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GHNHSFT ED guidelines Dr Helen Mansfield March 2019 RV March 2021 The Occupational Health (OH) department is responsible for the management of healthcare workers who are exposed to blood borne viruses at work. As the OH department does not provide cover out of hours, the initial management of exposures during these times are co-ordinated by the Emergency Departments, (EDs). This procedure is to be followed only for employees of the local NHS Trusts. It does not apply to members of the public, or workers from other organisations that are exposed to BBVs. Guidance for those groups is available separately, see ED guidelines intranet site.
What is significant exposure; Exposure occurs Perform First Aid Skin Mucous membrane Encourage bleeding Wash (soap, water) W/Proof dressing Wash copiously Significant Fluid? Table 1 No Yes Significant Route? Table 2 No Yes SIGNIFICANT NON-SIGNIFICANT EXPOSURE EXPOSURE No Out of hours? Reassure Yes Contact OH Dept Contact A&E Dept Table 1 Significant fluids Blood (++ risk) Internal body fluids Semen Vaginal Secretions Saliva (dentists only) NOT Urine/faeces Table 2 Significant route Percutaneous Broken Skin Mucous Membranes
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GHNHSFT ED guidelines Dr Helen Mansfield March 2019 RV March 2021 How do I assess if the source of the contamination is high risk? The prevalence of HIV infection and other blood borne viruses is higher in certain groups. 1. Check the patient’s history and notes. Are there any previous blood results for hepatitis B, hepatitis C or HIV? 2. Consider whether the following risk factors may apply: - Originated from sub-Saharan Africa - Men who have sex with men - Intravenous drug users - Sex industry worker - Unprotected sex with any of the above - If the source is a child does the mother have HIV?
- If the source patient is known to have or is under investigation for an AIDS indicator illness, then consider as high risk. 3. Remember that Gloucestershire has a low HIV prevalence compared with other places and this is particularly true for intravenous drug users and sex industry workers. How do I consent and take bloods from the source? If the patient is on the ward then the team looking after the patient should take responsibility for this. If the patient is in the ED then someone other than the treating clinician should approach the patient. Consent must be taken from the source patient for these tests.
A suggested form of words, taken from the Gloucestershire Hospitals NHS Foundation Trust policy, would be: Unfortunately one of the members of staff has had an accidental injury where your blood (or specify relevant body fluid) has been “involved”. I am here to ask if you would let me take a blood sample for testing for the viral infections that can be transmitted to staff in this way. This is something that we ask for routinely whenever a patient’s blood (or specify relevant body fluid) is involved in such an accident. We need your agreement to do this and would appreciate your help. The purpose of the testing is to reassure staff where the results are negative.
This may allow them to stop taking precautionary medication that often causes unpleasant side effects. In the unlikely event that a test is positive you will receive specialist advice and management including treatment if required. The staff member may also be offered additional treatment. The tests are for hepatitis B, hepatitis C and HIV. The test results are usually available within a few days but may take several weeks if extra investigations are required for clarification. The results will normally be given to you by a member of the medical staff. The results are confidential, but they will appear in your medical records and the affected staff member will also be informed.
Do you have any concerns? A common concern is whether having these tests done will affect any existing life insurance policies or future life insurance applications. The Association of British Insurers has issued guidance stating; “Existing life insurance policies will not be affected in any way by taking an HIV test, even if the result is positive.” For new life insurance applications, companies should only enquire about positive test results, not whether a test has been performed. A positive test result may affect the outcome of a life insurance policy application.
If you have any other concerns I can ask for a member of the Counselling and Support Service to see you (County HIV/AIDS counselling and support services: telephone 01452 311744). Do I have your permission to take a blood sample for hepatitis B, C and HIV testing? I should remind you that you can refuse to have some or all of these tests performed and that if you do choose not to be tested it will not affect your future care.”
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GHNHSFT ED guidelines Dr Helen Mansfield March 2019 RV March 2021 A record of the discussion and patient’s consent (or non-consent) to testing for HBV, HCV and HIV should be made in the medical records of the source Which blood tests should I take for the injured person?
Microbiology form PHLS SOUTH WEST PLEASE USE BLOCK CAPITAL LETTERS AND BALL POINT PEN PHLS SOUTH WEST Hospital/NHS Number Hospital Type of Specimen Date/Time VB 13.6.00 Surname Bloggs (staff) Investigations requested STORE SERUM (orange top) First Names Joe Requesting laboratory number Date of Birth Sex NHS PP 6.6.1966 M 3 Consultant/GP Occupational Health Consultant Patient’s Address insert the home address Address for report/Ward Copy report address Occupational Health GRH/CGH Relevant Clinical Details.
Antibiotic Treatment Date of Onset Needlestick/contamination incident 13.6.00 FOR LABORATORY USE ONLY Source patient John Smith DOB 11.11.59 Bleep No Signed XXXXX GLOUCESTER PUBLIC HEALTH LABORATORY ENQUIRIES 01452 305334/5 internal 4381/2
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GHNHSFT ED guidelines Dr Helen Mansfield March 2019 RV March 2021 Which blood tests should I take from the source person? Microbiology form What are the risks of contracting a blood borne virus infection after a needle stick? Following an injury with a sharp or needle that is obviously contaminated with wet blood, if the source is: Hepatitis B positive, 30% chance of contracting the illness Hepatitis C positive, 3 % chance of contracting the illness HIV positive, 0.3 % chance of contracting the illness. If the injury involves a splash to the eye or mucous membrane, the risk of contracting the illness is significantly lower.
If the source of the sharps injury is unknown, the risks are very low. The prevalence of HIV in Gloucestershire remains low. Healthcare staff should all be vaccinated against hepatitis B and it is an effective vaccine. Hepatitis C carriage rate in the IV drug user population is now quite high.
PHLS SOUTH WEST PLEASE USE BLOCK CAPITAL LETTERS AND BALL POINT PEN PHLS SOUTH WEST Hospital/NHS Number Hospital Type of Specimen Date/Time VB 13.6.00 Surname Smith Investigations requested Hep B S Antigen, Hepatitis C antibody + HIV antibody (orange top) *(BUT ONLY WITH CONSENT OF THE PATIENT) First Names John Requesting laboratory number Date of Birth Sex NHS PP 11.11.59 M 3 Consultant/GP Occupational Health Consultant Patient’s Address insert the patient’s home address Address for report/Ward Copy report address Occupational Health GRH/CGH Patients notes Relevant Clinical Details.
Antibiotic Treatment Date of Onset Source of Needlestick/contamination incident 13.6.00 to Bloggs, Joe (staff) on 13.06.00 Bleep No Signed XXXXX FOR LABORATORY USE ONLY GLOUCESTER PUBLIC HEALTH LABORATORY ENQUIRIES 01452 305334/5 internal 4381/2 MICROBIOLOGY
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