Sharps Injuries Management

Transcription

1 Sharps Injuries Management and other blood or body fluid exposure incidents This procedural document supersedes: PAT/IC 14 v.5 Sharps Injuries Management and other blood or body fluid exposure incidents Did you print this document yourself? The Trust discourages the retention of hard copies of policies and can only guarantee that the policy on the Trust website is the most up-to-date version. If, for exceptional reasons, you need to print a policy off, it is only valid for 24 hours. Name and title of author: Revised by: Date revised: April 2015 Approved by: Date of approval: 16 April 2015 Date issued: 12 May 2015 Next review date: April 2018 Target audience: D O Toole Occupational Health Service Manager Alison Stewart Senior Nurse Advisor Occupational Health and Wellbeing Services Infection Prevention and Control Committee Trust-wide Page 1 of 23

2 Amendment Form Please record brief details of the changes made alongside the next version number. If the procedural document has been reviewed without change, this information will still need to be recorded although the version number will remain the same. Version Date Issued Brief Summary of Changes Author Version 6 12 May 2015 Changes to PEP medication Appendix 4 Changed paragraph Equality Impact Assessment A Stewart Version 5 31 July 2013 Transferred to new Policy Format Added paragraph in Section 3 about the European Council Directive 2010 on safe sharps and employee training on prevention of sharps injuries. Section 5 - Inserted infection control team provide the annual mandatory training with liaison of Occupational Health and Wellbeing Service. T Barnes Version 4 April 2010 Added sentences regarding the legal aspects of testing unconscious and deceased patients page 5 &6 Added general roles and responsibilities Merged with HIV prophylaxis policy Changes to PEP medication page 12 Added a section on monitoring of the policy PEP medication side effects Appendix 4 Replaced healthcare worker with injured recipient throughout D O Toole Version 3 June 2009 Changed policy title Made changes to the format in accordance with CORP/COMM1 Added a Definitions section Included a section on roles and responsibilities Introduction of routine source patient testing wherever possible Added information regarding risk assessment of the incident D O Toole Version 2 October 2008 Policy unchanged at present. Awaiting business case funding for proposed source patient testing D O Toole Page 2 of 23

3 Section Contents 1 Introduction 4 2 Purpose 4 3 Duties and Responsibilities 4 Page No. 4 Procedure 4.1 Risk Assessment 42 Sharps Incidents involving the public attending A&E Department 4.3 Initial follow up in Occupational Health/A&E 4.4 Exposure incidents outside the health care setting Training/Support 13 6 Monitoring Compliance with the Procedural Document 14 7 Definitions 14 8 Equality Impact Assessment 15 9 Associated Trust Procedural Documents References 15 Appendices: Appendix 1 Appendix 2 Appendix 3 Obtaining consent for testing source patients for blood borne viruses and patient information Action following a significant blood exposure from a known source patient Action to be taken in case of an inoculation injury to a member of the public Appendix 4 Patient information leaflet for PEP drugs Appendix 5 Equality Impact Assessment Form 23 Page 3 of 23

4 1. INTRODUCTION From time to time health care workers are injured by sharp objects (especially needles) which are contaminated with a patient s blood or body fluids. They may also receive bites or scratches or their mucous membranes or broken skin may be splashed with blood or bloodstained body fluids. Occasionally patients, members of the public, or workers in the community will also sustain sharps injuries, for example children playing with discarded syringes or police officers arresting violent drug users. This policy sets out the steps to be taken in the event of a health care worker, patient, or member of the public sustaining a significant exposure to blood or other body fluids, which may pose a risk of infection with blood borne viruses or other infections and diseases. 2. PURPOSE This policy aims to prevent the acquisition of blood-borne viruses from sharps injuries, and other blood or body fluid exposures to health care workers, patients, and the general public. 3. DUTIES AND RESPONSIBILITIES The Trust To be assured that there are safe systems of work in place to comply with the relevant aspects of the Hygiene Code to minimise the risk of Health Care Associated Infections to staff, patients, and visitors. To ensure that adequate arrangements are in place for Hepatitis B vaccinations to be offered free-of-charge to those employees likely to be exposed to blood borne viruses in the course of their work. To ensure there are adequate resources to provide suitable personal protective equipment for use when dealing with blood and body fluids, to secure adequate control against blood borne viruses. The use of sharp-safe devices such as blood collection needles are advocated in order to reduce risk. The European Union Council Directive 2010/32/EU on Prevention from Sharps Injuries will be implemented though out the Trust by May This includes the use of safe sharps, the training of employees in their use and raising awareness on polices, and procedures associated with the prevention and management of sharps. The Manager Has a responsibility to ensure that staff are aware of and comply with all policies and procedures related to infection prevention and control, and that they receive the required Page 4 of 23

