Delaware County Medicine & Health Winter 2017 - 18

!
p
l
e
H
FEATURE

T

I Just Got Stuck
with a Needle

By Jill Brooks, MD, CHCO, First Healthcare Compliance

his is a phrase no one ever wants to hear,
especially in a healthcare setting. When a
distraught employee comes to you with a
needle stick injury, what should you do as the
employer? First and foremost, remain calm, which will
alleviate some of the overwhelming anxiety your employee
is already experiencing, and follow these simple steps:

Treat The Exposure Site Immediately
Document Exposure Incident on Exposure Incident Form.
The form should include details of the exposure incident such
as type, route, and location of exposure along with relevant
vaccination history of the employee and any protective controls
that are in place (personal protective equipment or safer needle
devices).
Obtain Exposure Source status, if possible
Infectivity status of the source individual should be determined
immediately, if possible. Don't wait until an exposure incident
occurs in your facility to find out if consent is required by your
state laws to test the source individual. If the source status is
already known, this might avoid unnecessary testing and need
for consent. Any relevant source status data should be included on the Exposure Incident form, however the exposed employee must be reminded of the confidentiality of the source's
protected health information.
Obtain Immediate Medical Treatment
by a Licensed Healthcare Provider (HCP)
Evaluation by a licensed HCP should be provided at no cost to
the employee and without delay. The employer should provide
a letter to the HCP with a copy of the Exposure Incident form
and any other relevant medical information. Accompanying
the letter should be a copy of the Bloodborne Pathogen Standard which outlines the requirement for obtaining a written
opinion from the HCP, which must be provided to the employee within 15 days.
Follow-up
Depending on the HCP's assessment of the exposure, post -
exposure prophylaxis (PEP) may or may not be initiated. It is

16 DELAWARE COUNTY MEDICINE & HEALTH

winter 2017

the employer's responsibility to provide the employee with the
HCP's written opinion within 15 days of the evaluation. Additional follow-up should include counseling for the employee
regarding: any possible ramifications of the exposure; reporting any possible exposure related illnesses or symptoms that
may occur; and using any necessary protections for prevention
of exposure to others. Appropriate OSHA Injury and Illness
forms should be completed by the employer and submitted
according to the newly revised OSHA Recordkeeping and
Reporting Requirements.
What is the Risk from a Needle Stick?
Risk of transmission of infection due to a needle stick depends
on many factors: viral load, length of time of the exposure,
depth of the injury, use of a hollow-bore needle, type of fluid,
presence of visible blood, and the type of bloodborne pathogen involved. The most common bloodborne pathogens are
Hepatitis B Virus (HBV), Human Immunodeficiency Virus,
(HIV) and Hepatitis C Virus (HCV). Fluids that are considered at risk of transmission include blood or bloody fluid and
other potentially infectious materials (OPIM) such as cerebrospinal, synovial, pleural, peritoneal, pericardial or amniotic
fluid, semen or vaginal secretions. Body fluids such as urine,
saliva, sputum, stool, emesis, nasal secretions, tears or sweat
unless visibly contaminated with blood are not considered at
risk for BBP transmission. HIV and HBV have a much higher
risk of transmission from an occupational exposure compared
to HCV.
When is Post Exposure Prophylaxis
indicated?
Hepatitis B Virus (HBV)
Fortunately, the vast majority of healthcare workers (HCWs)
at risk of occupational exposure have a first line of defense
against Hepatitis B virus (HBV). Due to OSHA's Bloodborne
Pathogen Standard mandate, healthcare employers were required to offer the Hepatitis B vaccine series to all employees at
risk of exposure beginning in 1991. Although this offer for the
vaccine is a requirement, the acceptance of the vaccine is not.
There are HCWs who decline the vaccine and others who receive the vaccine but mount an inadequate antibody response



Table of Contents for the Digital Edition of Delaware County Medicine & Health Winter 2017

Delaware County Medicine & Health Winter 2017 - 1
Delaware County Medicine & Health Winter 2017 - 2
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Delaware County Medicine & Health Winter 2017 - 24
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