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Managing Staff Exposure to Blood and Body Fluids

Margaret Jennings September 08

Is your policy and protocol correct? Your policy needs to be supportive of the injured staff member (and family) and not be punitive.

It needs to address the urgency of assessing the exposure; attending to privacy; who provides pre and post test counselling and possible prophylaxis, and that a follow up to any injury addresses safety issues in the practice.

Your procedure for staff to follow should not be complicated by possible outcomes or testing results. Refer to the table printed both in Appendix 8 of the current National Infection Control Guideline and Blue Book by DHS (see references below for free download) for management. Testing is not a first priority.

The steps are:

  1. After injury immediately wash site with soap and water immediately. For a splash to skin or eyes/mouth/nose flush gently with water. Check splashed skin for any cuts/breaks etc.
  2. Report injury immediately to practice manager and seek relief from duty to have an assessment performed. Indicate who the source is if known. The practice manager indicates to the source what has happened and arranges for him/her to see the doctor who will explain what has happened and have a discussion that may involve consent for blood tests. If there is information that indicates the source is infected or in a high risk group then this needs to be made available to assist treatment of the injured.
  3. An assessment of the injury is required. This may be done by phone. In Victoria, the Royal Melbourne Hospital can be contacted on 9342 7000 where a funded position of Infectious Diseases registrar on call exists. Ask to speak to him/her about assessment and what the next steps are. Assessment is urgent because any treatment you may require should be provided within hours of the injury if the risk is significant. Assessment, counselling and testing ought not be done by colleagues for reasons of privacy and in any case if you require prophylaxis for HIV it is not usually available at your workplace.

It is mandatory to report exposure to your manager by OHS, and it is mandatory to be counselled by a qualified person or a GP with experience prior to HIV testing and prior to receiving results. Results are given in person, not by phone. I advise attending the emergency department of a hospital if an assessment has not been done.

No health care worker in Victoria is more than 2 hours away from post exposure prophylaxis (PEP) for HIV.

There are many complex issues within this topic, which is why I strongly recommend you refer to the table mentioned above and incorporate it into your updated procedure along with the 24 hour contact number.

Management of an exposure should be regarded as a medical emergency, because prompt treatment may be life saving. PEP for HIV is not always well tolerated but it is recommended where exposure is significant.

Resources

  1. DoHA's Infection Control Guidelines for prevention of transmission of infection in the health care setting. Refer to chapter 23 on needlestick injuries etc and appendix 8.
  2. The blue book: guidelines for the control of infectious diseases (June 2005). Refer to appendix 4 on managing exposure. Call 1300 366 356 to order a hard copy.

This article is available online at http://bddgp.org.au/article/2008/09/bodily-fluids

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