OH and SSS 2005 Blood and body fluid exposures Order Tests on “Source” patient via Wiz so results are available in StarPanel when exposed employee receives treatment

OH and SSS 2005 When a healthcare worker is exposed to a patient’s blood or infectious body fluids, the stakes are high.

OH and SSS 2005 Risk of Infection After Needlestick From an Infected Patient Hepatitis B - 1 in 3 needlesticks Hepatitis B - 1 in 3 needlesticks Hepatitis C – 1 in 100 needlesticks Hepatitis C – 1 in 100 needlesticks HIV - 1 in 333 needlesticks & 1 in 1000 splashes HIV - 1 in 333 needlesticks & 1 in 1000 splashes Risk is Higher if: Risk is Higher if: the wound is deep the wound is deep the needle was hollow-bore the needle was hollow-bore the patient has a high viral load the patient has a high viral load CDC - MMWR 1998

OH and SSS 2005 Time is of the essence Antiviral therapy given within the first 2 hours reduces the risk by 80%.

OH and SSS 2005 Order Tests from Wiz on “Source Patient”. Tests conducted on Source of Exposure Rapid HIV Rapid HIV Hepatitis Panel Hepatitis Panel Who Should Order Tests On Source? Any MD/NP on Unit the exposure occurred Any MD/NP on Unit the exposure occurred Charge Nurse may enter the orders, conferring with any provider to include as ordering physician Charge Nurse may enter the orders, conferring with any provider to include as ordering physician

OH and SSS 2005 Timely Results on “Source Patient’s” Labs Make a Difference OHC and the ED can more accurately determine treatment needed for exposed employee if they have lab results on the “source” within 2 hours. OHC and the ED can more accurately determine treatment needed for exposed employee if they have lab results on the “source” within 2 hours. “Source” Lab results can be viewed in StarPanel by OHC or ED and will direct treatment of the employee. “Source” Lab results can be viewed in StarPanel by OHC or ED and will direct treatment of the employee. If Wiz is down or location doesn’t use Wiz, order Hepatic Panel and Rapid HIV manually. If Wiz is down or location doesn’t use Wiz, order Hepatic Panel and Rapid HIV manually.

OH and SSS 2005 Insert screenshot of Wiz Step 1: Type “source” (or “needlestick” or “exposure”) Step 2: Select “evaluate source patient”

OH and SSS 2005 The necessary lab tests are bundled together

OH and SSS 2005 Accept all orders in the set. The patient will not be billed.

OH and SSS 2005 ****Important**** Make sure the exposed employee goes to Occupational Health or the ED, regardless of the HIV results.

OH and SSS 2005 When should I go…ED or OH? Go to Occupational Health during office hours Go to Occupational Health during office hours 7:30am – 5:30pm, Monday – Friday When Occupational Health is closed, go to Emergency Department and identify yourself as an employee who has had an exposure When Occupational Health is closed, go to Emergency Department and identify yourself as an employee who has had an exposure

OH and SSS 2005 Take Home Points…. If Employee is Exposed, Test “Source” Immediately so Source Labs are available in StarPanel to help guide OH or ED staff in treating exposed employee. If Employee is Exposed, Test “Source” Immediately so Source Labs are available in StarPanel to help guide OH or ED staff in treating exposed employee. Order “Source” patient labs in Wiz from this order set: “Evaluate source patient whose blood/body fluids caused exposure.“ Orders can be entered by any MD or Charge Nurse conferring with an MD. Order “Source” patient labs in Wiz from this order set: “Evaluate source patient whose blood/body fluids caused exposure.“ Orders can be entered by any MD or Charge Nurse conferring with an MD. Send exposed employees to Occupational Health, or to the ED after hours, for evaluation. DO NOT TREAT EXPOSED EMPLOYEES YOURSELF!! Send exposed employees to Occupational Health, or to the ED after hours, for evaluation. DO NOT TREAT EXPOSED EMPLOYEES YOURSELF!! Always notify supervisor and complete “TN First Report of Work Injury” Always notify supervisor and complete “TN First Report of Work Injury”