5 level of training appropriate to their role. Members of Staff Employees have a duty to take reasonable care for their own health and safety and that of others who may be affected by their actions or omissions at work. They must use all work equipment safely as instructed. All members of staff are responsible for ensuring that they comply with Trust policies and procedures. They must undertake Infection Prevention and Control training programmes and updates, which include Standard Precautions, Hand Hygiene, Disposal of Sharps, and Management of Inoculation Injuries. 4. PROCEDURE PROCESS FOLLOWING AN INOCULATION INJURY The injured recipient The following actions should be taken immediately: Encourage bleeding Wash the injured area with soap and water Cover with a waterproof dressing For splashes to the eyes nose or mouth irrigate with copious amounts of water Report the incident to your manager or supervisor immediately. Contact Occupational Health immediately (Monday-Friday ) or Accident & Emergency out of these hours. If you have had a blood exposure incident from a HIV positive patient you should ideally be offered post exposure medication within one hour of sustaining the injury, this will be arranged by contacting Occupational Health during working hours, or attending Accident & Emergency Department out of hours. The Manager/Supervisor An urgent risk assessment should be undertaken to establish if the exposure has the potential to transmit a blood borne virus (see section on Risk Assessment). If a significant exposure has not occurred, e.g. a clean, uncontaminated sharps injury, no further action is required If a significant blood exposure incident has occurred, arrangements should be made for the source patient to be approached regarding blood testing Where the source patient is a neonate, the risk assessment will need to be based on the mother s risk factors for blood borne viruses. If antenatal screening results are not available and the injured worker has sustained a significant injury, the mother should Page 5 of 23

6 be asked to provide a blood sample for testing. The baby s blood should not be tested. Children under the age of 16 should not be tested unless the parent/guardian gives consent. The consent of the treating paediatrician is required before the parent/guardian is approached. If the source patient is unconscious or lacks capacity to give consent, blood can only lawfully be tested for serious communicable diseases if it is reasonably held to be in their best interests in accordance with the Mental Capacity Act Advise the health care worker to immediately contact Occupational Health or A&E Department out of hours, and complete an incident form. The person responsible for taking the blood sample from the source patient The recipient of the injury must not be the person who takes the blood sample from the source patient The blood test must be undertaken by a competent professional The source patient must be given a pre-test discussion and asked to consent to testing for blood borne viruses (Appendix 1). Ideally, this should be undertaken by a senior nurse or doctor. If the source patient requires any further advice or information regarding the testing, assistance can be sought from Occupational Health or the Consultants in Genito- Urinary Medicine during working hours, and Accident & Emergency department out of hours. They will contact the on-call Virologist at Sheffield directly (Weekdays 09:00 to 17:00 Bleep 2537 through NGH switch on , Out of these hours Bleep 2161 through NGH). If the source patient refuses consent, under no circumstances should testing will be carried out, even on previously stored blood. If the source patient is deceased, the taking and testing of blood samples requires consent from a nominated representative or a close relative to the deceased. If the source patient consents, a 5ml sample of clotted blood should be taken as soon as possible following the incident and sent to the Virology department. On the source patient s laboratory form, write in the clinical details section Sharps injury to (Name of injured recipient) on (Date, Time). Occupational Health During normal working hours, Occupational Health will manage the follow-up of the injured recipient. The Occupational Health Nurse will complete a detailed risk assessment of the incident in accordance with the local Occupational Health protocol. Page 6 of 23

