EXPOSURE TO BLOOD BORNE PATHOGENS
Policy: Insure a uniform response for employee intervention and follow-up after an exposure to blood borne pathogens.
Procedure: In the event of an exposure to blood and/or bodily fluids, the employee/student shall report that exposure to his/her director (or nurse supervisor) immediately. The director (or nurse supervisor) will complete and submit an Employee Accident Report. The director (or nurse supervisor) should refer the employee to the Director of Student Health Services for treatment and to order necessary laboratory workups.
It is important to obtain baseline data. If the “source patient” is known, the director, nurse or designee will contact the source patient, and inform him/her of the incident, requesting an HIV test, Hepatitis Profile (both Hepatitis B and Hepatitis C virus testing), and an RPR. The patient should be told that s/he shall not be charged for these tests. The patient should further be counseled about HIV testing, including the need for a signed informed consent. Any questions or concerns the patient has about HIV testing should be answered. If the patient agrees to the testing, the lab work is then drawn as soon as is feasible. The results are discussed in person, and then noted appropriately in the source patient’s chart and in the contact’s chart.
Baseline tests for HIV, Hepatitis B Antibody, Hepatitis C Antibody and RPR are to be done on the employee immediately following the exposure incident. The employee must also sign an informed consent regarding HIV testing, and have his/her questions answered fully about HIV testing. When results are received, the Student Health Services will notify the employee about the results of her/his testing in person, and noted appropriately the results in the employee’s chart.
Exposure to Known HIV Infection or Exposure Sources Considered at Risk for HIV Infection
When an employee sustains an exposure to a source known to have HIV infection, or if the exposure source is considered to be at risk for HIV infection, but the status is unconfirmed, the following procedures are to be instituted:
If the source is known to have HIV infection, the Director of SHS and/or the nursing staff will assess the risk factors for transmission. This will include an assessment of the route of transmission based on the charts below.
DEEP INJURY CRITERIA SUPERFICIAL INJURY CRITERIA Deep injury and large volume body fluid or large bore (<20g) needle previously in source patient’s vein or artery. Superficial injury and small volume blood and small bore (>20g) needle. Blood containing high HIV titer, or from source with acute illness or end-stage AIDS Mucous membrane exposures
The provider will evaluate and counsel for post-exposure management. The employee/volunteer will be offered Post-Exposure Prophylaxis (PEP) to possibly reduce the risk of transmission of HIV infection. For the appropriate post-exposure prophylaxis regimen, refer to Attachment A.
Prior to commencing drug therapy, the employee/volunteer will sign a consent form for the drug therapy. The consent form will be included in the employee’s chart. Once a determination has been made to begin drug therapy, the provider and staff will utilize a standing order sheet to assist in providing uniform, consistent treatment to employees/volunteers.
Drug therapy lasts for 28 days. If the source patient’s HIV test is negative, drug prophylaxis will stop. Student Health Services shall obtain the appropriate drugs from the Public Health Office, and dispense them. The employee/volunteer will contact the Student Health Services for his/her weekly supply. This is to insure that the employee/volunteer is appropriately monitored, and has the opportunity to report and discuss side effects as they occur. The Student Health Services, if concerned about an employee’s reaction to the drug therapy, will contact the State Public Health Office in Santa Fe for evaluation, further treatment, or discontinuation of treatment.
Exposure to Known Hepatitis B Infection
Recommendations for prophylaxis following percutaneous or permucosal exposure to Hepatitis B Virus are:
Exposed Person HbsAg*Positive HbsAg Negative Source not tested unvaccinated: HBIG** & start start HB Vaccine start HB Vaccine start HB Vaccine vaccinated: known responder no treatment no treatment no treatment vaccinated: known non-responder: HBIG x 2
HBIG x 1 & revaccinate
no treatment if high risk source, treat as if HbsAg + unknown response: test exposed person for anti-HB; if adequate: no tx. Otherwise: HBIG x 1 & vaccine boost no treatment test exposed person for antiHBs; if adequate: no tx. Otherwise: vaccine boost
*HbsAg – Hepatitis B surface antigen
** HBIG – Hepatitis B immune globulin: 0.06mL/kg IM
- If employee/volunteer had vaccine >7 years ago, s/he should receive the Hepatitis B vaccine booster and HBIG.
- If the source is HbsAG positive, give employee/volunteer Hepatitis B vaccine booster and HBIG.
- If the source is HBsAG negative, give employee/volunteer Hepatitis B vaccine booster only.
Exposure to Known Hepatitis C Infection
- If the exposure source is determined to be Hepatitis C negative, no further treatment will be necessary.
- If the exposure source is determined to be Hepatitis C positive, the employee should be counseled for risk of conversion and precautions to be instituted to reduce risk of secondary transmission.
Follow-up Laboratory Testing for Employees
Employees who sustain expire to blood borne pathogens will have periodic follow-up laboratory testing to monitor the possibility of transmission or the effectiveness of therapies provided. Follow-up testing for HIV, Hepatitis B and Hepatitis C will be done at 6 weeks, 3 months and 6 months following the date of the exposure. Follow-up testing will be instituted and monitored by the Student Health Services.
- If the source patient is negative for Hepatitis B and Hepatitis C, no follow-up testing will be done.
- If the source patient is Hepatitis C positive and Hepatitis C positive, follow-up testing will be done at 3 months and 6 months.
- If the source patient is HbsAG positive and the employee has not been immunized or is a non-responder, then test HbsAG and Hepatitis B Antibody at 6 months post-exposure.