Download Policy for blood-body fluid exposure

Procedure for blood/body fluid exposure:
For rotations at UVa:
1. Report the incident to the faculty supervising the clinical service.
All exposures should be reported immediately to the person on call
for Bloodborne Pathogen Exposures by paging (pic #1523) to
report the exposure. This pager will be covered by employee health
except during off hours, in which case the nursing supervisor
covers this pager. The person covering this pager will initiate the
triage process and contact individuals involved in the process.
2. If a medical student has been exposed to a patient’s blood or
body fluids in a manner that may transmit HIV or hepatitis B or C,
the Medical Center will test the source patient’s blood for HIV and
hepatitis B and C. The source patient’s treating physician or
designee will order the source patient’s tests and provide or
arrange for any necessary treatment. Employee Health will order
the exposed healthcare workers tests and provide all necessary
prophylactic treatment except during off hours, in which case the
Emergency Department will do the same.
For away rotations:
1. Report the incident to the faculty supervising the clinical service. For
hospital rotations, follow the procedure for that facility.
2. Page the Dean on Call (924-0000, pic 1416) for instructions. The
decision will be made at that time whether to seek care locally or
return to the University.
3. If a medical student has been exposed to a patient’s blood or body
fluids in a manner that may transmit HIV or hepatitis B or C, the
source patient’s treating physician or designee will order the source
patient’s testing.
For all students:
All students who have been evaluated and or treated for exposure
to blood and body fluids will be referred to the Student Health Center for
follow-up. The student will be advised to call Student Health (434-9823915) to be seen 48 Hours after exposure. All paperwork and laboratory
reports will be faxed from Employee Health prior to this visit.
The Student Health triage physician will review the needlestick and
blood and body fluid report forms at the 48 hour visit follow-up visit after
the exposure Post test counseling will be provided at this time. An
appointment schedule will be developed with the assistance of the triage
nurse for 6 weeks, 3 month and 12 month visits. The “Agreement for
follow-up of Needlestick/Blood or Body Fluid Exposure” form will be
completed by the triage nurse, and the student asked to sign it. The
student signature indicates their understanding of the recommendation
to comply with the schedule, especially if graduation occurs before the
final 12 month assessment.
Policies and procedures related to exposure to infectious agents
are available through Student Health and are based on CDC and OSHA
guidelines.
Billing
All costs for testing, immunization, diagnostics, and prophylactic
medications as a result of occupational exposure will be covered by fees
for the first month (insurance will be billed thereafter).
Students who sustain exposures on away rotations should have
billing fees charged to their personal insurance policies, and whatever is
not covered will be billed to the School of Medicine via Student Health.
Procedures for clerkship sites:
1. Salem VAMC :
ALGORITHIM FOR BLOODBORNE PATHOGEN
EXPOSURE
EMPLOYEE
 Reports immediately to Occupational Health during the hours of 8A-4:30P,
Mon-Fri, or to the ER after hours or on the weekend.
 If seen in the ER, employee MUST report to Occupational Health the next
working day or telephone the next day (x2908)
 Do not let the source patient leave until their labs are Drawn!!!!!!
EMERGENCY ROOM
 Provides care and post exposure prophylaxis is expedited to the employee if
indicated (note: 2 hour window to determine need for post exposure
prophylaxis)
 Contacts the attending physician of the source patient (if known) to alert them
to enter orders via SOURCE PT PROTOCOL see below (tell the provider
what to order)
 Notifies Occupational Health by forwarding CPRS notes to Dr. Kristina Bulas
 Notifies Infection Control by telephone of exposure (Charlene Scott ext 1701,
pager 1017)
 Follow EMPLOYEE PROTOCOL (see below)
 Determine the HIV/HEP B AND HEP C status of the SOURCE PATIENT .