7 The Occupational Health Nurse will arrange to take a 5ml clotted blood sample from the injured recipient. This sample will be saved for two years in the Virology Department in case during the subsequent months he/she develops problems related to the incident. This sample then acts as a baseline. The injured recipient s form should state: Sharps injury. Source of injury is (Name, Location). It should be documented if the recipient has had a course of hepatitis B vaccine and the result of the last antibody test if known. If the recipient has been immunised against hepatitis B but has not had their antibody level checked then this can be done on the baseline sample at the time of the incident. The sample will still be saved for two years for possible future reference. Further action will depend on the risk assessment and may include the provision of post-exposure prophylaxis for HIV or Hepatitis B or as indicated following discussions with the Consultant Virologist. Accident and Emergency Department Out of hours, the Accident and Emergency Department should follow steps above. If the incident is managed in A & E, it is essential that the Occupational Health Department is informed as soon as is practicable (usually the following working day), in order to document the incident and provide follow-up. A copy of the Inoculation Injury Risk Assessment form should be sent to Occupational Heath. Injured recipients who have not been vaccinated against Hepatitis B should be offered an accelerated course as soon as they report the incident, i.e. one dose immediately administered by A&E staff. (Further doses at one month, 2 months and 12 months will be given by Occupational Health). Staff in A&E who may be called upon to assist an individual immediately after an incident should be appropriately advised of the steps contained within this policy and should be able to provide the individuals with the necessary mechanisms to achieve the advice and the supply of the PEP starter pack if recommended. Training will be provided by Occupational Health, GU Medicine, and Pharmacy. The Clinician The Consultant or General Practitioner is responsible for informing the source patient of the results of their blood tests. If the result is negative, inform the source patient and reassure them that there are no implications for the long-term, e.g. for insurance purposes after a negative HIV test. Ask the source patient if they wish the test to be recorded in their notes and follow their wishes. If the results are positive, inform the source patient, arrange appropriate support and counselling, refer for assessment and treatment if appropriate, and inform the source Page 7 of 23

8 patient s General Practitioner with the source patient s agreement. 4.1 Risk Assessment A number of factors should be taken into account in the risk assessment including: Type of body fluid to which the recipient has been exposed Blood carries the highest risk, but blood borne viruses can be transmitted by other body fluids, especially if they are contaminated by blood. High risk body fluids: Amniotic fluid, vaginal secretions, semen, human breast milk, cerebrospinal fluid, peritoneal fluid, pleural fluid, pericardial fluid, synovial fluid, fluid from burns or skin lesions, saliva in association with dentistry, unfixed tissues and organs. Low risk body fluids: Urine, saliva, faeces, vomit, or tears (unless they are visibly blood stained). Route of exposure If the health care worker s skin is intact it is impervious to the three viruses. If the skin is not intact then transmission may occur. Splashes of blood or body fluids onto mucous membranes may result in virus transmission, although the risk is considerably lower than for percutaneous exposure. Nature of exposure Contaminated hollow-bore needles are more likely to transmit viruses than solid needles. Needles that have been present in a blood vessel are more likely to transmit viruses than needles used for intramuscular injection. Transmission is less likely to occur from a needle containing dried blood. Depth of injury The risk of transmission increases depending on the depth of the injury, a deep injury is likely to be a higher risk than a puncture wound or a surface scratch. Personal Protective Equipment If gloves were worn at the time of the incident there is a wiping effect as a needle pierces the glove, which may reduce the likelihood of transmission. Safety glasses, goggles, or a visor would offer the health care worker more protection in the event of a blood or body fluid splash to the eyes, nose, or mouth. The source patient If the source patient is known to have recent BBV tests then their blood borne virus status may be ascertained from records. If the blood borne virus status of the source patient is unknown then a 5ml clotted blood sample should be taken for BBV test with informed consent. If the source patient refuses consent for BBV testing then it should be established if they are in a high risk category: Page 8 of 23

