Introduction

The purpose of this protocol is to inform faculty and students regarding the risk of exposure to bloodborne pathogens and the required procedure to follow if an accidental exposure occurs. It is the student’s/faculty’s responsibility to utilize universal precautions during all clinical activities.

Definitions

1. A Significant Occupational Exposure is defined as: a. A needle stick or cut caused by a needle or sharp that was actually or potentially contaminated with blood or body fluids. b. A mucous membrane (i.e., splash to the eye or mouth) exposure to blood or body fluids. c. A cutaneous exposure involving large amounts of blood or prolonged contact with blood-especially when the exposed skin was chapped, abraded, or afflicted with dermatitis.
2. Blood – human blood, human blood components, and products made from human blood.
3. Bloodborne pathogens – pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis-B virus (HBV) and human immunodeficiency virus (HIV).
4. Contaminated – the presence or the reasonably anticipated presence of blood or other potential infectious material on an item or surface such as sharps, dressings, equipment or other materials which have been soiled with blood or other potential infectious material or may contain sharps.
5. Sharps – any contaminated object that can penetrate the skin including, but not limited to needles, scalpels, broken glass, torn metal, weapons, exposed ends of wires, paper cutter blades, or scissors.
6. Decontamination – the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.
7. Exposure – a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious material that results from the performance of student’s or faculty’s duties (clinical related).
8. HBV – Hepatitis-B virus
9. HIV – Human Immunodeficiency Virus
10. Other Potentially Infectious Materials – all human body fluids, especially saliva where oral trauma is a potential, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids. Note: This definition would universally apply at trauma scenes involving body fluids, or any unfixed tissue from a human.
11. Parenteral – piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions.
12. Specialized clothing – lab coats, aprons, gowns worn for protection against a hazard.
13. Source individual – any individual whose blood or other potentially infectious materials may be a source of exposure to the student/faculty.
14. Universal Precautions – the concept that all human blood and certain body fluids are treated as if known to be infectious.

The following universal precautions for preventing HIV transmission in health care settings are recommended by the Centers for Disease Control (MMWR 1987 Aug. 21; 36: 1-18S; MMWR 1988, June 24; 37:377-382, 387-388; MMWR, 1991, July 23; 40:1-9):

• Use of precautions for blood, for body fluids containing visible blood, and for certain other body fluids** for all patients, since medical history and examination cannot reliably identify all patients infected by HIV and other fluid or blood-borne pathogens.
• Use of appropriate barrier precautions for handling items or surfaces soiled with blood or body fluids containing visible blood, and certain body fluids to which universal precautions apply**, or performing venipuncture and other vascular access procedures.
• Gloves should be worn when in contact with blood, body fluids containing visible blood, body fluids to which universal precautions apply, tissues, and mucous membranes and for handling items or surfaces soiled with the above, or for performing venipuncture or other vascular access.
• Masks and protective eyewear or face shields should be worn during procedures that are likely to generate air-born droplets of blood or body fluids to which universal precautions apply to prevent exposure of the mucous membranes of the mouth, nose, and eyes.
• Gowns or aprons should be worn during procedures that are likely to generate splashes of blood or the body fluids to which universal precautions apply.
• Resuscitation bags, mouthpieces, and ventilation devices should be available in areas where the need is predictable.
• Used equipment should be disposed of in a manner to prevent transmission of disease and to prevent injury to personnel with potential contact with the equipment, i.e., health care workers, housekeeping, and laundry personnel.
• Particular attention should be given to prevent injuries caused by needles, scalpels, and other sharp instruments. To prevent needle-sticks, needles should not be recapped or purposely bent or broken by hand. In particularly high-risk situations, such as during resuscitation, prevention of needle-stick injury to oneself and/or other health care workers from exposed needles or sharps requires special attention regarding the use and safe disposal of needles and sharps.
• Risk reduction to prevent sharp injuries include the use of engineering controls such as needle-free intravenous access systems, needle disposal containers as near as is practical to the point of use, and self-sheathing needle/syringe units. When recapping is necessary due to the lack of a readily accessible disposal container or due to the nature of the task (e.g., some situations for drawing arterial blood gases), the use of work practice modifications such as a one-handed scoop method or a passive recapping device is recommended. Recapping of needles using two hands is prohibited by the Occupational Safety and Health Administration (OSHA) and will not be permitted where students are assigned for clinical rotations.

