Policy hiv & needleprick.doc

Labour Broker, Payroll Administrator & Nursing Agency P O Box 74028, Lynnwood Ridge, 0040
Tel (012) 804 8039 Fax (012) 804 4862


POLICY:
PROCEDURES TO FOLLOW IN EVENT OF HEALTH CARE WORKERS
EXPOSED TO BLOOD & BLOOD STAINED BODY FLUIDS
Background:

The Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) are serious public health
threats and Skills Hire is committed to encouraging an informed and educated response to issues and questions concerning these infections. HIV is transmitted much less readily than HBV. Health workers frequently have to deal with patients’ blood and other body fluids, and risk HIV & Hepatitis infection when they are • needle-stick injuries (pricking yourself with a used needle) • cutting yourself with sharp objects contaminated with body fluids • exposure of non-intact skin to blood or body fluids • splashes of body fluid into your eyes or mouth. It is very important to start post exposure prophylactic treatment within 6 hours of injury. If not done, it is still valuable to start up to approximately 24 hours after the injury.
How to Protect yourself:
• Wash your hands thoroughly with soap and water before and after contact with patients, and immediately after touching body fluids. • Wear gloves when touching broken skin, mucous membranes, body fluids and instruments that have been in contact with body fluids. • For examinations and cleaning, use clean gloves. • For surgery and deliveries, use sterile gloves. • Change gloves after each patient contact. If sterile gloves are washed and re-sterilised for re-use, invisible tears can occur, so wear two pairs for procedures involving contact with body fluids. • Don’t eat, drink or put anything in your mouth that might have • Wear a mask if there is a chance of body fluids splashing into your • Wear protective glasses if there is a chance of body fluids splashing • Wear a plastic apron or gown during procedures where body fluids • Remove dirty clothes and linen as soon as possible and place them in • Clean up spilt blood immediately and wipe the surface with • Use paper towels, then place these in a disposal bag for incineration. • De-contaminated and sterilise instruments immediately after use. De- contaminate instruments in disinfectant solution such as Jik. • Wipe surfaces with disinfectant (e.g. Biocide, Milton or Jik mixed 2:1 with water) after each examination or procedure and before the next. • Contaminated waste, like used swabs, should be disposed of safely • Put used disposable needles immediately in a container for “sharps” • Don’t re-sheath (cap) needles. When “sharps” containers are full, close them securely and dispose of them. Never re-use a sharps container. • Put re-usable needles in de-contamination solution immediately after • Place laboratory specimens in a leak-proof container. • Once used, keep the sharp end of needles or blades pointing away from you, but be careful not to stick anyone. SKILLS HIRE (PTY) LTD
PROCEDURE WHEN ACCIDENTALLY EXPOSED TO:
Needle stick injury:
1. Encourage bleeding from a wound caused by sharp objects by applying pressure to the 2. Wash it with soap and running water for two minutes. 4. Report incident immediately to Person in Charge of unit. 6. Proceed to the area where prophylactic treatment may be administered (Trauma Unit). 7. The following will take place immediately: • Filling in forms requesting relevant testing • Receiving an appropriate supply of antiviral tablets (HIV prophylactic AZT AND 3TC must be administered if the source person is positive. Nothing if the source person is negative Give AZT only, if the source person is unknown. (Skills Hire prefers to regard the source person as positive until
shown to be negative, and hence recommends AZT and 3TC is
given.)
8. The following will take place the next day: • Filling in forms requesting relevant testing Baseline testing is done to determine the HIV status of the injured If your baseline indicates that you were already HIV positive prior to the incident, no prophylactic treatment will be given since If you refuse to undergo baseline testing, no prophylactic treatment will be given as the responsibility for and the expense of the treatment can only be justified if baseline testing objectives indicates HIV negative status prior to the incident. • Receiving an appropriate supply of AZT tablets with your informed consent (one month if source person is unknown and with the inclusion of 1 month of 3TC if source person is known to be HIV positive). You will be expected to undergo pre-test counseling, filling in request forms requesting relevant testing, undergoing testing and return to receive results. Non-compliance will result in Skills
Hire not being accountable for the costs incurred.
9. Follow up the source person (being tested) by ensuring your Line Manager contacts the Person in Charge of the source person who makes the necessary arrangements for:
Responsibility of the person in charge of the source person
• To attempt to persuade the source person to make themselves available for: Testing for HIV, Hepatitis B & C and Syphyllis (VDRL) • If the HIV status of the source person found to be HIV positive, treatment will not be administered to the source person. Post test counseling procedures will be followed. • The blood results of the source person will determine if the exposed person’s treatment will The results of the test should remain confidential to the source person, the tester and the medical personnel involved in the process.
Thereafter:
• If the source person’s results are HIV positive, ensure one month supply of AZT tablets are administered and include one month supply of 3TC in the treatment for the exposed • If the source person is unknown, administer AZT and 3TC for one month. • If the source person is HIV negative, discontinue treatment. • If the source person’s results are Hepatitis B positive, proceed with Hepatitis B immunization and possible immunoglobulin and other relevant treatment as well as counseling of the exposed person. • If the source person’s results are Hepatitis C positive, proceed with counseling the the exposed person and refer to their preferred health care provider. • If the source person’s results are VDRL positive, proceed with relevant treatment and Syphyllis (VDRL) – 6 weeks and 3 months AZT safety monitoring – 2 weeks, 1 month Arrange for follow up on appropriate changes to treatment depending on results of the above. The Hospital must notify Skills Hire of the incident, together with the following documentation Employer’s report of an accident (W.CL.2 (E) SKILLS HIRE (PTY) LTD
NEEDLESTICK INJURY PROTOCOL