9 High risk Known to have or be a carrier of a blood borne virus. A known close contact of a Hepatitis B, Hepatitis C, or HIV positive individual. Had unprotected sex with someone who has a blood borne virus. Sharing injecting equipment with someone who has a blood borne virus. PAT/IC 14 v.6 The following factors are associated with increased risk of occupationally acquired Hepatitis C infection: History of intravenous drug misuse History of a blood transfusion in the UK before 1992 Received a blood transfusion or injections abroad The following factors are associated with increased risk of occupationally acquired HIV infection: Deep injury Visible blood on the device which caused the injury Injury with a needle which had been placed in the source patient's artery or vein Terminal HIV-related illness in the source patient. Medium risk Had multiple sexual partners Had unprotected sex abroad (may be at high risk if had unprotected sex in countries with high prevalence of HIV) Born outside the UK or the Republic of Ireland people from certain parts of the world have a high risk of HIV If the incident arose from an unknown source, a risk assessment may still be possible in the light of local knowledge of the prevalence of blood borne virus infections. Hepatitis B status of the health care worker Has the recipient previously received any doses of Hepatitis B vaccine, and have they responded? Grading of risk: Very low risk This would include blood or body fluids on intact skin or clothing. No further action is necessary. Low risk This would include a percutaneous injury from a dried-up abandoned needle in a public place, or a mucous membrane splash from an individual not at high risk of being a blood borne virus carrier. High risk This would include a percutaneous injury, or skin/mucous membrane exposure to blood or body fluids from a source patient with significant risk factors for a blood borne virus infection. Page 9 of 23

10 4.2 Sharps Incidents Involving the Public Attending A&E Department PAT/IC 14 v.6 Document the time, type, place and nature of injury. Ask if the patient has ever been vaccinated against Hepatitis or has suffered from Hepatitis B. Take a baseline 5 ml clotted blood sample and label Sharps Injury to Member of the Public. Commence an accelerated course of Hep B vaccine (0, 1, 2 and 12 months). The first dose should be given immediately. Subsequent doses should be organised through the G.P. Specific information must be given on the A&E discharge letter. The patient should be informed that the vaccine offers good protection against Hepatitis B. Further counselling may be offered via the G.P or the Genito- Urinary Medicine Department. If the source of the sharp is known and is in a particularly high-risk group (e.g. drug user, homosexual, originates from high risk country, known hepatitis B, C or HIV positive), then an attempt should be made to obtain blood from the source patient for testing for blood-borne viruses (consent required). This should be discussed with the Consultant Virologist. If the source of the injury is unknown but may be an Intravenous Drug User, it is advisable to check the injured person for Hepatitis C antibody 3 months following the injury. 4.3 Initial Follow up in Occupational Health /A&E If the source patient is considered low risk or has no evidence of a BBV A Hepatitis B booster is offered to the injured recipient if it is more than 5 years since their last booster, if they are known to be a low or non-responder to the vaccine. An accelerated course of Hepatitis B vaccine will be commenced if the injured recipient has not completed a full course. A follow-up blood test for Hepatitis C will be taken at intervals advised by the Virologist if the source patient s status is unknown or a blood sample has not been obtained. If the source patient is Hepatitis B positive or in a high risk group for Hepatitis B The Consultant Virologist on-call will be contacted for advice. A Hepatitis B booster is offered to the injured recipient if they are a known responder to the vaccine and it is more than 5 years since their last booster. An accelerated course of Hepatitis B vaccine and 2 doses of Hepatitis B Page 10 of 23

