Harbor:Occupational exposure: Difference between revisions

No edit summary
No edit summary
 
(17 intermediate revisions by 6 users not shown)
Line 1: Line 1:
== Harbor Management ==
* [https://lacounty-my.sharepoint.com/personal/spouv_dhs_lacounty_gov/_layouts/15/stream.aspx?id=%2Fpersonal%2Fspouv%5Fdhs%5Flacounty%5Fgov%2FDocuments%2FBlood%20Exposure%20Presentation%2FBlood%20Exposure%20Presentation%20for%20Healthcare%20Facilities%5FHUCL Employee Health Guidance Video]
*'''Exposure during weekdays (non-holidays), from 7:00a-3:30p:'''
*'''Exposure during weekdays (non-holidays), from 7:00a-3:30p:'''
**Send employee directly to Employee Health office for evaluation
** Send employee directly to Employee Health office for evaluation unless the employee has sustained an injury that warrants ED evaluation (i.e. laceration)
***Except if employee has sustained injury that warrants ED evaluation (i.e. laceration)
**Goal time from exposure to Employee Health office < 15 minutes
**Goal time from exposure to Employee Health office < 15 minutes
**Have provider for source patient call Employee Health at '''x2360'''
***Gives NP in Employee Health a contact in case of labs need to be drawn on source patient
**Do not draw any labs on source patient, unless asked to do so by the NP in Employee Health
*'''Exposure during all other times:'''
*'''Exposure during all other times:'''
**Employee with potential blood-borne pathogen exposure should be evaluated in ED
** Employee with potential blood-borne pathogen exposure should be evaluated in ED
**Obtain '''OCCUPATIONAL EXPOSURES-ED''' form (see below)
*** Charge RN has the exposure packet (needs to be filled out to avoid employee getting the bill)
**Use form to guide you in assessment of risk and need for testing
*** Use autotext '''.edexposure''' for documentation template and guidance text on when to consult HIV service
**If exposure warrants rapid HIV test on the source patient, then must give source patient opportunity to opt out of HIV test
***'''Source patient''': Orchid '''Blood or Body Fluid Exposure - Source Patient''' order set includes:
**Only contact HIV service if:
**** HIV Antibody/antigen screen
***Source patient has capacity and opts out OR
**** Hepatitis B Surface Antigen
***Source patient lacks capacity
**** HCV Quantitative Dx Assay
**Check Affinity for recent (weeks or months) HIV results on source patient
**** Consent not needed if lab already has blood sample to add on test
*'''When to call HIV service:'''
***** '''If source patient refuses HIV, it can be added on to a pre-existing blood specimen but the results may not be shared with the patient''' (HIV=gold top ... as is chem, LFT, TSH)
**Must fill out form and present exposure case to ED attending prior to contacting HIV service
***'''Employee'''
**If source patient is HIV+ AND exposure has potential to transmit HIV
**** Ensure employee has Hep B vaccine
***HIV+ either by history or if rapid HIV is positive at time of exposure
**** '''no blood testing of the employee in the ED''' for privacy reasons
**Source patient lacks capacity OR chooses to opt out of HIV test
***'''Call HIV service if the source patient's Rapid HIV is positive or is untestable''' AND was a clinically meaningful exposure (see occupational exposure template https://www.wikem.org/wiki/Harbor:_Macros_and_Autotext#Occupational_Exposure)
***Only HIV service has authority to approve testing in these situations
***If HIV Service recommends PEP, ED will prescribe initial prescription and the patient will follow-up at Employee Health the next day; '''first dose can be given in the ED'''
**** PEP must be prescribed to the Harbor Pharmacy to avoid generating a bill for the employee(patient)
*Message Jeremy Ramon at Employee Health after any exposure to ensure follow-up
*Additional info in "INDUSTRIAL ACCIDENTS" section below


== Resident Duties ==
*Obtain details of exposure
*Obtain details of source patient
**Name, MRN, Diagnosis
**Prior HIV results in past year?
**'''If source patient known to be HIV+ contact HIV service immediately''' ('''pager 310-501-4260''')
*Order Rapid HIV test on source patient if:
**'''Percutaneous injury''' occured via needle, scalpel, or other sharp object '''that has been in contact with source patient's blood, body fluid, or tissue'''
**'''Mucosal splash''' to eyes, mouth, or into nose involving blood or other body fluid
*Rapid HIV test not indicated on source patient if:
**Blood or body fluid came into contact with employee's intact skin
**Employee exposure involved patient's '''saliva, urine''' (unless visible blood is present in saliva or urine)
**Employee exposure to needle, scalpel or other sharp object that had '''NOT been in contact with patient's blood, body fluid, or tissue'''
*Ordering rapid HIV on source patient:
**Place rapid HIV order in source patient's chart
**VERIFY rapid HIV correctly ordered by clerk in the computer (NOT HIV Elisa)
**Notify Blood bank that specimen for rapid HIV is forthcoming '''(x2252)'''
**Check results 1 hour after blood has arrived in blood bank
**FAX filled out form to Employee Health at '''310-222-5326'''
[[File:OE harbor2.jpeg|thumb|Occupational Exposure form p.1]]
[[File:OE harbor1.jpeg|thumb|Occupational Exposure form p.2]]


==See Also==
==See Also==
*[[Harbor:Main]]
*[[Harbor:Main]]
*[[Harbor:Occupational exposure (dot-phrases)]]
*[[Occupational Exposure]]
*[[Occupational Exposure]]
*[[HIV Prophylaxis (Occupational)]]
*[[HIV Prophylaxis (Occupational)]]

Latest revision as of 19:45, 24 September 2025

  • Employee Health Guidance Video
  • Exposure during weekdays (non-holidays), from 7:00a-3:30p:
    • Send employee directly to Employee Health office for evaluation unless the employee has sustained an injury that warrants ED evaluation (i.e. laceration)
    • Goal time from exposure to Employee Health office < 15 minutes
  • Exposure during all other times:
    • Employee with potential blood-borne pathogen exposure should be evaluated in ED
      • Charge RN has the exposure packet (needs to be filled out to avoid employee getting the bill)
      • Use autotext .edexposure for documentation template and guidance text on when to consult HIV service
      • Source patient: Orchid Blood or Body Fluid Exposure - Source Patient order set includes:
        • HIV Antibody/antigen screen
        • Hepatitis B Surface Antigen
        • HCV Quantitative Dx Assay
        • Consent not needed if lab already has blood sample to add on test
          • If source patient refuses HIV, it can be added on to a pre-existing blood specimen but the results may not be shared with the patient (HIV=gold top ... as is chem, LFT, TSH)
      • Employee
        • Ensure employee has Hep B vaccine
        • no blood testing of the employee in the ED for privacy reasons
      • Call HIV service if the source patient's Rapid HIV is positive or is untestable AND was a clinically meaningful exposure (see occupational exposure template https://www.wikem.org/wiki/Harbor:_Macros_and_Autotext#Occupational_Exposure)
      • If HIV Service recommends PEP, ED will prescribe initial prescription and the patient will follow-up at Employee Health the next day; first dose can be given in the ED
        • PEP must be prescribed to the Harbor Pharmacy to avoid generating a bill for the employee(patient)
  • Message Jeremy Ramon at Employee Health after any exposure to ensure follow-up
  • Additional info in "INDUSTRIAL ACCIDENTS" section below


See Also

References

HUCLA

Retrieved from "https://www.wikem.org/w/index.php?title=Harbor:Occupational_exposure&oldid=378037"