ACTION AFTER POSSIBLE EXPOSURE TO BLOOD BORNE VIRUSES

Transcription

1 CONTROLLED DOCUMENT DO NOT COPY ACTION AFTER POSSIBLE EXPOSURE TO BLOOD BORNE VIRUSES REFERENCE NO: [OHS-PRO-1-C REV001.2] CREATED/ REVISED: May 2012/July 2013 REPLACES: Version No 1.1 Dated May 2012 VALID UNTIL: 5 years from approval date (unless superseded) Prepared by: Date Occupational Health Practitioner Newcastle University X J T Craggs Date Occupational Health Physician Newcastle University X Dr F C Pickering Occupational Physician Page 1 of 11

2 Contents ACTION AFTER EXPOSURE TO POSSIBLE INFECTION WITH BLOOD-BORNE VIRUSES (BBV)... Error! Bookmark not defined. 1. Scope Procedure Potential sources of infection with BBV include: Immediate action in the event of possible contamination with BBV Assessment of risk of BBV Action by Occupational Health Staff Workers with Hepatitis B Workers with HIV Workers with Hepatitis C Virus Follow up action Counselling Blood/Body Fluid Contamination Form Testing For Hepatitis B, Hepatitis C and HIV Status Action Card for Hepatitis C Page 2 of 11

3 1. Scope This procedure is applicable to any workers exposed to Blood Borne Viruses (BBV). 2. Procedure 2.1 Potential sources of infection with BBV include: Sharps injury involving blood or body fluids Significant contamination of wounds or broken skin with blood or body fluids Significant contamination of mucous membranes with blood or body fluids 2.2 Immediate action in the event of possible contamination with BBV Wash off splashes on the skin with soap and running water Encourage bleeding if the skin has been broken Wash out splashes in the eye, nose or mouth using fresh running water Record the source of the contamination (name/type of fluid/type of injury) Report the incident immediately to the occupational health department for completion of the Blood/Body Fluid Contamination form and accident report form Further report the incident using the university incident reporting form 2.3 Assessment of risk of BBV The level of risk will be assessed by the Occupational Health department type of body fluid source subject (if known) extent of injury are all skin layers breached level of contamination type of sharp causing injury possibility of injection of fluid test status of source blood untested tested negative tested positive vaccination history of injured person 2.4 Action by Occupational Health Staff Page 3 of 11

4 Occupational Health will request the injured party s consent to take a blood specimen for storage to test for evidence for pre-existing infection (as a baseline). Samples will be stored at the Freeman hospital for a period of up to 2 years. 3. Workers with Hepatitis B If risk assessment indicates a risk of Hepatitis B infection in an unvaccinated subject, Occupational Health will arrange for passive immunisation treatment with high titre immunoglobulin followed by active immunisation. Additionally Occupational Health will arrange for counselling as required 4. Workers with HIV If risk assessment indicates a risk of HIV, Occupational Health will refer workers for consideration of AZT therapy. Additionally Occupational Health will arrange for counselling as required 5. Workers with Hepatitis C Virus Where a risk assessment indicates a risk of exposure to Hepatitis C virus the following action is required. Baseline Serum (clotted) sample collected for storage for 2 years 6 weeks: EDTA blood obtained for HCV RNA by PCR analysis. If PCR test is positive for HCV RNA Occupational health will immediately refer the employee to Viral Hepatitis Service at Freeman Hospital to either Dr. MacPherson, Dr Schmidt or Dr Price (tel ) for anti-viral treatment which can cure >90% in the acute phase. Occupational health will inform the employees G.P of this referral 12 weeks: EDTA blood obtained for HCV RNA by PCR analysis AND serum (clotted blood) for HCV antibodies. 24 weeks: Clotted blood collected and analysed for HCV antibodies 12 weeks: EDTA blood for HCV RNA by PCR AND serum (clotted blood) for HCV antibodies 24 weeks: Clotted blood for HCV antibodies 6. Follow up action Staff exposed to BBV should also complete the University Accident, Incident and Near Miss Reporting form ( this will enable an investigation of the incident and recommendations for future action to prevent recurrences. Page 4 of 11