11 Immunoglobulin. will be commenced if the injured recipient has only had one dose or no Hepatitis B vaccination previously. Continue an accelerated course of Hepatitis B vaccine if the injured recipient has had two or more Hepatitis B vaccines previously. Two doses of Hepatitis B Immunoglobulin one month apart, and consider a booster dose of Hepatitis B vaccine if the injured recipient is a non-responder to Hepatitis B. If the source patient is Hepatitis C positive or a known intravenous drug user The Consultant Virologist on-call will be contacted for advice. Hepatitis C PCR will be requested from the source patient with consent. If the source patient is Hepatitis C PCR positive the injured recipient should be tested for Hepatitis C PCR at 6 & 12 weeks following the injury. The injured recipient should be tested for Hepatitis C antibody at intervals advised by the Virologist. If the injured recipient is Hepatitis C antibody positive they will be referred to the Occupational Health Physician and may require onward referral to a Specialist. If the source patient is HIV positive or in a high risk group The Consultant Virologist on-call will be contacted for advice. Arrangements should be made for the source patient to be tested for HIV viral load with their informed consent. If Post-Exposure Prophylaxis (PEP) is recommended it should ideally be commenced within one hour of the incident, although it is most likely to be effective if started within 72 hours following the injury. A 5-day pack of drugs will be issued and administered by the A&E doctor. This will then require the patient to go to GU Medicine for a follow up to be reassessed and further supplies issued if required. When offering PEP, it is important to take into account the view of the injured recipient at all stages of the decision-making process. PEP packs containing a 5 day course of the recommended drugs are kept in A&E DRI + Bassetlaw, GU Medicine (including Bassetlaw, Retford and DRI) and the pharmacy departments. 28 day packs are kept in the GU med clinics for issue when required. Post exposure prophylaxis will be prescribed for a four-week period. Individuals may be excluded from work during this period if they are suffering from side effects. PEP may be discontinued at any time however it is likely to be more effective if continued for at least 28 days. Page 11 of 23

12 Choice of drugs for post exposure prophylaxis Current recommendations are; Truvada - 1 tablet daily (245mgs Tenofovir + 200mgs Emtricitabine) Isentress 1 tablet twice daily (Raltegravir 400mg) Domperidone and Loperamide are also contained in the pack and appropriately labelled for relief of side effects. Possible side effects and interactions of drugs Some details are enclosed in Appendix 4 of possible side effects and interactions of drugs. Further information can to be obtained from the relevant Data Sheets. The following factors should also be taken into account: Allergy to one or more of these drugs Pregnancy Interaction with other medicines (including over the counter) Possible viral resistance Long term toxicity unknown Please note that Domperidone is contra-indicated in certain patients and the Domperidone in the PEP pack should be removed and an alternative anti-emetic supplied. The contra-indications for Domperidone are; With conditions where cardiac conduction is. Or could be impaired With underlying cardiac disease such as congestive heart failure Receiving other medication known to prolong QT interval or potent CYP34A inhibitors With severe hepatic impairment Further follow-up Pending follow-up, health care workers need not be subject to any modification of their working practices. Advice should be given about safe sex and avoiding blood donation during the follow-up period. Regular medical follow-up by the GU Medicine Department is needed during the period of PEP. Antibody tests will be carried out by the Occupational Health Department. A negative HIV antibody test 12 weeks after completion of PEP can be regarded as reassurance that infection has not been transmitted. Further follow-up tests may be indicated in complex cases. Those who do not receive PEP following exposure should also have follow-up blood tests by the Occupational Health Department. Page 12 of 23

13 4.4 Exposure Incidents outside the Health Care Setting Members of staff should follow the principles of this policy and guidance and they should seek to have the necessary advice and guidance within one hour of the incident occurring. All other individuals should report to the nearest Accident & Emergency Department in the normal way. PEP for patients after possible exposure to an infected health care worker Implementation of the guidance in AIDS/HIV Infected Health Care Workers (2005) will minimise the risk of a patient being exposed to the blood of an infected health care worker. All health care workers are obliged to continually assess their own risk and to seek advice where necessary if they may be at risk of HIV. When an incident occurs in which a health care worker may have exposed a patient to their blood, this should immediately be reported to the designated doctor (the Consultant Physician) for an assessment of the risks involved. The Occupational Health Department should be informed at the earliest opportunity and a critical incident report completed if appropriate. Details of the incident including outcomes should be recorded in the Occupational Health records of the health care worker. If the incident is considered to be a significant blood exposure, involving bleeding back to the patient, the injured healthcare worker should routinely be asked to consent for HIV, Hepatitis B and C testing. HIV testing should be considered urgently, if possible, and ideally within 8 hours. Only if the health care worker tests positive for any blood-borne virus should the patient be notified (while maintaining confidentiality of the injured health care worker). Such incidents should be reported to the National Patient Safety Agency. PEP for HIV should only be offered to a patient following a positive HIV test in the health care worker (except in exceptional circumstances). If PEP is recommended, a 28-day course should be used, but particular attention should be paid to the risk-benefit ratio in sick patients with systemic organ failure/insufficiencies. This should be discussed with the GU Physician. Follow-up for exposed patients should be as for exposed health care workers. 5. TRAINING/ SUPPORT Inoculation Injury training is mandatory for all clinical staff. The Control of Infection Team provides this training annually in liaison with Occupational Health and Wellbeing Service. The Occupational Health and Wellbeing Team also provide training for A&E staff in the management of inoculation injuries out-of-hours. Page 13 of 23

