Needlesticks/Exposures as related to HIV and Hepatitis
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. Links to the blood borne pathogens standard and CDC Guidelines for Prevention of Transmission of HIV & Hepatitis B are available.
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.
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 317-274-6824. 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. 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. Information is also available on the OUCH page.
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,
- 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 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.
*Indiana state law now allows verbal consent for HIV testing. IU Health and St. Vincent Hospitals have verbage included in the General Consent and Financial Statement which is signed upon admission to the hospital.. It gives the hospital permission to test for Blood Borne Pathogens, including HIV. The Clarian 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 and documented in the chart.
The IU Health consent form ("Consent for Testing of Patient Blood" for IU Health 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, Methodist or Wishard Hospital, a rapid HIV test is done on the source patient's blood. The rapid HIV result is available within an hour of the receipt of the blood in 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.
. 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). If the source patient's results are negative AND the clinic has documentation that the exposed person is imune to Hepatitis B, no futher follow up is necessary. If the source patient is unknown or if source patient tests positive for Hep C or HIV, the labs may be repeated at 6, 12 and 24 weeks. If the source patient is HIV+ and Hep C +, testing is also done at 12 months.
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
- IU employees complete an IU Incident Report form. It may be obtained only from your supervisor or the IUPUI Campus Health clinic.
- IU Health employees complete the IU Health 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).
- Medical students do not complete an exposure or incident form.
- Residents complete an IU form.
Bring the completed form to IUPUI Campus Health 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 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.
Occupational Exposures Resources
- IU Health Hazard Communication General Patient Care Quick Reference and Comprehensive Manual
Hazards are listed by chemical beginning on page 4.
- Exposure to Blood: What Healthcare Personnel Need to Know
CDC booklet updated July 2003
- Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005
Links to the December 30, 2005 MMWR.
- IUPUI Bloodborne Pathogens Handbook
Developed by the IUPUI Department of Environmental Health and Safety.
- IUPUI Laboratory Safety Handbook
Developed by the IUPUI Department of Environmental Health and Safety.
- Material Safety Data Sheet (MSDS) Search
A list of MSDS databases compiled by the IUPUI Department of Environmental Health and Safety.
- OSHA Bloodborne Pathogens Standard
Describes the Bloodborne Pathogen Standard (29CFR1910.1030) set forth by the U.S. Department of Labor's Occupational Safety & Health Administration.
- U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis
Links to the June 29, 2001 MMWR.
- U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis
Links to the September 30, 2005 MMWR.