Policy No.: HR.4.01 Back to previous page
Section: Human Resources
Effective: September 1, 1989
Revision: July 16, 1997
Subject: NEEDLESTICK/SHARPS INJURIES AND BLOOD/BODY
FLUID EXPOSURE
Source: Administration
POLICY:
All faculty, employees, residents, or students, who suffer a parenteral (e.g. needlestick or cut) or mucous membrane (e.g., splash to the eye or mouth) exposure to blood or other body fluids, or who have a cutaneous exposure involving large amounts of blood or prolonged contact with blood—especially when exposed skin is chapped, abraded, or afflicted with dermatitis—shall:
Information about the source patient shall be documented on the Employee Incident and Injury (I&I) report form by the nursing supervisor or his/her designee from which the source patient is receiving care.
All employees and students who have a blood/ body fluid exposure are to be evaluated either by the EH/SPHS or the ED regardless of the type of exposure or risk status of the source patient.
The I&I form shall accompany the employee/student to EH/SPHS or the ED at the time of the initial evaluation.
It is the responsibility of the employee’s supervisor or student’s instructor to make sure that all information relevant to the I&I has been completed and the involved employee or student has called either EH/SPHS or the UAMS ED, for triage. It is the responsibility of the Nursing Supervisor or designee to record all information regarding the source patient on the I&I, notify either EH/SPHS or the ED with the risk factors for HIV, and ensure that orders are written for lab work on the source patient’s chart.
PROCEDURES:
I. "Clean " Needlestick/Sharps Injury
A. The nursing supervisor or designee shall record that a "clean" needlestick has occurred. A "clean" injury is one where the instrument involved has not been used on a patient.
B. The employee shall call EH/SPHS or the ED to arrange to be seen within 24 hours for wound treatment and tetanus prophylaxis, if necessary. No further treatment is necessary.
II. Sharps Injury/Blood or Body Fluid Exposure Involving A Patient
A. If the involved patient cannot be identified:
1. The nursing supervisor or designee shall note on the I&I form that the source patient is unknown.
2. The employee/student shall contact EH/SPHS or the ED immediately after the exposure.
3. The employee or student will start or resume the Hepatitis B vaccine series if it is determined to be necessary.
4. The employee or student will have a baseline HIV and HBSAb drawn at the time of the initial visit. The HIV will be repeated in 3 months.
B. Source Patient Involved Can Be Identified
1. The nursing supervisor or designee shall:
a. Record the source patient’s name, medical record number, physician, and pertinent medical information from the source patients chart regarding the risk status for Hepatitis and HIV infection (e.g. history of blood transfusions, IV drug use, incarceration, sexually transmitted diseases) on the I&I form.
b. Obtain orders from the physician for a Hepatitis B Surface Antigen (HBSAg) and HIV serologies to be drawn as soon as possible on the source patient. The lab work will be performed at the hospitals expense. Document in the chart that this is an "Occupational Exposure- No Charge".
2. The employee’s supervisor or instructor shall:
a. Ensure that the above information has been documented on the I&I and that the involved employee or student has been referred for appropriate evaluation and treatment.
3. When used in this paragraph, the
term "employee" shall be deemed to include all UAMS employees,
residents, faculty, or students, who suffer an exposure at UAMS. A source
patient’s blood may be tested for HIV, Hepatitis B, and other diseases as
recommended by the AR State Health Department at the hospital’s expense without
the consent of the patient or a patient representative. If the source patient
is capable of understanding, the patient’s attending physician shall inform the
patient of the incident, the need to test the patient’s blood, and that the
patient will be informed of the results of the tests. The patient’s physician
is not required to provide such information to the patient’s representative if
the patient is incapable of understanding. When the results are obtained, the
physician shall advise the patient of the results and shall provide appropriate
counseling. Results of the tests will also be provided to the affected employee
and the employee’s physician, both of whom shall have an obligation to maintain
the patient’s confidentiality. It is
the responsibility of the supervisor to insure that this policy is carried out.
4. Treatment of the employee following
patient testing:
a. The nursing supervisor or designee shall record which tests were done on the source patient and the date on which they were done on the I&I form.
b. The employee shall contact either EH/SPHS or the ED as soon as possible after the exposure. The employee must be evaluated by a physician in EH/SPHS or the ED within 24 hours of the exposure.
c. If the source patient has AIDS or is sero-positve for HIV, the employee will be tested for HIV at the initial evaluation, and, if the employee is sero-negative, will re-test at 6 weeks, three months and 6 months following the exposure. The employee will be counseled to report back to EH/SPHS for any febrile illness that occurs within 12 weeks of exposure (such as illness, particularly characterized by fever, rash, or lymphadenopathy which may be indicative of recent HIV infection). Especially during the first 6 to 12 weeks of the follow-up period, the employee should be advised to follow the U.S. Public Health Service recommendations for preventing the transmission of HIV.
d. If the source patient is sero-negative for HIV, the employee will be tested for HIV at the initial evaluation, and if sero-negative, the employee shall be retested at three months.
e. Any employee who agrees to be tested for HIV following an injury or exposure and is found to be sero-positive shall be informed of the test results and will be seen and counseled by an EH/SPHS physician regarding the need for further confirmatory testing. Reporting of confirmed HIV tests will be done in accordance with Hospital Policy and Procedure number A-14, Reporting of HIV Antibody Results.
III. Source Patient Is Diagnosed Or Suspected Of Having A Blood-Borne Infection:
A. The supervisor or instructor shall record any of the following diagnosed or suspected blood-borne infections:
1. Arthropod-borne viral fevers
2. Babesiosis
3. Creutzfeltd-Jacob Disease
4. Hepatitis C
5. Leptospirosis
6. Malaria
7. Rat-bite fever
8. Relapsing fever
9. Syphilis, primary and secondary
10. HIV
B. EH/SPHS shall follow recommendations for tetanus, HIV, and Hepatitis B evaluation according to the situation.
C. EH/SPHS may consult an infectious disease specialist in the event that an employee had an injury/exposure to any of the above- listed diseases.
IV. Billing for Blood/Body Fluid exposure
A. Employees:
Since this type of injury is classified as "job-related", a claim for Worker’s Compensation shall be initiated at the time that the employee reports to either EH/SPHS or the ED.
B. Students:
Students who have a blood/body fluid exposure shall also be evaluated by EH/SPHS or the ED and are subject to completing an I&I Report form so that proper evaluation and treatment may be accomplished. Insurance and/or the appropriate college shall be billed in the case of students with a blood/body fluid exposure.
V. The Administration of Chemoprophylaxis Post-Exposure to Blood/Body Fluids
A. The hospital will make chemoprophylaxis available for UAMS employees who have sustained an occupational exposure from either a high risk or HIV positive patient. Insurance or the appropriate college will be billed for Chemoprophylaxis for UAMS students.
B. EH/SPHS has developed a protocol for Post-Exposure Prophylaxis which involves counseling, informed consent, prescribing the drug, and follow-up visits with laboratory assessment. Symptoms and laboratory work will be monitored to minimize toxicity. The use of Chemoprophylaxis following occupational exposure to HIV is controversial. The decision will rest with the individual and the EH/SPHS or ED physician. In theory, chemoprophylaxis is best given within the first 2 hours following the exposure.