Microsoft word - contamination injury 7.doc

CONTAMINATION INJURY
PURPOSE
The purpose of this policy is to ensure that panel members exposed to blood and body
fluids are managed in the appropriate manner to mitigate the risk of acquiring diseases
from blood borne viruses in the workplace.
POLICY STATEMENT
Ensure an organised system to handle contamination injuries Monitor health and safety in the working environment Ensure timeous first aid and post-exposure prophylaxis Ensure that injuries are reported timeously to the commissioner RESPONSIBILITIES
Responsibilities
Apply standard precautions during the management of patients at all times Ensure that they are vaccinated against Hepatitis B Send injured panel member to INCON (if available) or emergency unit PROCEDURE
Action to be taken by panel member after exposure
Encourage free bleeding and clean injury site with water DO NOT apply caustic agents or antiseptic agents to the wound Report injury immediately to the manager of the particular department (within 20 minutes) or manager on duty for the client, if after hours Action to be taken by the manager on duty of the department
Panel member to complete Near Miss / Adverse Event report (client’s Near Miss / Adverse Event form) Client to complete Employer’s report of an Accident (W.CL. 2(E)) form (Available at hospital) Manager of department/ manager on duty must send MHR panel member to INCON (if available at hospital and during office hours) or emergency centre (after hours) Emergency centre (No INCON clinic available at client) for consultation by a doctor Emergency Centre
Panel member
pre-council the panel member for HIV testing obtain consent for withdrawal of blood for a HIV test from injured panel member Important:
Complete ‘Refusal of HIV blood testing and/or anti-retroviral prophylactic treatment’ form if panel member refuses Panel member
Implement the following steps according to outcome of test: counselling to be given by attending doctor • investigate the health status of the source patient, • assess the risk factors (see Risk Assessment table, Addendum 2) • start with post exposure prophylaxis (PEP) treatment within 1-2
hours after exposure
• The panel member needs to be informed regarding: The side-effect of the ARV’s (antiretroviral drugs) Importance of completing the full 28 day course of prophylactic treatment • obtain baseline blood tests (U&E, Creatinine, FBC, ALT, AST and • complete ‘Refusal of HIV blood testing and/or anti-retroviral prophylactic treatment’ form if panel member refuses treatment (See Addendum 1) Contact INCON Health if any other tests are required to
confirm permission for payment (See Addendum 4)
Source patient:
Inform the patient’s doctor of the incident Pre council the source patient (performed by the treating doctor or according to client policy) obtain blood for HIV, Hepatitis B and C testing after consent is obtained Note: Account will be paid by MHR
If patient refuses consent for obtaining of blood specimen, implement the following steps: investigate the health status of the source patient, assess the risk factors (see Risk Assessment table, Addendum 2) start with post exposure prophylaxis (PEP) treatment within 1-2 hours
after exposure
The panel member needs to be informed regarding: • The side-effect of the ARV’s (antiretroviral drugs) • Importance of completing the full 28 day course of prophylactic obtain baseline blood tests from panel member (U&E, Creatinine, FBC, ALT, AST and Gamma GT) complete ‘Refusal of HIV blood testing and/or anti-retroviral prophylactic treatment’ form if panel member refuses treatment (See Addendum 1) If source patient is HIV negative, implement the following steps: Consult patient’s doctor to determine possibility of source patient being in a window period Give panel member the option to decide if she/he wants to continue with Prophylactic treatment If source patient is HIV positive, implement the following steps: Consulting doctor to inform panel member and give counselling Panel member to continue with prophylactic treatment • The panel member needs to be informed regarding: The side-effect of the ARV’s (antiretroviral drugs) Importance of completing the full 28 day course of prophylactic treatment Doctor to inform source patient regarding outcome of blood results If the source patient is positive for Hepatitis B or C, blood should be drawn from the panel member for Hepatitis B and C Client to notify INCON Health of incident and send the following documentation through: Employer’s report of an Accident (W.CL.2 (E)) form Refusal of HIV testing and/or anti-retroviral prophylactic treatment form, if applicable Laboratory and pharmacy account (made out to MHR) Certified copy of Identity document of panel member Note: See Annexure 3: INCON Health Contact details
All necessary documentation will be processed by INCON Health. Clinical follow up and lab monitoring of panel member receiving treatment
(INCON)
Test injured panel member for HIV infection at 6 weeks, 3 month and 6 month after exposure. Conduct follow up FBC and U&E after two weeks if the baseline U&E was abnormal or in the event of pre-existing kidney disease. Note: The follow up testing is to establish if there is no bone marrow Conduct follow up ALT, AST and Gamma GT after 6 weeks. ASSOCIATED DOCUMENTS
Location/Number
Refusal of HIV blood testing and/or anti-retroviral REFUSAL OF HIV BLOOD TESTING AND ANTI RETROVIRAL
PROPHYLACTIC TREATMENT
Tick relevant block
1. I hereby refuse consent to have bloods drawn and tested for HIV 2. I hereby refuse to receive Anti Retroviral Prophylactic treatment I accept full responsibility for my decision and indemnify MHR against any claim of whatever nature, which may be made against them. RISK ASSESSMENT TABLE
Addendum 2
Exposure
Prophylaxis
Percutaneous
visible blood tissue or other possibly infectious fluid Membranes
visible blood or other possibly infectious fluid visible blood or other possibly infectious fluid PEP DRUG REGIMEN
Addendum 3
Exposure
PEP regimen
Lamivudine (3CT)150 mg 12 hourly (taken as Combivur®/Cipla Duovir®/Aspen Lamzid® 12 hourly Aluvia (Lopinavir 200 mg / Ritonavir 50 mg) 2 tables 12 hourly or Stocrin 600 mg once a day at night (Efarenz® / Cipla or Aspen Evavirenz®) Note: Since nausea is a common problem,
INCON HEALTH CONTACT DETAIL
ADDENDUM 4
Contact person:
Simone Bushby
E-mail address:
coid@incon.co.za
Phone number:
021 975 2694 Ext 2010
Fax number:
021 979 1797

Source: http://www.medinurse.co.za/policies/Contamination%20Injury%207.pdf