** Universal precautions apply to blood, semen, vaginal secretions, as well as tissues, cerebral spinal fluid, synovial fluid, pleural fluid, pericardial fluid, and amniotic fluid. These body fluids have been epidemiologically associated with transmission of HIV and/or HBV.

Exposure Protocol

If an exposure occurs students and faculty should implement the following protocol:

1. Immediately cleanse the affected area with soap and water.
2. If skin is punctured, bleeding should be encouraged if not excessive.
3. Provide first aid measures if applicable.
4. Students will immediately report an exposure to the clinical instructor. If a clinical instructor is exposed, he/she will immediately report the exposure to the head nurse and the Division Chairperson. The clinical instructor will complete an exposure report which will be forwarded to the Chairperson of the Division of Nursing. Confidentiality will be maintained and all records will be kept in the Chairperson’s office.
5. The exposure report should include the following information:
   a. name of the individual exposed with date, time, and location of exposure.
   b. route(s) and description of the circumstances leading to and including the exposure.
   c. immediate first aid procedures implemented and/or medical interventions.
   d. identification of the source individual unless the agency has established that such identification is unfeasible or prohibited by state or local law.
6. The clinical instructor/student will also follow the exposure procedures of the agency in which the exposure occurs.

Post-Exposure Prophylaxis

It is the responsibility of the student/faculty to arrange and finance post-exposure medical follow-up and care. However, the Chairperson of the Division of Nursing will advise the student/faculty of the following Center for Disease Control recommendations.

1. OSHA Guidelines direct the clinical facility’s infection control officer to attempt to determine the infectivity status of the source individual. In the event that the infectivity status is determined, the exposed individual will be notified. If the infectivity status of the source individual cannot be determined, then the exposed individual should proceed with the following post-exposure recommendations:
2. The student/faculty should be clinically and serologically evaluated as soon as possible.
3. If the exposed student/faculty initially tests negative for Human Immunodeficiency Virus (HIV), he/she should be periodically retested for six months after exposure. (HIV seroconversion generally occurs 6-12 weeks after exposure).
4. If the student/faculty does not have Hepatitis B immunity, the administration of Hepatitis B Immune globulin (HBIG) appears to be highly effective in preventing HBV infection. The incubation period for HBV is 40-180 days, but HBIG should be administered within 7 days following exposure.

IRA D. PRUITT DIVISION OF NURSING
BLOODBORNE PATHOGENS EXPOSURE REPORT

NAME _________________________________

Social Security # _________________

Title (Student or Faculty) __________________________________________

Source Individual ________________________________________________

Hospital Number _________________________ Diagnosis _______________

Date of Incident/Accident __________________________________________

Exact Location of Incident/Accident___________________________________
______________________________________________________________

Was there a witness to the incident/accident _____YES ______NO

If YES, print name, title/position ___________________________________________

Describe the circumstances in which the incident/accident occurred including protective precautions (Specialized clothing, gloves, etc.) being observed at the time of exposure and contaminated or potentially infectious material(s) to which the student/faculty was exposed:

Describe follow-up care (decontamination, clean-up, etc.):

Exposure reported to:______________________________________________________

Agency exposure protocol implemented: A. _____YES _____NO
B. If no, explain why ____________________________________________________

Student comments:

Faculty Comments:

Signatures: Student _________________________________ Date ________

Faculty __________________________________ Date ________

Division Chairperson _______________________ Date ________

Developed August 1995
Reviewed July 2001