14 6. MONITORING COMPLIANCE WITH THE PROCEDURAL DOCUMENT What is being Monitored Sharps injury reporting process audit Who will carry out the Monitoring Occupational Health and Wellbeing How often Annual How Reviewed/ Where Reported to Action plan on outcomes of audit and fed back to Infection Control Committee. Uptake of staff training Occupational Health and Wellbeing/ Infection Control As and when training takes place Reported on OML system and feedback from staff evaluation with regards to changing presentation of training sessions on an annual basis. 7. DEFINITIONS A blood exposure incident refers to an incident where there is: Percutaneous exposure Mucous membrane exposure Contact with broken skin Source patient Injured recipient Needle or other sharp object contaminated with blood or body fluids causing injury, a bite causing visible bleeding, or other visible skin puncture. Blood or body fluid splashes to the eyes, nose, or mouth. Blood or body fluids entering cuts, abrasions, or patches of eczema. The person from whom the blood or body fluid originates. The person exposed to blood or body fluids that have the potential to be infected with a blood borne virus. HIV (Human Immunodeficiency Virus): A virus that can be transmitted through blood, body fluids, and sexual exposure. Examples include sharing needles, syringes or equipment for drugs, tattoos, body piercing, through unscreened blood transfusions, and from mother to baby. Hepatitis B: A virus that affects the liver and is passed on in the same way as HIV. Hepatitis C: A virus that affects the liver and is usually passed on through blood or sharing needles or other equipment during recreational drug injecting. Other examples include tattoos, body piercing, and unscreened blood transfusions. Page 14 of 23

15 8. EQUALITY IMPACT ASSESSMENT An Equality Impact Assessment (EIA) has been conducted on this procedural document in line with the principles of the Equality Analysis Policy (CORP/EMP 27) and the Fair Treatment For All Policy (CORP/EMP 4). The purpose of the EIA is to minimise and if possible remove any disproportionate impact on employees on the grounds of race, sex, disability, age, sexual orientation or religious belief. No detriment was identified. See Appendix ASSOCIATED TRUST PROCEDURAL DOCUMENTS Mental Capacity Act 2005 Policy and Guidance - PAT/ PA 19 Privacy and Dignity Policy - PAT/ PA 28 HIV and AIDS in Employment - CORP/ EMP 5 Sharps Policy Safe use and Disposal PAT/ IC REFERENCES Department of Health (1998) Guidance for Clinical Healthcare Workers: Protection against Infection with Blood-Borne Viruses. HSC 1998/063 Department of Health (2004) Hepatitis C: Essential information for professionals and guidance on testing. Department of Health (2005) HIV Infected Health Care Workers: guidance on management and patient notification. Department of Health (2006) 3 rd Ed. Immunisation against Infectious Disease. The Stationery Office, Department of Health. Department of Health (2015) HIV Post-exposure prophylaxis. Guidance from the UK Chief Medical Officers Expert Advisory Group on AIDS, London, Department of Health Health & Safety Executive Advisory Committee on Dangerous Pathogens (2008) Protection against blood borne infections in the workplace: HIV and Hepatitis. Page 15 of 23

