Friday, November 30, 2012

Exposure to Blood: If an Exposure Occurs

What should I do if I am exposed to the blood of a patient?

  1. Immediately following an exposure to blood:
    • Wash needlesticks and cuts with soap and water
    • Flush splashes to the nose, mouth, or skin with water
    • Irrigate eyes with clean water, saline, or sterile irrigants
    • No scientific evidence shows that using antiseptics or squeezing the wound will reduce the risk of transmission of a bloodborne pathogen. Using a caustic agent such as bleach is not recommended.
  2. Report the exposure to the department (e.g., occupational health, infection control) responsible for managing exposures. Prompt reporting is essential because, in some cases, postexposure treatment may be recommended and it should be started as soon as possible. Discuss the possible risks of acquiring HBV, HCV, and HIV and the need for postexposure treatment with the provider managing your exposure. You should have already received hepatitis B vaccine, which is extremely safe and effective in preventing HBV infection.

Thursday, November 15, 2012

Exposure to Blood: What Healthcare Personnel Need to Know

OCCUPATIONAL EXPOSURES TO BLOOD

Introduction

Healthcare personnel are at risk for occupational exposure to bloodborne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Exposures occur through needlesticks or cuts from other sharp instruments contaminated with an infected patient's blood or through contact of the eye, nose, mouth, or skin with a patient's blood. Important factors that influence the overall risk for occupational exposures to bloodborne pathogens include the number of infected individuals in the patient population and the type and number of blood contacts. Most exposures do not result in infection. Following a specific exposure, the risk of infection may vary with factors such as these:
  • The pathogen involved
  • The type of exposure
  • The amount of blood involved in the exposure
  • The amount of virus in the patient's blood at the time of exposure
Your employer should have in place a system for reporting exposures in order to quickly evaluate the risk of infection, inform you about treatments available to help prevent infection, monitor you for side effects of treatments, and determine if infection occurs. This may involve testing your blood and that of the source patient and offering appropriate postexposure treatment.
How can occupational exposures be prevented?
Many needlesticks and other cuts can be prevented by using safer techniques (for example, not recapping needles by hand), disposing of used needles in appropriate sharps disposal containers, and using medical devices with safety features designed to prevent injuries. Using appropriate barriers such as gloves, eye and face protection, or gowns when contact with blood is expected can prevent many exposures to the eyes, nose, mouth, or skin.

We will discuss this very important topic as it relates to healthcare personnel as the CDC has put forth the information.

Thursday, November 8, 2012

OSHA 300 "A Log to Live By"

Health care Joint Commission article calls OSHA 300 "A Log to Live By"

The OSHA 300 form is explained and praised as a valuable analytical tool to protect health care workers in a recent article published by Joint Commission Resources. In its October article, "OSHA 300: A Log to Live By," the Joint Commission states that "properly documenting work-related injuries can reduce incidents” of worker injuries and illnesses."
The OSHA 300 Log is one of the key forms that OSHA requires hospitals and other large businesses to complete. The 300 form is "far more than recordkeeping," wrote the Joint Commission; for employers, the log "is an invaluable resource that should be integrated into monitoring and analysis" to target where workplaces are having problems with injuries and illnesses.
"Looking closer [at the 300 Log] can reveal a lot of important information, such as what tasks employees are performing when they are injured and how," said Mark Hagemann, Acting Director of OSHA's Office of Technological Feasibility, who was interviewed for the article. "You need to identify the problems so you can fix them," he said. "That's the only way to assure a culture of safety for both patients and health care workers."
An independent, not-for-profit organization, the Joint Commission accredits and certifies more than 19,000 health care organizations and programs in the United States. The Joint Commission is the nation's oldest and largest standards-setting and accrediting body in health care. OSHA and the Joint Commission have worked together since 2004 under an Alliance agreement to protect health care workers' health and safety.

Monday, November 5, 2012

Reporting an Exposure Incident and Medical Evaluation and follow-up

Reporting an Exposure Incident

Exposure incidents should be reported immediately to the employer since they can lead to infection with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), or other bloodborne pathogens. When a worker reports an exposure incident right away, the report permits the employer to arrange for immediate medical evaluation of the worker. Early reporting is crucial for beginning immediate intervention to address possible infection of the worker and can also help the worker avoid spreading bloodborne infections to others. Furthermore, the employer is required to perform a timely evaluation of the circumstances surrounding the exposure incident to find ways of preventing such a situation from occurring again.
Reporting is also important because part of the follow-up includes identifying the source individual, unless the employer can establish that identification is infeasible or prohibited by state or local law, and determining the source's HBV and HIV infectivity status. If the status of the source individual is not already known, the employer is required to test the source's blood as soon as feasible, provided the source individual consents. If the individual does not consent, the employer must establish that legally required consent cannot be obtained. If state or local law allows testing without the source individual's consent, the employer must test the individual's blood, if it is available. The results of these tests must be made available to the exposed worker and the worker must be informed of the laws and regulations about disclosing the source's identity and infectious status.

Medical Evaluation and Follow-up

When a worker experiences an exposure incident, the employer must make immediate confidential medical evaluation and follow-up available to the worker. This evaluation and follow-up must be: made available at no cost to the worker and at a reasonable time and place; performed by or under the supervision of a licensed physician or other licensed healthcare professional; and provided according to the recommendations of the U.S. Public Health Service (USPHS) current at the time the procedures take place. In addition, laboratory tests must be conducted by an accredited laboratory and also must be at no cost to the worker. A worker who participates in post-exposure evaluation
and follow-up may consent to have his or her blood drawn for determination of a baseline infection status, but has the option to withhold consent for HIV testing at that time. In this instance, the employer must ensure that the worker's blood sample is preserved for at least 90 days in case the worker changes his or her mind about HIV testing.
Post-exposure prophylaxis for HIV, HBV, and HCV, when medically indicated, must be offered to the exposed worker according to the current recommendations of the U.S. Public Health Service. The post-exposure follow-up must include counseling the worker about the possible implications of the exposure and his or her infection status, including the results and interpretation of all tests and how to protect personal contacts. The follow-up must also include evaluation of reported illnesses that may be related to the exposure.