Exposure to Blood: What Health Care Workers Need to Know
INFORMATION ON POST-EXPOSURE BLOOD TESTSI have been informed that my blood will be tested in order to detect whether or not I have antibodies and/or antigens in my blood to the Human Immunodeficiency Virus (HIV), which is the causative agent of Acquired Immune Deficiency Syndrome (AIDS). I have been informed that the test results may, in some cases, indicate that a person has antibodies and/or antigens to the virus when the person does not (false positive), or that it may fail to detect that a person has antibodies to the virus when the person has antibodies (false negative). I understand that in order to diagnose AIDS, other clinical evidence must be used in conjunction with this blood test. I have been informed that if I have any questions regarding the nature of the blood tests, its expected benefits, its risks and alternative tests, I may ask those questions before I decide to consent to the blood test. I understand that the results of this blood test are confidential and will only be released as required by law. I further understand that no additional release of the results will be made without my written RMATION ON PREVENTATIVE MEDICINE AFTER EXPOSURE TO HIVWashington Regional Medical System offers the currently prescribed prophylaxis (preventative) treatment to its employees who are exposed to HIV positive blood or body fluids on the job. You must decide if this medicine is right for you. Before deciding, carefully read the following questions and answers. If you have more questions, ask the Employee Health Nurse or the ER/Urgent Care doctor or nurse.1. What are the chances I’ll contract HIV after being exposed to HIV positive blood?Studies show that a person has a 3 in 1,000 chance of contracting HIV after being exposed to HIVpositive blood. The chance of getting HIV depends on how much blood or body fluids you were exposed to, how deep the puncture or cut was, and the HIV Titer of the patient source. The more blood and the deeper the wound, the greater the chance for getting HIV. The risk of getting HIV where there was no puncture or cut, as with a splash, is very small.2. What medicine will I be taking? How long will I take it?The doctor might prescribe Truvada and/or Isentress. The medicine is taken orally, usually for 4 weeks.3. What are the side effects from taking the medicine?The most common side effects are nausea, anemia, and fatigue. To check for other side effects, blood tests are done before starting the medicine, two and four weeks after treatment is begun.4. If I am pregnant, can I take this medicine?The recommendation is to take it only if patient source is HIV positive and you are at high risk for HIV. The medicine can be harmful to your unborn baby. A pregnancy test must be done before prescribing the medicine to any female of childbearing age.5. Will this medicine prevent me from getting HIV?A study published by the Center for Disease Control (CDC) suggests there may be a benefit inpreventing HIV in the health care worker by taking this medicine after a significant exposure to HIV positive blood.6. When should I start taking the medicine?Start as soon after exposure as possible, preferably within 2 hours.7. Should I begin the treatment?You must make the decision. Weigh the potential risks against the potential benefits. If you want more information, call the Public Health Service Hotline, 24 hours a day, 7 days a week: 1-800-342-2437 or 1-800-342-7514.Definitions:Employee Health Service (EHS): Nurses specializing in the care of Washington Regional Medical Systememployees. Health Care Worker (HCW): any person whose activities involve contact with patients or with blood or other body fluids from patients in a health-care or laboratory setting. *Patient Source (PS): any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to a HCW.Exposure: A percutaneous injury (e.g., a needle stick or cut with a sharp object), contact of mucous membrane or non-intact skin (e.g., when the exposed skin is chapped, abraded, or afflicted with dermatitis), or contact with intact skin when the duration of contact is prolonged (i.e., several minutes) or involves an extensive area, with blood, tissue, or other body fluid contaminated with visible blood. Human bites are considered an exposure if it results in blood exposure.Post-Exposure: After the exposure.Post-Exposure Prophylaxis (PEP): medication given after an exposure that contributes to the prevention of infection.Human Immunodeficiency Virus (HIV): A virus that causes acquired immune deficiency syndrome (AIDS).Hepatitis B Virus (HBV): a highly contagious liver disease that is spread through contact with infected blood or body fluid.Hepatitis C Virus (HCV): a chronic liver disease that is spread through contact with infected blood or body fluid.General Information:EHS uses a code in place of the HCW’s name when ordering post-exposure blood tests.The HCW’s blood and PS blood will be tested for HIV and HCV. If the HCW does not have proof of having positive HBV antibodies, the PS will be tested for HBV.If the PS tests negative for HIV, baseline testing or further follow-up of the HCW is normally notnecessary. Additional follow-up testing will be done after 6 weeks, 12 weeks, and six months, if the employee requests it.If the PS tests positive