16 APPENDIX 1 Obtaining consent for testing source patients for blood borne viruses and patient information Testing information for patients A member of staff has been accidentally exposed to your blood or body fluids during the course of their work. We are requesting to test your blood in order to assist the member of staff. There are three specific viruses that are covered in this information sheet. All three viruses can be present in your body without your knowledge. We ask patients in this situation if we can test them for: HIV (Human Immunodeficiency Virus): A virus that can be transmitted through blood, body fluids, and sexual exposure. Examples include sharing needles, syringes or equipment for drugs, tattoos, body piercing, through unscreened blood transfusions, and from mother to baby. Hepatitis B: A virus that affects the liver and is passed on in the same way as HIV. Hepatitis C: A virus that affects the liver and is usually passed on through blood or sharing needles or other equipment during recreational drug injecting. Other examples include tattoos, body piercing, and unscreened blood transfusions. What does the test involve? A 5 ml sample of blood will be taken from your arm. If any of the results are positive, the test will be repeated to confirm the result. Who will know my test result? The result will be given to you in confidence and your own doctor will be informed. The doctor looking after the member of staff affected will be informed, unless you request otherwise. What if I am found to have one of these viruses? If the test shows that you have one of these viruses, you will be offered care, support, and treatment. What are the benefits of having these tests now? You can have these viruses with or without any symptoms. If you have Hepatitis B or Hepatitis C virus, treatment can often help to cure you and reduce the damage to your liver. New treatments are available for individuals with HIV. The treatment for HIV may be more effective if it is given before any serious illness develops. How can this help the member of staff who has been exposed to my blood? If you are carrying a blood borne virus the member of staff affected can be followed up to see if the virus has been transmitted to them and treated if necessary. Page 16 of 23

17 Will having the HIV test affect my chances of getting life insurance? Doctors do not need to report negative HIV tests when writing insurance reports. Insurance companies should no longer ask whether you have had an HIV test, they should only ask whether or not you are HIV positive (As agreed by the Association of British Insurers 1994). What are the drawbacks of having the HIV test? If you do have HIV, the benefits of knowing usually outweigh the disadvantages, which may include difficulties in relationships with family and friends or, for some, employment issues. Travel to some countries is currently restricted for people who know they have HIV. CONSENT If you have any further questions, please do not hesitate to ask a member of staff. When you have read this information sheet and asked any questions please sign below. You may have a copy of this information sheet. I fully understand the information given to me and have had the opportunity to ask questions regarding the tests. I agree/do not agree to have my blood tested for HIV, Hepatitis B, and Hepatitis C. Signed Date. Page 17 of 23

18 APPENDIX 2 Action following a significant blood exposure from a known source patient Take 5mls of clotted blood from the recipient and Source patient not Infected with a BBV Source patient not given consent to testing Hepatitis B positive or in a high risk group Hepatitis C positive or in a high risk group HIV positive or In a high risk group No further action. Update HCW vaccines Risk assessment of source patient for BBV Contact Occupational Health or A&E immediately Contact Occupational Health or A&E Contact Occupational Health or A&E immediately OH/A&E Follow Hepatitis B protocol dependent on OH/A&E Follow Hepatitis C protocol OH/A&E Follow HIV Post- Exposure Prophylaxis Page 18 of 23

19 APPENDIX 3 Action to be taken in case of an inoculation injury to a member of the public SOURCE OF SHARP KNOWN YES NO TAKE 5ml CLOTTED BLOOD FROM RECIPIENT FOR SAVING. LABEL INJURY TO MEMBER OF PUBLIC TAKE 5ml CLOTTED BLOOD FROM RECIPIENT FOR SAVING. LABEL INJURY TO MEMBER OF PUBLIC AND IF POSSIBLE, ARRANGE FOR 5ml CLOTTED BLOOD SAMPLE FROM USER OF SHARP (e.g. IVDU) (Consider Hep B/C/HIV test if significant risk factors) COMMENCE ACCELERATED* COURSE OF HEPATITIS B VACCINE FOR INJURED PERSON (ASSUMING NOT PREVIOUSLY VACCINATED) DISCUSS CASE WITH VIROLOGIST Page 19 of 23 OFFER BBV TESTING 3 MONTHS POST-EXPOSURE

20 APPENDIX 4 Patient Information Leaflet: Truvada & Raltegravir You have been prescribed post-exposure prophylaxis (PEP) because you may have been exposed to the HIV virus. Prophylaxis means a preventative treatment. The treatment consists of a combination of two tablets, containing 3 drugs. All three are antiviral drugs which are effective against the HIV virus. Used together, there is evidence that they can reduce the risk of developing HIV infection following exposure to the virus. The names of your medicines are: Truvada - each tablet contains emtricitabine 200mg + tenofovir 245mg. They are blue and marked GILEAD and 701 Isentress each tablet contains raltegravir 400mg. They are pink, oval and marked with 227 on one side. You have been supplied with a starter pack but the treatment will need to be continued for four weeks. Arrangements will be made for you to attend a GU clinic for follow-up and to obtain further supplies. Taking your medicines For this treatment to work, it is important you take your medicines properly. Treatment should start as soon as possible after potential exposure to the virus. Page 20 of 23