*** If HIV, HBV AG, HVC AB results are older than 6 months on the source
patient —follow the SOURCE PATIENT PROTOCOL -then follow the SOURCE
UNKNOWN pathway in attachment D
Complete attachment B - EMPLOYEE EXPOSURE PROFILE
Follow attachment C - HEP B PROPHYLAXIS RECOMMENDATIONS
Follow attachment D - GUIDELINES FOR MANAGEMENT OF EXPOSURE TO
HIV
EMPLOYEE PROTOCOL
 Order EXPOSURE PANEL (Exposure Panel includes the HIV,- HCVab,HBVsAg,- HBVsAB,- SGOT,- SGPT)
 Complete CA1/election of care
 Review Hepatitis B vaccination status and tetanus status—offer boosters if
indicated
 Obtain verbal consent for HIV testing.
 If Post-exposure prophylaxis is given—offer anti-nausea meds and order
CBC/LFTS and pregnancy test (if applicable)
SOURCE PATIENT PROTOCOL




Notify source patient of exposure and obtain verbal consent for HIV testing
Document consent in chart
Order EXPOSURE PANEL
YOU MUST CALL THE LAB (otherwise labs will be done as routine tests)
Phlebotomy – ext 2303
Micro for testing priority – ext 2192
After hours – ext 2290 for both
3. Inova Fairfax:
4. Western State Hospital: Students are treated by the same procedure as
employees.
•
Employees injured while in the course of, or arising out of
employment should immediately seek medical attention if such attention is
deemed necessary by the supervisor in charge or at the employee’s request.
•
Minor injuries (scratches, etc.) may be taken care of in the work area
or treatment room. Minor injuries must be reported. Employees on the units
should advise the supervisor of minor injuries requiring first aid.
•
An exposure that may place the employee at risk for HBV, HCV or HIV
infection is defined as contact with blood, body fluids that contain visible
blood, semen, vaginal secretions or body cavity fluids such as spinal fluid,
pleural fluid, amniotic fluid, etc. through:
-Needle stick, puncture or cut with a sharp object.
-Contact of mucous membrane or non intact skin (skin that is
chapped, abraded, or dermatitis)
-Human bite that breaks the skin (may expose both the person bitten
and the person who inflicted the bite)
-Note: Feces, nasal secretions, saliva, sputum, sweat, tears, urine and
vomitus are not considered potentially infectious unless they contain visible
blood.
•
Following the report of an exposure incident, the hospital will make
available a confidential medical evaluation and follow-up. The HR Office will
ensure that the healthcare professional evaluating the employee after
exposure is provided all relevant medical records; Western State Hospital
Form #25, results of the source individual’s blood testing if available.
5. Bon Secours
CONTRACT/NON-EMPLOYEE POST EXPOSURE PROTOCOL
Non-employees are considered to be: students, physicians or other licensed
independent practitioners, emergency services workers, or agency staff
providing care, but are not Bon Secours employees. Visitors are also included
in this category.
You have had an occupational exposure to blood or body fluids that may
contain HIV/HBV/HCV or other pathogens.
1. Wash affected area.
Wash needle sticks with soap and water
Flush splashes to the nose, mouth or skin with water
Irrigate eyes with clear water, saline or sterile irrigation solution
2. In order for your private insurance or employer’s workers’ compensation
to cover potential charges incurred from your injury/illness, you must follow
these steps:
-Notify the department manager and your immediate
supervisor/instructor of the occurrence
-Complete an online Quantros Report. Add Infection Prevention as the
“other area involved”.
3. Call Infection Prevention if the exposure has occurred 7:30 am - 4:30 pm,
Monday through Friday.
St. Mary’s Hospital
281-8024
Memorial Regional Medical Center
764-6415
Richmond Community Hospital
225-7363
St. Francis Medical Center
594-3480
*If after hours, notify the nursing supervisor of the incident.*
4.
Collect 2 amber top tubes from the source patient immediately. Print
the lab form labeled, Source Patient Exposure Labs. Be sure to complete all
information requested. Send the specimen to the lab immediately. Ensure
that the patient’s name, SSN, and birth date is on the lab form.
Print a copy of the post exposure prophylaxis information.