MUSC Occupational Bloodborne Pathogen Protocol Off Campus Procedure Packet. Instructions for Employees/Students:

Transcription

1 MUSC Occupational Bloodborne Pathogen Protocol Off Campus Procedure Packet MUSC has established these protocols in accordance with the OSHA Bloodborne Pathogen Standard and Center for Disease Control recommendations for Occupational Blood and Body Fluid exposure. CDC strongly recommends HIV prophylaxis start as soon as possible (ASAP) in the event of occupational bloodborne exposure, please perform the following emergency medical care: Instructions for Employees/Students: Know or carry your Hepatitis B (HBV) vaccination information and your HBV antibody results In the event of a blood or body fluid exposure: 1. Wash the site immediately with soap and water. Splashes to the eye should be flushed for 15 minutes with water or a Liter of Lactated Ringers. 2. Go to the nearest Emergency Facility immediately, preferably to a Hospital Emergency Department. 3. Report the BBP exposure immediately by calling the Employee Health Services (EHS) at (843) Monday Friday 7:30am 4:00pm. Students report by calling Student Health Services (SHS) at (843) Monday Friday 8:00 am 4:30 pm. After hours contact the MUSC Medical Center Hospital Supervisor by calling the operator at (843) For general instructions on BBP, call the BBP Hotline 24 hours a day at (843) Leave the following information on the recording: Employee/Student name and phone number Date and time of exposure Name of the BBP Source, medical record # Name of facility, ER, MD who will treat you for BBP exposure Name and phone number of health care worker to contact for lab follow up 4. Immediately complete the online ACORD form (Worker s Compensation First Report of Injury Form). Employee/Student results and source results must be submitted to Worker s Compensation and EHS/SHS. 1

2 Instructions for Care of MUSC Employee/Student with BBP exposure Please complete the following medical evaluation for our Employee/Student. If outside South Carolina, refer to the appropriate state law. Responsible Area Medical Provider Billing Manager Reporting Instruction 1. Identify and obtain blood from BBP Source. Perform labs. Draw STAT HIV, HbsAG, HCV AB if available. 1 Gold Serum Separator blood tubes-no microtainers 2. Evaluate employee/student for Hep B exposure risk. See Hep B chart. Provide care as indicated. Hep B surface antibody (for unknown titer only.) 3. Counsel the employee/student on HIV exposure. 4. Offer Post Exposure Prophylaxis (PEP) as per CDC recommendation. 5. If the employee/student elects PEP have them sign the consent form and report to EHS/SHS immediately or the next business day (if after hours or holiday) for baseline lab draw. Provide wound care as indicated. Tdap booster as indicated. For Billing or Worker s Compensation questions contact the following: 1. Elise Giles (843) (MUSC) 2. Brandy Atkins (843) (MUSC-P) 3. Kathryn Singleton (843) (Students) Please forward all documentation to: MUSC Employee Health Services 57 Bee Street Charleston, SC (843) (phone)/(843) (fax) MUSC Student Health Provider 30 Bee Street Charleston, SC (843) (phone)/(843) (fax) 2

3 Hepatitis B Prophylaxis Following Blood Exposure Hepatitis C (HCV) Exposure: 1. HCV Negative Source No treatment is indicated. 2. HCV Positive Source Instruct the Employee/Student to contact their Employee/Student Health provider for follow up. There is currently no prophylaxis for HCV exposure. 3

