Health Services

Occupational Health

Needlesticks/Exposures

What to do for Needlesticks and other exposures to Blood and Body Fluids

Bloodborne Pathogens, Exposures, Risks, and Prophylaxis

Chemical Exposures

The information below was gathered from multiple web pages from the Indiana State Department of Health. The numbers reflect positive lab tests for both the State of Indiana and Marion County. Information in blank boxes could not be located.

Total population of Marion County is estimated at 6,080,485 for 2006 data.

Web information accessible at http://www.in.gov/isdh/dataandstats/data_and_statistics.htm and http://www.in.gov/isdh/dataandstats/disease/2005/idtoc.htm.

	TB		Hepatitis B		Hepatitis C		HIV
	2005	2006	2005	2006	2005	2006	2005	2006
Indiana State	146		57		5370
Marion County	45	110	40	53	505			387

What to do for Needlesticks and other exposures to Blood and Body Fluids

The CDC has extensive information regarding potentially infectious body fluids; indications for antiviral treatment; and information about occupational transmission of HIV and Hepatitis B and C. Links to the blood borne pathogens standard and CDC guidelines are found in the Health Resources section of the website.

Potentially infectious body fluids include:

• Cerebrospinal fluid - surrounds the brain or spinal cord
• Pericardial fluid - surrounds the heart
• Pleural fluid - surrounds the lungs
• Amniotic fluid - surrounds the fetus
• Peritoneal fluid - abdominal fluid
• Semen and vaginal fluids
• Synovial fluid - surrounds the hip, knee, wrist and elbow joints
• Blood or
• Any other body fluid contaminated with visible blood or DENTAL procedures involving saliva

An exposure is a...

• percutaneous (cuts the skin) injury or
• contact of a mucous membrane (eyes, mouth and nose) or
• non-intact skin with blood or the above listed body fluids.

Urine and sputum do NOT constitute an exposure unless visible blood is present in the urine or sputum.

What to do in case of exposure

An informational recording is available at 962-6824 (Methodist employees) and 274-6824 that describes actions to be taken in event of an exposure. Please call the appropriate number or read the information below.

First Aid

If blood or a body fluid has splashed onto skin, into the eyes, nose, or mouth; wash the skin with soap and water or rinse the eyes/mouth/nose with tap water for 15 minutes. Remove contact lenses from the eyes. Splashes of blood or body fluids onto intact skin does not pose a danger and is NOT considered an exposure.

If you have a needlestick or laceration, the first thing to do is to clean the wound with soap and water. Then apply direct pressure to stop the bleeding if needed and apply a bandaid or dressing.

OUCH line and pager

A pre-recorded n informationl line for exposures is available at 274-6824. The nurse or physician on call for the IUPUI OUCH pager (312-6824) is available to discuss exposures and antiviral treatment and prescribe it if indicated. It is to be used during evening, night, and weekend hours. Call the pager number, punch in your full 7 digit number, and press the # key. Hang up and wait for your call to be returned. During regular business hours, please report to the clinic.

Lab Tests

The source patient (person whose blood or body fluids are on contaminated needle/scalpel or splashed onto health-care personnel) will be tested for

• HIV 1 and 2 antibodies (if consent obtained/or copy of General Consent at Clarian facilities sent with blood),
• Hepatitis B surface antigen (HepBsAg), and
• Hepatitis C antibodies (HepCAb).

Occupational health clinic staff will call the lab and order the source patient labs.

The patient's nurse obtains consent and draws the blood.* Two filled gold top tubes and one purple top are needed. Label the blood tubes with the source patient's name and medical record number. The blood and signed HIV consent form (or General Consent and Financial Statement) is tubed to the Methodist Hospital ER Point of Care Lab (tube station #136). Call the lab (962-9222) to tell them to expect the blood and consent before it is tubed.

*Special consent forms are no longer needed if the source patient (at Clarian) has signed the Clarian General Consent and Financial Statement. It gives the hospital permission to test for Blood Borne Pathogens, including HIV. The form was revised January 07 and is numbered CH 222. If your source patient has signed this form, additional consent is unnecessary. however the patient should be informed the tests will be done due to an exposure. The form must be copied and sent with the blood to the ER Point of Care Lab.

The Clarian consent form ("Consent for Testing of Patient Blood" for Clarian patients) is available at http://pulse.clarian.org under Forms then EOHS-Infection Control-HR.

If the source patient is a patient at IU, Riley, or Methodist Hospital, a rapid HIV test is done on the source patient's blood or saliva, providing consent has been given. The rapid HIV result is available within an hour of the blood and consent being received by the lab. Once the lab notifies the on-call person of the HIV result, the exposed individual will be notified by the on-call or clinic staff.

Rapid HIV tests may be done if the source patient is at Wishard Hospital. Two gold top tubes and a purple top tube are needed for rapid tests at Wishard. Source patients (who consent to the HIV test) at other sites will have a non-rapid HIV test done.

The employee/student/faculty member with an exposure will be tested at baseline for HIV 1 and 2 antibodies, Hepatitis B surface antibodies (HepBsAb) and HepC antibodies (HepCab). These labs may be repeated at 6, 12 and 24 weeks. If the source patient is HIV+ and Hep C +, testing at 12 months is recommended.

Labs on the exposed person are drawn at the health clinic unless antiviral medications are prescribed after usual business hours.

Incident and Exposure forms - bring to the clinic

1. IU employees complete an IU Incident Report form. It may be obtained only from your supervisor or the IUPUI Health Services clinic.
2. CLARIAN employees complete the Clarian Employee Incident/Exposure form (form downloadable from http://pulse.clarian.org; click on Forms in the toolbar at the top of page, then scroll to EOHS-Infection Control-HR and choose the appropriate form).
3. Medical students do not complete an exposure or incident form.
4. Residents complete an IU form.

Bring the completed form to IUPUI Health Services during business hours. Be sure the name of the source patient, the medical record number and the attending physician's name is on the form. A supervisor's signature is also required.

Other information used to make decisons regarding level of risk is explained below.

Type of injury

Sterile or non-sterile
A sterile injury from a needlestick or scalpel does not need to be reported as an exposure. If the injury requires sutures, report to the UH ER. If unsure and the injury occurs during business hours, report to IUPUI HS for an evaluation. The clinic can close some wounds with steri-strips, duo-derm or staples. While some injuries may not be considered an exposure, a tetanus shot may be needed.

Depth of injury
If the needle or scalpel was used on a patient, how deep is the injury? A deep injury has higher risk of transmitting a virus or bacteria than a superficial injury that does not bleed. A stick with a suture needle carries less risk than with a hypodermic needle. A hypodermic (hollow needle) may contain blood within the hollow bore which may be injected into the health care personnel's tissues.

Used within blood vessel or not
A needle or scalpel used within a blood vessel has a higher risk of transmitting virus or bacteria.

Was the needle or scalpel from a known HIV infected individual or someone with high risk behaviors for HIV infection?
Talk to the patient or check the chart to determine if the patient has a history of homosexuality, IV drug use, multiple sexual partners, or blood transfusion received prior to 1986. If the patient has high-risk behaviors or is known to be HIV infected, antiviral treatment may be indicated and prescribed.