Should an employee of Skills Hire sustain a needle stick or any related injury whilst on duty,
please ensure that the following is adhered to:

CLIENT/HOSPITAL POLICY STATEMENT

*

DOCUMENTATION TO BE COMPLETED

*
Employer's report of an Accident (W.CL.2 (E)) Checklist for Sharps Injury/Exposure to Blood/Body Fluids Form. Consent to Anti Retroviral Prophylaxis Treatment Form. Anti Retroviral Prophylactic Schedule Form. Refusal of Treatment Form (If necessary) Prescription for Anti Retroviral Medication. SKILLS HIRE (PTY) LTD
INCIDENT REPORT FOLLOWING OCCUPATIONAL EXPOSURE
TO BODILY FLUIDS
SKILLS HIRE (PTY) LTD
CHECKLIST FOR SHARPS INJURY/EXPOSURE TO BLOOD/BODY
FLUIDS
2 Incident reported to Sister in charge of the Ward? 3 Incident reported to Sister in charge of the Hospital? 4 Casualty File been opened in employee's personal name? 6 Has the employee signed consent for HIV testing? 7 Have bloods been drawn from the employee for HIV and Hep B? 8 Have other baseline bloods been drawn as specified in the Anti Retroviral Schedule. 9 Has the patient's private doctor been informed of the incident? 10 Has the patient's doctor deemed it necessary for the patient's blood to be drawn and 11 Has the patient consented to blood being drawn and tested? 12 If the employee refuses to have bloods drawn or to commence the starter pack, has the Indemnity form been completed and signed? 13 Has a prescription for Anti Retroviral drugs been issued? (Copy to be retained for 14 Has the doctor prescribing the Anti Retroviral Drugs given the employee the relevant information regarding the medication and follow up treatment and consultations? 15 Has the Anti-Retroviral Prophylactic Schedule been filled in? 16 Has The employee been instructed to complete the entire course of Anti Retroviral Has the "EMPLOYER'S REPORT OF AN ACCIDENT" (W.CL.2 (E)) form been 18 completed and filed in the Skills Hire WCA file?
19 Has the Skills Hire office been notified of the incident?
EMPLOYEE AT RISK
NURSING MANAGER

SKILLS HIRE (PTY) LTD
CONSENT TO ANTI RETROVIRAL PROPHYLAXIS AGAINST HIV
SEROCONVERSION FOLLOWING OCCUPATIONAL EXPOSURE TO
BODY FLUIDS
I understand that the efficiency and long term toxicity of Zidovudine (AZT/Retrovir), 3 TC (Lamivudine) and Indinavir (Crxivan) are unknown and Indemnify Skills Hire against any claim of whatever nature which may be made against them related to the Prophylaxis. I wish and consent to receive the following Anti Retroviral Prophylaxis against seroconversion to positive human immune deficiency viral antibody status: I consent to the necessary blood investigations required during the prophylactic regime. I undertake to complete the full course of Prophylaxis, the side effects of which have been explained to me, unless this is counter-indicated by medical opinion. I accept full responsibility for continuing with the treatment and follow up.
SKILLS HIRE (PTY) LTD
ANTI RETROVIRAL PROPHYLACTIC SCHEDULE
RESPONSIBLE FOR SUPERVISING PROPHYLAXIS: DATE SIGNATURE OF PROPHYLAXIS
SUPERVISOR
SKILLS HIRE (PTY) LTD
INDEMNITY FORM

REFUSAL OF HIV / HEPATITIS B BLOOD TESTING AND
ANTIRETOVIRAL PROPHYLACTIC TREATMENT
1. I hereby refuse to have bloods drawn for HIV and Hepatitis B. 2. I hereby refuse to receive Antiretroviral Prophylaxis against sero-conversion to positive Human Immune Deficiency viral antibody status. I accept full responsibility for my decision and indemnify Skills Hire against
any claim of whatever nature which may be made against them.

Source: http://www.skillshire.co.za/Nursing/Policy%20HIV%20Needleprick.pdf