21 Read the labels on the medicines. They should be taken as follows: Truvada: take ONE tablet with your breakfast Raltegravir: take ONE tablet in the morning and ONE tablet in the evening (ideally 12 hours apart). This tablet can be taken before or after food. It is important that Raltegravir tablets are swallowed whole and not chewed, broken or crushed. The Truvada tablets can be disintegrated in about 100ml water, orange or grape juice and taken straight away. Take the medicines at the indicated time, even if you have not actually had a meal. If you forget a dose, take it as soon as possible and then continue as before. If you have difficulty remembering to take them, use an alarm e.g. on your phone. You may drink moderate amounts of alcohol while taking these medicines (within normal recommended safe limits). Other Medicines & Medical Problems With this treatment there is a risk of other problems developing if you are taking other medication or if you have other medical problems (e.g. kidney or liver problems). You must tell your doctor about any medical problems and any medication you are taking (either from your GP or bought over the counter). Do not start any new medication without talking to your doctor first. You should not breastfeed while taking these medicines. General Advice Do not take more than the recommended dose. Do not give your medicines to other people. Keep your medicines in a cool, dark, dry place, out of the reach of children. Page 21 of 23

22 Side Effects The most common side effects are: dizziness, feeling sick / vomiting, diarrhoea, headache, tiredness, decreased appetite, rash, weakness and muscle aches. They usually settle if you keep taking the medicines. You should have been given some anti-sickness and anti-diarrhoea tablets with this treatment. Serious side effects are rare. They include: allergic reactions, liver, kidney and pancreas problems, reduced production of red blood cells (causing anaemia) or white blood cells (which can make you prone to infections). You will have regular blood tests to check your blood count, kidney and liver are normal. Tell your doctor if side effects persist. Pregnancy You must tell the doctor if you could be pregnant. You should take precautions to avoid becoming pregnant whilst taking these medicines. The medication will reduce the effectiveness of hormonal contraception (The Pill). These methods should not be relied on whilst taking this medication and you should use a barrier method (e.g. condoms) in addition. Page 22 of 23

23 APPENDIX 5 - EQUALITY IMPACT ASSESSMENT PART 1 INITIAL SCREENING Service/Function/Policy/Project/Strategy CSU/Executive Directorate Assessor (s) New or Existing Date of Assessment and Department Service or Policy? PAT/IC 14 v.6 Sharps Injuries Management P&OD Alison Stewart Existing Policy ) Who is responsible for this policy? P&OD 2) Describe the purpose of the service / function / policy / project/ strategy? All Trust employees 3) Are there any associated objectives? Yes, Department of Health legislation 4) What factors contribute or detract from achieving intended outcomes? Non-compliance with policy 5) Does the policy have an impact in terms of age, race, disability, gender, gender reassignment, sexual orientation, marriage/civil partnership, maternity/pregnancy and religion/belief? No If yes, please describe current or planned activities to address the impact N/A 6) Is there any scope for new measures which would promote equality? N/A 7) Are any of the following groups adversely affected by the policy? No Protected Characteristics Affected? Impact a) Age No b) Disability No c) Gender No d) Gender Reassignment No e) Marriage/Civil Partnership No f) Maternity/Pregnancy No g) Race No h) Religion/Belief No i) Sexual Orientation No 8) Provide the Equality Rating of the service / function /policy / project / strategy tick () outcome box Outcome 1 Outcome 2 Outcome 3 Outcome 4 *If you have rated the policy as having an outcome of 2, 3 or 4, it is necessary to carry out a detailed assessment and complete a Detailed Equality Analysis form in Appendix 4 Date for next review: April 2018 Checked by: Alison Stewart Date: 12 May 2015 Page 23 of 23