School of Nursing - CSU, Chico

Bloodborne Pathogen Exposure

Nursing Student Protocols

This document provides a guide to safeguarding your health following an exposure to bloodborne pathogens in the clinical setting. Keep this document handy when in clinical. Keep information on your health insurance handy as well. All costs involved in your testing and treatment are your responsibility.

In the event that you experience a needlestick, cut, mucous membrane exposure, or nonintact skin exposure (i.e. chapped or abraded skin) to

Procedures to Follow

  1. Clean the area exposed immediately. For needlesticks or cuts, use soap and water to wash the area. For eye exposure, irrigate the area with clean water or saline. For splash exposures on nose, skin, or mouth, flush the area with water.
  2. Immediately report, within 10 minutes, this exposure to your clinical instructor and preceptor or staff nurse, who should report to the nursing supervisor.
  3. With the assistance of your instructor or staff nurse, determine the risk of transmission and the status of the source (patient).

    Consider:

    • the type of exposure (intact skin, mucous membranes, percutaneous)
    • the type of fluid involved
    • depth of puncture
    • volume of fluid
    • duration of contact
    • age of specimen

    Assess the Source (Patient):

    • Assessment of any risk factors for blood borne pathogens (history of IV drug use, blood transfusion or organ transplants prior to 1992; chronic hemodialysis; high risk sexual behaviors; received clotting factors before 1987.
    • History of Hepatitis B, Hepatitis C or HIV?
    • If known HIV positive, is there information on viral load or treatment history?
    • Obtain HIV antibody, Hepatitis B surface antigen (HbsAG), Hepatitis B core and surface antibodies, and Hepatitis C antibody levels on the source patient if possible. If the patient is hospitalized, the patient's physician will be contacted and the patient will be asked for informed consent to have bloodworm drawn. Some hospitals can obtain stat results from an HIV test in 20 minutes.
    • If the patient is in a community setting, the patient's physician must be contacted for the lab work order, the patient must consent to the lab work and to the release of the results to your physician. Assistance may be needed to get the patient to the designated lab. The nursing instructor or preceptor may assist with this process. Cost of the lab work will usually not be covered by the patient's insurance coverage or by the agency where the injury occurred. The student will usually be responsible for the lab costs for the patient blood draw. (The student's health insurance is usually not willing to pay for lab work for the source patient, though this may be negotiable).

    In community settings which don't have access to the STAT HIV test, you may not know the patient source HIV status for several days. In this case, you may start the PEP regimen, and then discontinue it once you know the patient's HIV status is negative.

    If the combination of the exposure code and the HIV status code for the patient indicate that post-exposure prophylaxis (PEP) is needed (i.e. treatment with anti-HIV drugs), treatment should be started within one hour of the exposure. If the exposure code and the HIV status code for the patient are low, treatment may not be indicated, but the decision should be made within one to two hours, in consultation with a physician.

  4. Seek treatment within one hour. Time is of the essence.
    • Use hospital emergency rooms or prompt care centers, which are close to you. Urgent care or prompt care type facilities may be able to get you in more quickly than a full-service ER. In Chico, Enloe Prompt Care at Bruce Road is recommended.
    • The Student Health Center cannot do the initial lab screen and does not carry the PEP drugs.
    • You may also contact your own physician, but don't delay getting treatment if you can't see your own physician within one to two hours.
    • Treatment includes drawing baseline lab values for the student (HbsAG, Hep C antibody and HIV).
    • All costs of lab work and treatment are the responsibility of the student. The institution or the agency where the exposure occurred has no responsibility to provide any testing or treatment related to the exposure. Estimated cost of PEP drugs for four weeks is about $330.

    Besides the initial lab work and decision about the need for PEP, the following is recommended:

    Tetanus:

    • If your last tetanus booster was over five years ago, get another.

    Hepatitis B:

    • If your HbsAG results indicate you are a "nonresponder" you will need a Hep B vaccine booster. You may be recommended to repeat the entire Hep B series.
    • If the source (patient) was Hep B positive or unknown, you will likely need Hep B Immune Globulin (HBIG) also.
    • If you have not yet completed the Hep B vaccine series, tell your physician where you are in the series to decide when the next booster should be given.
    • No routine follow-up after treatment for Hep. B is recommended because postexposure treatment is highly effective.
    • Report symptoms of hepatitis (yellow eyes or skin, loss of appetite, nausea, vomiting, fever, stomach or joint pain, extreme tiredness).

    Hepatitis C:

    • There is no vaccine against HCV, and no treatment after exposure that will prevent infection.
    • Obtain baseline HCV testing, and testing 4-6 months after exposure.
    • Be aware of signs and symptoms of hepatitis (see above) and report to your physician.

    HIV:

    • After baseline testing, follow-up testing should be done at 6 weeks, 12 weeks and 6 months. (Student Health Center can do the follow-up testing).
    • If you start PEP, you should be checked for drug toxicity (CBC, kidney and liver function tests) before starting treatment and two weeks after starting treatment.
    • Report sudden or severe flu-like illness, especially if you have fever, rash, muscle aches, tiredness, malaise, or swollen glands.
    • Follow recommendations for preventing transmission of HIV (don't donate blood, organs, semen; avoid sexual intercourse or take precautions; avoid breast feeding.
  5. Complete an accident form at the School of Nursing.
  6. Obtain a copy of Exposure to Blood: What Health-Care Workers Need to Know from the School of Nursing Office.

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