. Counseling will be provided to you at the time you receive your test results. An HIV test has been
ordered for you. This test is entirely voluntary and you can refuse it without stopping your medical care.
I understand the above information and have had the opportunity to have my questions answered. I will
follow-up with EHS to receive the lab results in one week.
Signature of Patient/Date:________________________________________________________________
Signature of Counselor/ Date: _____________________________________________________________
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Consent or Refusal of Post-Exposure Chemoprophylaxis Treatment
I understand that while I am taking post-exposure HIV prophylaxis and for an additional month following
completion of therapy it is important to:
● Either abstain from sexual activity or use condoms with or without another form of birth control in
order to avoid becoming pregnant
● Either abstain from sexual activity or use condoms in order to avoid the sexual transmission of HIV.
● Discontinue or delay starting breastfeeding
● Refrain from donating blood, blood products, organs, tissue or semen.
I have been given the opportunity to ask questions about post-exposure prophylaxis.
I would like to take the post-exposure prophylaxis and agree to abide by the treatment protocol.
________________________
Employee Signature
________________
Date
________________________
Name (Print)
I have been informed of the potential benefit of taking HIV post-exposure prophylaxis in reducing the
transmission of HIV when exposed to infected blood. I have been given the opportunity to ask questions
about post-exposure prophylaxis and have decided that I am not going to take post-exposure prophylaxis.
I understand the importance of initiating this therapy immediately and that medication will not be offered
at a later time.
________________________
Employee Signature
________________
Date
________________________
Name (Print)
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EMPLOYEE COMPLETES
EMPLOYEE COMPLETES
EMPLOYEE COMPLETES
Bloodborne Pathogen Exposure/Follow-up
___________
Employee name
Cell Phone
EMPLOYEE HEALTH SERVICES
Date of Birth
57 Bee Street
Charleston, South Carolina 29425
Telephone: 843-792-0303
Fax: 843-792-0423
Work Phone /Ext. / Pager#
Employer____________________ Department____________ Occupation/Job Title_______________________________
Date & time of exposure ____________________/______________ am/pm
Location: Main Hosp_____ ART
RT
Other (indicate where)__________
__RM#____
Type of exposure: O Needle stick ____hollow bore, what gauge______, or ___solid suture needle
O Laceration, What type of Instrument ___________brand name________________ size______
O Bite
O Splash
O Other
If applicable, were you DOUBLE_____ or SINGLE_____ gloved? (for sticks and lacerations)
If applicable, was visible blood in sources mouth or under nails___________ (for bites and scratches)
Identifiable Source:
Name:
__ Med Record #: _________ Date of Birth_____________
Blood contamination screen drawn on source patient?: O Yes O No
Attending MD Name:
Known communicable disease?:
Experience (months or years) _________Length of time employed by MUSC ________
Circumstances (what caused the exposure)? (example: equipment failure, user error, etc.)
________________________________________________________________________________________
________________________________________________________________________________________
What could have been done differently to prevent the exposure? __________________________________
________________________________________________________________________________________
________________________________________________________________________________________
If applicable, were you wearing PPE? Yes_____ No_____
If yes, what PPE wear you wearing?
________________________________________________________________________________________
If no, why not? ___________________________________________________________________________
________________________________________________________________________________________
Employee Signature: _______________________________________
Date:_______________________
Completed by Treating Facility Designee
____________________________
Employee’s Medical History and Treatment:
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Employee completed Hepatitis B vaccine series?
HIV consent and Pre-HIV counseling MD signature?
Blood contamination screen drawn on employee?
Post exposure protocol (PEP) initiated?
Baseline (PEP) labs drawn?
PEP counseling by MD completed?
PEP consent or declinations signed?
Employee instructed to follow-up in 3 days?
Copy of all medical records prepared for Employee Health Services?
O Yes
O Yes
O Yes
O Yes
O Yes
O Yes
O Yes
O Yes
O Yes
O No
O No
O No
O No
O No
O No
O No
O No
O No
O N/A
O N/A
O N/A
O N/A
O N/A
O N/A
O N/A
O N/A
______________________
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Source Blood Contamination Results
HIV
HbsAg __ ________
Employee Blood Contamination Results
HIV
AHbsAg __
HCV ___________
HCV ___________
Post Exposure Follow-up (Employee please initial)
________
________
________
ALT_____________
I have been informed of the results of the post exposure evaluation
I have been informed of any medical conditions resulting from exposure to blood or other potentially infectious
materials which require evaluation or treatment.
I have been counseled about adherence to Universal Precaution procedures and maintaining confidentiality of the
Sources’ medical information.
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