Harbor:Occupational exposure

Harbor Management

• Exposure during weekdays (non-holidays), from 7:00a-3:30p:
  • Send employee directly to Employee Health office for evaluation
    • Except if employee has sustained injury that warrants ED evaluation (i.e. laceration)
  • Goal time from exposure to Employee Health office < 15 minutes
  • Have provider for source patient call Employee Health at x2360
    • Gives NP in Employee Health a contact in case of labs need to be drawn on source patient
  • Do not draw any labs on source patient, unless asked to do so by the NP in Employee Health
• Exposure during all other times:
  • Employee with potential blood-borne pathogen exposure should be evaluated in ED
  • Obtain OCCUPATIONAL EXPOSURES-ED form (see below)
  • Use form to guide you in assessment of risk and need for testing
  • If exposure warrants rapid HIV test on the source patient, then must give source patient opportunity to opt out of HIV test
  • Only contact HIV service if:
    • Source patient has capacity and opts out OR
    • Source patient lacks capacity
  • Check Affinity for recent (weeks or months) HIV results on source patient
• When to call HIV service:
  • Must fill out form and present exposure case to ED attending prior to contacting HIV service
  • If source patient is HIV+ AND exposure has potential to transmit HIV
    • HIV+ either by history or if rapid HIV is positive at time of exposure
  • Source patient lacks capacity OR chooses to opt out of HIV test
    • Only HIV service has authority to approve testing in these situations

Resident Duties

Occupational Exposure form p.1

Occupational Exposure form p.2

• Obtain details of exposure
• Obtain details of source patient
  • Name, MRN, Diagnosis
  • Prior HIV results in past year?
  • If source patient known to be HIV+ contact HIV service immediately (pager 310-501-4260)
• Order Rapid HIV test on source patient if:
  • Percutaneous injury occured via needle, scalpel, or other sharp object that has been in contact with source patient's blood, body fluid, or tissue
  • Mucosal splash to eyes, mouth, or into nose involving blood or other body fluid
• Rapid HIV test not indicated on source patient if:
  • Blood or body fluid came into contact with employee's intact skin
  • Employee exposure involved patient's saliva, urine (unless visible blood is present in saliva or urine)
  • Employee exposure to needle, scalpel or other sharp object that had NOT been in contact with patient's blood, body fluid, or tissue
• Ordering rapid HIV on source patient:
  • Place rapid HIV order in source patient's chart
  • VERIFY rapid HIV correctly ordered by clerk in the computer (NOT HIV Elisa)
  • Notify Blood bank that specimen for rapid HIV is forthcoming (x2252)
  • Check results 1 hour after blood has arrived in blood bank
  • FAX filled out form to Employee Health at 310-222-5326

See Also

• Harbor:Main
• Occupational Exposure
• HIV Prophylaxis (Occupational)

References

HUCLA

Authors

Manuel Celedon, Ross Donaldson, Michael Holtz, Neil Young