Occupational Health—Sharps injury protocol and post exposure to HIV

Incidents were members of staff are exposed to blood, serum or other body fluids contaminated with blood, including:

¨ Percutaneous injuries such as needle stick injuries or sharps injuries, bites (where blood is drawn)

¨ Scratches (blood drawn)

¨ Contamination of the mucous membrane (through the mouth & nose), or conjunctivae (through the eye)

¨ Minor cuts, abrasions and other open skin lesions which become contaminated

 

Action to be taken following an incident:

1. Wash the site of exposure / injury liberally with soap and warm water but do not scrub. Exposed mucous membranes or conjunctivae should be irrigated copiously with water. If there is a puncture wound free bleeding should be encouraged but the wound should not be sucked.

2. If you or another healthcare worker has suffered a needlestick injury or other occupational exposure to blood or body fluids and you consider it necessary to test the patient for a serious communicable disease, the patients consent should be sought once the patient has regained full consciousness. If appropriate, the injured person can take prophylactic treatment until consent has been obtained  and the test result is known.

3. With consent bleed the source patient for Hepatitis B & C as soon as possible (clotted yellow-topped bottle). Routine testing of the patient for HIV is not appropriate unless an appropriate risk assessment has been carried out. The source patient should be provided with appropriate information about the implications of these tests and given appropriate time to consider and discuss them

4. Bleed the staff member involved in the incident for the 1st storage sample (clotted yellow-topped bottle). Complete a virology request form.

 

Reporting procedure:

All incidents must be reported to the Occupational Health Department as soon as possible. A staff accident / incident report form must be completed and forwarded to the appropriate Department.

 

The responsibility for compliance with these instructions lies with the injured employee and his / her immediate manager.

 

NB: The fact that the injured employee has been vaccinated against Hepatitis B does not preclude the need to bleed both the injured member of staff and the source patient or the necessity to follow the correct reporting procedure.

 

Post Exposure Prophylaxis for HIV (PEP):

Contact the needlestick hotline if there is concern about exposure to HIV. Advice will be provided on testing the source patient and HIV post exposure drugs. These unusually involve a 3-day supply of:          zidovudine           250mg bd

                             lamivudine           150mg bd

                             indinavir               800mg tds

 

The Consultant Occupational Physician usually advises the use of the POST EXPOSURE PROPHYLAXIS.