for HIV, HIV-antibody testing shall be offered to the HCW for at least 6 months post exposure (e.g. at 6 weeks, 12 weeks, and 6 months).If PS tests positive for Hepatitis C, a baseline SGPT will be done and tests for Hepatitis C and SGPT will be offered to the HCW in 4 months and 6 months.If the HCW has not had a Tetanus vaccine in the past ten years, one should be obtained in Employee Health office within 72 hours of the exposure.If HCW terminates employment with WRMS, the follow up tests will be done at no charge to the HCW, but it is the responsibility of the HCW to keep up with the test due dates.HIV information:Prospective studies of HCWs have estimated that the average risk for HIV transmission after a percutaneous exposure to HIV infected blood is approximately 0.3% and after a mucous membrane exposure is 0.09%. The risk for HIV transmission increases with exposure to a larger quantity of blood from the source patient as indicated by:a) a device visibly contaminated with the patient’s bloodb) a procedure that involved a needle directly in a vein or artery, or c) a deep injury. The following materials are considered potentially infectious for HIV: Blood, amniotic fluid, cerebral spinal fluid, pericardial fluid, pleural fluid, semen, synovial fluid, tissue, vaginal secretions.The following body materials are usually considered non-infectious for HIV (unless contaminated with visible blood): Saliva, sputum, stool, sweat, urine, vomitus.The decision to recommend HIV post exposure prophylaxis must take into account the nature of the exposure and the amount of blood or body fluid involved in the exposure and if the HCW is pregnant. Assessments of the risk for infection resulting from the exposure and the infectivity of the exposure source are key determinants of offering PEP. The medication will be ordered by a doctor and should be started as soon as possible after the exposure. Occupational exposure is considered an urgent medical concern to ensure timely administration of the medication. If the PS HIV status is unknown or high risk, the PEP may be initiated until laboratory results have been obtained and later the regimen may be modified or discontinued accordingly. If the exposure source is unknown, use of PEP should be decided on a case-by-case basis. HBV information:HBV is much more transmissible that HIV and is one of the most common bloodborne pathogensamong HCWs. Those at greatest risk work in areas where they are directly exposed to blood. The riskof a HCW contracting HBV from needlestick injuries ranges from 6-30%. This risk can be greatlydecreased by using Universal Precautions and being vaccinated for HBV. Post-exposure, the unvaccinated HCW, or the vaccinated HCW without a blood test indicating positiveantibodies to HBV, should be evaluated for the need for Hepatitis B Immunoglobulin. **HCV information:HCVs whose work activities involve handling human blood and body fluids are at a greater exposurerisk. Needlestick injuries are the most common cause of occupational exposure to HCV. No vaccine isavailable for HCV and no effective post-exposure prophylaxis is known at this time. ****Center for Disease Control (CDC) “Morbidity and Mortality Weekly Report” May 15, 1998 / Vol. 47 /No. RR-7** CDC “Personnel Health Guideline” 1998, Volume 26, Number 3*** Occupational Safety & Health Administration (OSHA) “Safer Needle Devices: Protecting HealthCare workers” October 1997Due to your exposure to blood/body fluids, the following points should be considered until you know the patient source HIV test to be negative or for six months if source is high-risk or unknown:HIV infection is spread by blood and body fluids, especially during sexual contact. Time needed betweeninoculation of a virus until contagious stage is unknown. Therefore, you should begin precautions now.PRECAUTIONS:Do not donate blood, plasma, body organs, other body tissue or sperm.The efficacy of condoms in preventing the spread of the virus during sexual intercourse is notproven but consistent use of them may reduce transmission.Exchange of body fluids during oral-genital contact or intimate kissing should be avoided.Do not share razors, toothbrushes, or other implements that may become contaminated withblood.Do not share needles you have used on yourself.Clean blood and other body fluid spills on household or other surfaces with freshly dilutedhousehold bleach (1 part bleach to 10 parts water).Inform your doctor, dentist, and eye doctor of your status so proper precautions may be taken to protect you and others.Seek medical evaluation for any acute illness that occurs within 12 weeks of exposure,especially if illness is accompanied by fever, rash, myalgia, fatigue, malaise, orlymphadenopathy.Other sources of information:“Exposure to Blood, What Health-Care Workers Need to Know” a booklet available on the Submission Page of Clarity.Public Health Service (1-800-342-2437)CDC National AIDS Hotline (1-800-342-2437)HIV/AIDS Treatment Information Services (1-800-448-0440)CDC National Prevention Information Network: or call 1-800-458-5231CDC Hospital Infection Program: ncidod/hipCDC National Institute of Occupational Safety & Health: niosh or call 1-800-356-4674 Washington Regional Employee Health NurseRevised 08.23.16 ................
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