5 Additionally, the Blood/Body Fluid Contamination form should be completed and returned to Occupational Health. 7. Counselling The provision of information, advice and reassurance should be made available to any employee who reports a risk of BBV infection. Counselling may include encouragement of submission to testing for HIV, HBV and/or HCV infection and advice about treatments. Pre-test counselling should reflect the importance of the test procedure and the implications of the results. Counselling after the tests should provide the necessary support. Where local sites do not have the facilities to provide a trained counsellor provision should be made to refer persons at risk to a local specialist unit. (Updated May 2013 version2) Page 5 of 11

6 8. Blood/Body Fluid Contamination Form Subject Name Site Department Position Vaccination status for hepatitis B Incident Location Date Details of incident - level of contamination/agent causing injury/nature of incident Type of body fluid Source subject reference code Type of source subject - healthy volunteer/clinical trial subject/patient Test status of source blood Hepatitis B HIV Assessment of infection risk Action Accident report form completed? Baseline blood sample taken from subject (note where stored)? Immunisation of subject against Hepatitis B (passive or active) required? Arrangements for counselling Person completing the form Page 6 of 11

7 Signed Dated Page 7 of 11

8 9. Testing For Hepatitis B, Hepatitis C and HIV Status Following you recent incident involving contamination with potentially infected blood you have been advised to undergo screening for blood-borne viruses Testing will be undertaken for the following viruses Hepatitis B Hepatitis C HIV Hepatitis B and Hepatitis C are virus liver diseases transmitted by infected blood, injections or by sexual contact. Carriers of the virus are not normally adversely affected with regard to their health. HIV virus is responsible for the acquired immune deficiency syndrome more commonly known as AIDS This test is required to protect the people handling your blood from possible infection You should understand the implications of these tests before being asked to sign the consent form If any of these tests are positive you will be referred to a specialist in the management of infectious diseases for advice on the management of the condition The presence of HIV infection or Hepatitis carrier status may affect Life Insurance Policies The presence of blood borne virus infection may affect your ability to undertake clinical medical work which involves exposure prone procedures You are therefore asked to give your specific consent before we can send your blood sample for testing for Hepatitis B/C and HIV I have read the above information and agree to the testing of a blood sample for Hepatitis B/C and HIV Name: Signed and dated: Witness and dated: Page 8 of 11

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10 10. Action Card for Hepatitis C Occupational Health & Safety Service Health Guidance Card Working with ACDP Hazard Group 3 Blood-borne Pathogen Hepatitis C virus (HCV) Name: Work Location: Address: D.O.B.: The above named individual is working with HCV. Accidental exposure to this pathogen can result from a sharps / needle-stick injury and cause infection. If the individual presents with any of the following symptoms a clinical diagnosis of HCV infection should be considered. Symptoms of acute (early) HCV infection: >70% have no symptoms <30% may develop acute Hepatitis with lethargy, myalgia (aching muscles) and jaundice Symptoms of late HCV infection: Usually asymptomatic, but may have fatigue, lethargy and persistently abnormal liver function tests. After acute HCV exposure ~25% will resolve spontaneously but chronic infection results in the majority. Early treatment can cure > 90%, therefore it is important to report any needle-stick injury to occupational health and request immediate referral to the Newcastle upon Tyne Hospitals NHS Trust Viral Hepatitis Service (led by Prof Bassendine, Freeman Hospital) for monitoring and early treatment if it is confirmed that HCV has been transmitted. For further information or guidance please contact: 1. Maggie Bassendine, Principal Investigator (Primary Contact) or Dr Stuart McPherson, Consultant Hepatologist : via Freeman Hospital Steven Darby, Biological Safety Officer, Newcastle University: Page 10 of 11

11 3. Janice Craggs, Occupational Health Practitioner, Newcastle University: On Call Registrar in Infectious Diseases, Royal Victoria Infirmary: Health Protection Agency: Tel: Page 11 of 11