Page Up to Reverse  Employee Health  Page Down to Advance  Employee Health 

Page Up to Reverse  Employee Health  Page Down to Advance Blood Borne Pathogen Exposures A HealthCare Worker Guide 4 part series Prevention Education Safety Sharps HELP I’ve been EXPOSED What do I do?

Page Up to Reverse  Employee Health  Page Down to Advance DO NOT EXPOSE THE SOURCE PATIENT TO YOUR BLOOD HELP I’ve been EXPOSED What do I do? If you are performing a procedure and suffer a sharps stick from the instrument, STOP. Change to clean gloves. Change to a clean instrument and resume the procedure. If any equipment involved is broken or is not functioning, report it to the supervisor immediately so that the equipment can be removed from service for repair or replacement.

Page Up to Reverse  Employee Health  Page Down to Advance For percutaneous/needlestick/sharp injury – Wash the wound with soap and water. Antiseptics are not contra-indicated. However, there is no evidence that use of antiseptics for wound care further reduces the risk of HIV transmission. There is no evidence that expressing fluid by squeezing the wound further reduces the risk of HIV transmission. The application of caustic agents such as bleach is not recommended. Injection of antiseptics or disinfectants into the wound is not recommended. Remove any foreign materials embedded in the wound if possible. IMMEDIATE CARE of EXPOSED AREA HELP I’ve been EXPOSED What do I do?

Page Up to Reverse  Employee Health  Page Down to Advance For non-intact skin exposure – Wash the area immediately with soap and water. Antiseptics are not contra-indicated. However, there is no evidence that use of antiseptics for wound care further reduces the risk of HIV transmission. The application of caustic agents such as bleach is not recommended. Injection of antiseptics or disinfectants into the wound is not recommended. IMMEDIATE CARE of EXPOSED AREA HELP I’ve been EXPOSED What do I do?

Page Up to Reverse  Employee Health  Page Down to Advance For mucous membrane exposure (i.e. eye or mouth) – Irrigate continuously for 15 minutes with tap water, sterile saline, or sterile water. If there is an eye splash involving blood and/or body fluids, remove any contacts before irrigating. IMMEDIATE CARE of EXPOSED AREA HELP I’ve been EXPOSED What do I do?

Page Up to Reverse  Employee Health  Page Down to Advance HELP I’ve been EXPOSED What do I do? REPORT THE EXPOSURE to the SUPERVISOR Fill out an Employee Report of Injury specific for the facility or company you work for: Forest Park Des Peres SLU Hospital SouthPointeSLU St. Alexius

Page Up to Reverse  Employee Health  Page Down to Advance The designated after hours reporting location for Employee Health is HELP I’ve been EXPOSED What do I do? REPORT FOR EVALUATION PROMPTLY!! Emergency Department

Page Up to Reverse  Employee Health  Page Down to Advance HELP I’ve been EXPOSED What do I do? URGENT DECISION IS WHETHER TO ACCEPT or DECLINE Post-Exposure HIV Prophylaxis The procedures at Employee Health and the ER are updated to remain consistent with current CDC recommendations. The exposed healthcare worker should be counseled about the risk assessment of the exposure, the current data about post-exposure HIV prophylaxis, and that there is an option to accept or decline post-exposure HIV prophylaxis. !!

Page Up to Reverse  Employee Health  Page Down to Advance HELP I’ve been EXPOSED What do I do? URGENT DECISION IS WHETHER TO ACCEPT or DECLINE Post-Exposure HIV Prophylaxis The studies done in animal models indicate that post- exposure HIV prophylaxis should be started early (i.e. within one hour) following exposure. Animal studies suggest that post-exposure prophylaxis is probably not effective when started later than 36 hours post-exposure. The urgent nature of the decision whether or not to accept post-exposure HIV prophylaxis does not allow time to determine the HIV infection status of the source patient if it is not already known. !!

Page Up to Reverse  Employee Health  Page Down to Advance HELP I’ve been EXPOSED What do I do? URGENT DECISION IS WHETHER TO ACCEPT or DECLINE Post-Exposure HIV Prophylaxis At the initial evaluation tetanus booster is given if indicated -- if the Hepatitis B vaccination 3 shot series was not previously completed other treatments may be needed !!

Page Up to Reverse  Employee Health  Page Down to Advance ALL SOURCE PATIENT LAB TESTING IS ARRANGED THROUGH EMPLOYEE HEALTH HELP I’ve been EXPOSED What do I do? Lab tests that are ordered because of an employee exposure are not ordered in the patient’s chart. Neither the patient nor the patient’s insurance are charged for the testing. Informed consent is obtained from the source patient by Employee Health. A suitable specimen is usually available in the lab and it is rare that a source patient has to undergo a separate venipuncture to obtain a specimen.

Page Up to Reverse  Employee Health  Page Down to Advance ALL SOURCE PATIENT LAB TESTING IS ARRANGED THROUGH EMPLOYEE HEALTH HELP I’ve been EXPOSED What do I do? Employee Health can only arrange source patient testing if the exposed employee reports the exposure to Employee Health. If an employee is at an off site location and there is a labeled red top tube blood sample and HIV consent available, it is acceptable for the exposed employee to bring these items to Employee Health. At no time is an employee REQUIRED to bring the source patient sample and HIV consent to Employee Health.

Page Up to Reverse  Employee Health  Page Down to Advance HELP I’ve been EXPOSED What do I do? EXPOSED EMPLOYEE BASELINE LAB TESTING All exposed employees should, after informed consent, have baseline HIV testing performed. This step is done at Employee Health and is important in terms of implications for possible compensation claims should seroconversion occur. Healthcare worker HIV test results are kept confidential.

Page Up to Reverse  Employee Health  Page Down to Advance HELP I’ve been EXPOSED What do I do? EXPOSED EMPLOYEE FOLLOW UP LAB TESTING Follow up testing is closely tracked when confirmed exposure to HIV, Hepatitis B, or Hepatitis C is documented. If source patient testing does not reveal HIV, Hepatitis B, or Hepatitis C infection, follow up testing is available.

Page Up to Reverse  Employee Health  Page Down to Advance HELP I’ve been EXPOSED What do I do? EXPOSED EMPLOYEE FOLLOW UP LAB TESTING 6 weeks HIV test – This marks the beginning of the period during which both acute infection and seroconversion are most likely to occur. 3 months HIV test – This is performed even if the 6 week test was negative since seroconversion may have occurred in the interim. 6 months HIV test – It is unlikely that seroconversion will occur after this point. 12 months HIV test – A final HIV test at 1 year may reassure healthcare workers who so far have had negative test results.

Page Up to Reverse  Employee Health  Page Down to Advance Exposed employees may experience a range of emotions after being faced with a series of decisions. Exposed employees can have difficulty with anxiety, work performance, or inter-personal relationships. This can occur at the time of the exposure or during the follow up period. Employee Assistance Program services are confidential and free of charge. Contact number is available through Employee Health. HELP I’ve been EXPOSED What do I do? EMPLOYEE ASSISTANCE PROGRAM

Page Up to Reverse  Employee Health  Page Down to Advance Exposed employees must take precautions to avoid potential HIV transmission to others during the six months of follow up. These include: Avoiding blood, semen, or organ donations. Adopting safer sex practices. Deferring pregnancy for female employees. HELP I’ve been EXPOSED What do I do? HIV TRANSMISSION PRECAUTIONS

Page Up to Reverse  Employee Health  Page Down to Advance  Employee Health 