4 BLOODBORNE PATHOGEN EXPOSURE: GUIDELINES AND RISKS This data is from the Updated U.S. Public Health services guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV Recommendations for Post exposure Prophylaxis; CDC MMRW Recommendations & Reports, June 29, 2001 / 50 (RR11); 1-42 Exposure that may place a health care provider at risk for contracting Hepatitis B (HBV), Hepatitis C (HCV), or Human Immunodeficiency Virus (HIV) infection is defined as a percutaneous injury (example, a needlestick or cut with a sharp objet) or contact of mucous membrane / non-intact skin (example, exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or other body fluids that are potentially infectious. Blood Synovial fluid Pericardial fluid Amniotic fluid Pleural fluid Body fluids with visible blood Cerebral spinal fluid Peritoneal fluid Semen & Vaginal secretion Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus are not considered potentially infected unless they contain blood. Any direct contact (example, contact without barrier protection) to concentrated virus in a research Laboratory is considered an exposure that requires clinical evaluation. For Human Bites, the clinical evaluation must include the possibility that both the person bitten and the person who inflicted the bite was exposed to bloodborne pathogens if a bite results in blood exposure. Healthcare providers should report occupational exposures immediately after they occur, particularly Because HBIG and Hepatitis B vaccine (in addition to HIV post exposure prophylaxis) are most likely to be effective if administered as soon after the exposure as possible. Risk for Occupational Transmission HBV HBV infection is well recognized risk for healthcare providers. HBV has been demonstrated to survive in dried blood for at least 1 week The risk of HBV infection is primarily related to the degree of contact with blood & hepatitis B e antigen (HbeAg) status of the source person HCV HIV HCV is not transmitted efficiently through occupational exposure to blood. The average incidence of anti- HCV seroconversion after accidental percutaneous exposure from an HCV +positive source is 1.8%. Data is limited on survival of HCV in the environment. The average risk of HIV transmission after a percutaneous exposure to HIV infected blood had been estimated to approx. 0.3%; and after a mucous membrane exposure approx. 0.09% 4 week post exposure prophylaxis with positive HIV exposure noting that the initiation of antiviral therapy be administered as soon after the exposure as possible Introduction Exposure to another person s blood or body fluids by needlestick, splash, or other exposure may place a worker at risk for exposure to HIV, Hepatitis B, Hepatitis C, or other infectious agents. Medication is available that may reduce a worker s risk of HIV transmission. A vaccine is available for Hepatitis B. There is currently no vaccine available for Hepatitis C or recommendation for Post exposure chemoprophylaxis. Risk of Work Related Bloodborne Infection Actual transmission of HIV in the workplace is rare. Studies of healthcare workers show that even the greatest risk of HIV infection due to injury with a hollow needlestick with HIV position blood into the skin is 0.3%. That means that even with the highest risk, the chances of getting HIV from one such exposure is 1 in 300. The risk of HIV for splashes to the face and eyes is 1 in 900. Risk factors for hepatitis infection depend on illness in the source, the type of hepatitis virus, and previous vaccination status. Workers should always seek medical care immediately for any bloodborne exposure. Management of Work Related HIV Exposure Treatment for blood or body fluid exposure is based on recommendations by the CDC (Center for Disease Control). Only workers with the highest risk of HIV exposure should receive post exposure combination therapy. Follow Up When you are seen for a blood or body fluid exposure, you will be given a follow-up appointment. Further follow-up depends upon these results. Exposure management decisions are made by Employee Health Services (EHS). 4

5 INFORMATION FOR HUMAN IMMUNODEFICIENCY VIRUS (HIV) TESTING HIV INFORMATION: HIV is spread through contact with certain body fluids from an infected person. This can occur during sexual intercourse, receiving infected blood products, exposure to blood and infectious body fluids, during the birth process, or by sharing needles for intravenous drug use. HIV is not known to be spread by other contact, and infection can be prevented by avoiding the contact described above. OCCUPATIONAL HIV EXPOSURE: The body fluids to which Universal Precautions apply have been defined by the CDC as blood, semen, vaginal secretions, and spinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids, but not urine, feces, sweat, saliva, or tears, unless they contain visible blood. All but four of the published accounts of occupational HIV transmission have arisen from puncture wounds from sharp instruments freshly contaminated with HIV-infected blood or blood containing body fluids. In persons sustaining percutaneous exposure to blood from a known HIV positive individual, the risk of transmission is about 4 in TEST INFORMATION: The test is done on a sample of your blood. The purpose is to look for the presence of antibodies to HIV. Antibodies are produced in the blood in response to infection. Most people will develop antibodies to HIV within six months of infection. CONFIDENTIALITY: The HIV test results will be considered confidential and released only to the health professionals who have responsibility for your care, and to the S.C. Department of Health and Environmental Control (DHEC), as required by state law. Information about this may not be released to any other persons without your written approval, except by a valid court order or subpoena. Due to the highly confidential nature of the test, results will be given only in person to the employee being tested. Therefore, it will be the responsibility of the employee to schedule a brief follow-up visit a week later to receive their results. NEGATIVE TEST RESULTS: A negative result means that no antibodies were detected. On rare occasions, this can occur if you are infected but have not yet developed antibodies to HIV. POSITIVE TEST RESULTS: A positive test result means you are infected with HIV. A positive test does not mean you have already developed AIDS. Your physician will discuss with you the need for further testing. Counseling will be provided to you at the time you receive your test results. An HIV test has been ordered for you. This test is entirely voluntary and you can refuse it without stopping your medical care. I understand the above information and have had the opportunity to have my questions answered. I will follow-up with EHS to receive the lab results in one week. Signature of Patient/Date: Signature of Counselor/ Date: 5

