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.

 

  1. 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.

 

  1. 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 (434-982-3915) 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

 

 

 

  1. Inova Fairfax:

 

  1. 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.

 

  1. 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

 

  1. 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”.

 

  1. 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.*

 

  1. 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.