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Post-Exposure Evaluation and Follow-up

IV. POST-EXPOSURE EVALUATION AND FOLLOW-UP
  1. Should an exposure incident occur, contact                                   immediately at the following number:                           .
  2.  

  3. An immediately available confidential medical evaluation and follow-up will be conducted by (Licensed health care professional)       ______________. Following the initial first aid (clean the would, flush eyes or other mucous membrane, etc.), the following activities will be performed:
    1. * Document the routes of exposure and how the exposure occured.

      * Identify and document the source individual (unless the employer can establish that identification is infeasible or prohibited by state or local law).

      * Obtain consent and make arrangements to have the source individual tested as soon as possible to determine HIV and HBV infectivity; document that the source individual's test results were conveyed to the employee's health care provider.

      * If the source individual is already known to be HIV and/or HBV positive new testing need not be performed.

      * Assure that the exposed employee is provided with the source individual's test results and with information about applicable disclosure laws and regulations concerning the identity and infectious status of the source individual (e.g., laws protecting confidentiality).

      * After obtaining consent, collect exposed employee's blood as soon as feasible after exposure incident, and test blood for HBV and HIV serological status

      * If the employee does not give consent for HIV serological testing during collection of blood for baseline testing, preserve the baseline blood sample for at least 90 days; if the exposed employee elects to have the baseline sample tested during this waiting period, perform testing as soon as feasible.

 

Notes to Employer:

An exposure incident is defined in the standard as "a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties." Employees may document each exposure on a form such as that provided on page A-7 of this document, EPINet Universal Blood and Body Fluid Exposure Report, and on the OSHA No. 200 log, if appropriate.

If consent is not obtained from the source individual, the employer must show that the required consent could not be obtained. Where consent is not required by law, the source individual's blood, if available, shall be tested and the results documented. This must be done whether or not the employee elects baseline testing and follow-up.

Following an exposure incident, prompt evaluation and prophylaxis is imperative. Timeliness is, therefore, an important factor in effective treatment. The American Nurses' Association Position Statement on "Post-Exposure Programs in the Event of Occupational Exposure to HIV/HBV" (September, 1991; cited with permission) includes the following Guidelines for Immediate Treatment:

    1. Wound care/First Aid

      A. Clean wound with soap and water.

      B. Flush mucous membranes with water or normal saline solution.

      C. Other wound care as indicated.

    2. Notification of Responsible Parties

      A. Notify supervisor or on-call staff member at the 24-hour hotline number after wound care has been provided.

Procedures for reporting an exposure should be in place which apply to any and all working hours. Following immediate wound care and supervisor notification, the post-exposure evaluation must be provided as in IV. B., above.

 

  1. Administration of Post-Exposure Evaluation and Follow-Up
  2.  

    1. ________________________ will ensure that health care professionals responsible for employee's hepatitis B vaccination and post-exposure evaluation and follow-up be given a copy of OSHA's bloodborne pathogens standard.
    2.  

    3. ________________________ will ensure that the health care professional evaluating an employee after an exposure incident receives the following:
    4.  

        * a description of the employee's job duties relevant to the exposure incident
        * route(s) of exposure
        *circumstances of exposure
        * if possible, results of the source individual's blood test
        *relevant employee medical records, including vaccination status

    5. ________________________ will provide the employee with a copy of the evaluating health care professional's written opinion within 15 days after completion of the evaluation. 

Notes to Employer:

See sample forms for post-exposure: Health Care Professional's Written Opinion for Post Exposure Evaluation, and Bloodborne Pathogen Exposure Evaluation Form.

If the employer is also the health care professional, the employer must ensure that the results of the employee's post-exposure evaluation remain confidential and are not disclosed to his/her co-workers, managers and supervisors, except to the extent absolutely necessary to comply with the standard or other legal requirements.

Post-exposure counseling is mandatory under the standard. The American Nurses' Association recommendations for exposed health care worker counseling are provided as an example. (From the Position Statement on Post-Exposure Programs, September, 1991.)

    * Counseling should be provided by skilled personnel through previously established agency protocol.
    * Counseling should include the following: meaning of test results; discussion of personal life factors such as safer sex practices, conception/contraception, and informing sexual partners; discussion regarding avoidance of blood, semen, and tissue donation.
    * Counseling should include a validation of the health care workers' concerns and fears, and the implications of disclosure to other persons in their support system.
    * The health care worker should be encouraged to monitor for signs/symptoms of acute sero-conversion illness (fevers, myalgias, rash, etc.) and to report these symptoms to designated personnel immediately.
    * Information regarding workers' compensation, disability, and other benefits should be provided.

 

V. Procedures for Evaluating the Circumstances Surrounding an Exposure Incident

  1. ________________________ will review the circumstances of all exposure incidents to determine:

    * engineering controls in use at the time

*Work practices followed

*A description of the device being used

*Protective equipment or clothing that was used at the time of the exposure incident (gloves, eye shield, etc.)

*Location of the incident (O.R., E.R., patient room, etc.)

*Procedure being performed when the incident occurred

*Employee's training

If it is determined that revisions need to be made, ___________________ will ensure that appropriate changes are made to this ECP. (Changes may include an evaluation of needleless systems, adding employees to the exposure determinations list, etc.)

     

 

 

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