What should be done first when a blood exposure incident has occurred with a client?

Footnote

1. A qualified health care professional is any health care provider who can provide counseling and perform all medical evaluations and procedures in accordance with the most current recommendations of the U.S. Public Health Service, including providing postexposure chemotherapeutic prophylaxis when indicated.

References

CDC. Basic Expectations for Safe Care Training Module 5 – Sharps Safety. Available at: https://www.cdc.gov/oralhealth/infectioncontrol/safe-care-modules.htm. Accessed May 8, 2018.

CDC. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR 2013:62(No.RR-10). Available at: https://www.cdc.gov/mmwr/PDF/rr/rr6210.pdf pdf icon[PDF-712K].

CDC. Exposure to Blood: What healthcare personnel need to know. Updated July 2003. https://www.cdc.gov/HAI/pdfs/bbp/Exp_to_Blood.pdf pdf icon[PDF-329K].

CDC. National Institute for Occupational Safety and Health. NIOSH Alert: Preventing needlestick injuries in health care settings. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, CDC, National Institute for Occupational Safety and Health, 1999.

CDC. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR 2001;50(No.RR-11). Available at: https://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf pdf icon[PDF-333K].

CDC. Workbook for designing, implementing, and evaluating a sharps injury prevention program. Available at: https://www.cdc.gov/sharpssafety/.

Cleveland JL, Cardo DM. Occupational exposures to human immunodeficiency virus, hepatitis B virus, and hepatitis C virus: risk, prevention, and management. Dental Clinics of North America 2003;47(4):681-96.

Kuhar DT, Henderson DK, Struble KA, Heneine W, Thomas V, Cheever LW, Gomaa A, Panlilio AL; US Public Health Service Working Group. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013;34(9):875–892.

US Department of Labor, Occupational Safety and Health Administration. 29 CFR Part 1910.1030. Occupational Exposure to Bloodborne Pathogens: Needlestick and Other Sharps Injuries: Final Rule. Federal Register 2001;66:5317–5325. Updated from and including 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; final rule. Federal Register December 6, 1991;56:64003–64182. Available at: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051external icon.

Would you know what to do if an employee at your company had a needlestick injury or other exposure incident?  Other routes of exposure to biological material include accidents with other types of sharps as well as exposure to the mucous membranes of the eyes, nose, mouth, and non-intact skin.

Don’t be caught off guard! The last thing you want to be doing following an incident involving an exposure to potentially infectious material, or material known to be infectious, is figuring out the appropriate steps to take.  Proper incident response is critical to worker health and safety.  The Centers for Disease Control (CDC) recommends that these steps be followed after an exposure incident:

Step 1, provide immediate care to the exposure site: this includes washing the puncture area for 15 minutes with soap and water.  Remember, do not force bleed the wound!  Splashes to the mucous membranes (eyes, nose, mouth, or non-intact skin) should also be flushed thoroughly for 15 minutes with water.

Step 2, evaluate and report the exposure: incidents involving a potential risk of infection transmission should be reported immediately (e.g., to a supervisor and/or biological safety officer) and medical care sought as soon as possible through the company’s occupational health provider or local emergency room.

Step 3, obtain post-exposure prophylaxis (PEP) for exposures posing a risk of infection: this includes transmission of HBV, HCV, and HIV, as recommended by an occupational health physician. PEP should be given as soon as possible, preferably within 24 hours to be most effective.

Step 4, obtain follow-up testing and counseling: for exposures to human blood, this includes obtaining test results from the source individual (when feasible) to determine their infectivity status.  In addition, exposed employees should also be tested ~ 6-months post-exposure (depending on the particular biological agent they may have been exposed to) to see if they have contracted HBV, HCV, HIV, or other bloodborne pathogen.

Note that for potential bloodborne pathogens exposures, employers must make immediate confidential medical evaluation and follow-up available to the exposed employee at no cost. The employer must also obtain and provide the worker with a copy of the evaluating healthcare professional’s written opinion within 15 days of completion of the evaluation.

For all exposure incidents, remember to complete an incident report so that the cause of the incident can be investigated to prevent similar type incidents from occurring.  For incidents with needles and other sharps, a sharps injury log must also be completed. The sharps log must contain, at a minimum, information about the injury, the type and brand of device involved in the injury (if known), the department or work area where the exposure occurred, and an explanation of how the incident occurred. The log must be recorded and maintained in such a manner so as to protect the confidentiality of the injured employee.

In addition to internal reporting, did you know that many local health departments require that they be notified of exposure incidents? For instance, Cambridge requires that any exposure which represents a significant potential hazard to employees, or any significant biological agent-related accident or illness, be reported immediately and in no case more than twenty-four hours after the exposure, accident or illness.

Does your biosafety program include a detailed post-exposure policy that clearly specifies the steps to follow in the event of an exposure incident, and are employees trained on the policy?  Things can really go wrong when companies are not prepared!

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