6 Consent or Refusal of Post-Exposure Chemoprophylaxis Treatment I understand that while I am taking post-exposure HIV prophylaxis and for an additional month following completion of therapy it is important to: Either abstain from sexual activity or use condoms with or without another form of birth control in order to avoid becoming pregnant Either abstain from sexual activity or use condoms in order to avoid the sexual transmission of HIV. Discontinue or delay starting breastfeeding Refrain from donating blood, blood products, organs, tissue or semen. I have been given the opportunity to ask questions about post-exposure prophylaxis. I would like to take the post-exposure prophylaxis and agree to abide by the treatment protocol. Employee Signature Date Name (Print) I have been informed of the potential benefit of taking HIV post-exposure prophylaxis in reducing the transmission of HIV when exposed to infected blood. I have been given the opportunity to ask questions about post-exposure prophylaxis and have decided that I am not going to take post-exposure prophylaxis. I understand the importance of initiating this therapy immediately and that medication will not be offered at a later time. Employee Signature Date Name (Print) 6

7 Confidential Initially to be completed by Treating Facility Designee (EHS) EMPLOYEE COMPLETES EHS or HS COMPLETES EMPLOYEE COMPLETES Bloodborne Pathogen Exposure/Follow-up Employee ID # Employee name Cell Phone Date of Birth Work Phone /Ext. / Pager# Employee Health Services 57 Bee Street Chas SC Telephone FAX#: Employer Department Occupation/Job Title Date & Time of Exposure am/pm Location: Main Hosp ART RT Other (indicate where) RM/bed/bay# Type of exposure: ONeedle stick solid suture needle, hollowbore, gauge, OLaceration/Puncture/Cut What type of Instrument Brand name Safety Device OYes ONo size OBite OPatient Scratch OOther Injured/Exposed body part OLeft ORight Which part If applicable, were you DOUBLE SINGLE NOT gloved ; or N/A? (for sticks and lacerations) If applicable, was visible blood in sources pts mouth or under nails prior to Bite or Scratch? Yes No Unk Identifiable Source: Was blood contamination screen drawn on source patient? OYes ONo Name: Med Record #: DOB Attending MD Name: Known Positive/High Risk for HIV, Hep B, Hep C Experience (months or years) Length of time employed by MUSC Explain Circumstances (describe what caused the exposure) What could have been done differently to prevent this exposure? If applicable, were you wearing approved PPE for the face? Yes No (prescription glasses w/o safety goggles/faceshield are NOT PPE) If yes, What PPE for the face were you wearing? If no, Why Not? Employee Signature Date Employee s Medical History and Treatment: to be completed by EHS Employee completed Hepatitis B vaccine series? HIV consent and Pre-HIV counseling MD signature? Blood contamination screen drawn on employee? Post exposure protocol (PEP) initiated? Baseline (PEP) labs drawn? PEP counseling by MD completed? PEP consent or declinations signed? Employee instructed to call and make follow-up appt. in 3 days? O Yes O No O Yes O No O N/A O Yes O No O N/A O Yes O No O N/A O Yes O No O N/A O Yes O No O N/A O Yes O No O N/A O Yes O No O N/A Copy of all medical records prepared for Employee Health Services? O Yes O No Source (Patient) Blood Contamination Results STAT HIV Employee Blood Contamination Results HbsAg HCV HIV HbsAg HCV ALT Post Exposure Follow-up: To be completed by employee when all source labs are received, then initial all 3 places when you receive all source lab results 1. I have been informed of the results of the post exposure evaluation 2. I have been informed of any medical conditions resulting from exposure to blood or other potentially infectious materials which require evaluation or treatment. (If N/A then results are all negative then I am not at risk for any medical conditions resulting from this exposure) 3. I have previously been counseled about adherence to Universal Precaution procedures, and maintaining confidentiality of the source medical information.

8 8