Blood and Body Fluid Exposure Incident Management Pack

Sheffield Health Community Blood and Body Fluid Exposure Incident Management Pack Sheffield Occupational Health Service NB This is a single use pack (28 pages), please check this pack is complete before use, after use replace with new pack Revised Version: November 2011

Sheffield Health Community Management procedure for the Initial Management of Blood and Body Fluid Exposure Incidents to Health Care Workers FIRST AID Inform the Nurse in Charge or Manager, who will take charge of the situatuion Nurse in Charge or Manager completes the Initial Assessment Form NO Has a significant exposure occurred? YES Complete an Incident Report Form Is the source patient known to be HIV +ve or an infectious Hepatitis B carrier or high risk for Blood Borne Virus carriage YES NO Unknown source - contact Occupational Health Contact Occupational Health immediately Medical Staff ask source patient (if known) for consent to have their blood tested for HBV, HCV & HIV Patient unable to consent How to Contact Occupational Health Weekdays 8.30-4.30 Contact Occupational Health and arrange to be seen Out of Hours Contact on call Consultant Virologist via Northern General Switchboard N.B. HCW takes the Assessment Form to Occupational Health Give information leaflet to the patient Patient Signs the Consent Form Obtain Blood Sample Contact on call Consultant Virologist Do not test patient without consent Inform Laboratory or on call Biomedical Scientist Send Blood Sample to Laboratory (See Section 5 Appendix 4) Contact on call Consultant Virologist

Sheffield Health Community Blood and Body Fluid Exposure Incident Management Pack Contents Page No 1. Blood and Body Fluid Incident Management Protocol 3 2. Initial Assessment Form (Appendix 1) 13 3. Consent Form for screening for blood borne viruses - 15 source patient (Appendix 2) Child under 16 (Appendix 2A) 17 4. Consent for blood sampling - information leaflet for 19 source patient (Appendix 3) Child under 16 (Appendix 3A) 21 5. Guidance notes for clinicians obtaining blood samples 23 from source patients (Appendix 4) Samples of completed laboratory request forms (Appendix 4A, STH, SHSC, PCT) 25 (Appendix 4B, SCH) 27 1

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SHEFFIELD HEALTH COMMUNITY PROTOCOL FOR THE MANAGEMENT OF OCCUPATIONAL BLOOD AND BODY FLUID EXPOSURE INCIDENTS This protocol sets out the steps to be taken in the event of a Health Care Worker sustaining a significant exposure to blood or other body fluids which pose a risk of infection with blood borne viruses or other infections and diseases. It sets out the procedures to be followed to ensure that risks are properly assessed and the Health Care Worker is appropriately managed. Key areas are :- (i) Immediate management of the incident : first aid (ii) Risk assessment is there a significant risk? (iii) Source patient testing procedures (iv) Management of the Health Care Worker This protocol accompanies the Trust s policies "Management of Occupational Blood and Body fluid Exposure Incidents and Administration of Post Exposure Prophylaxis" and "Local Policy for the Provision of Post Exposure Prophylaxis (PEP) for Health Care Workers occupationally exposed to HIV". The protocol sets out the actions required of the following people as follows :- (a) The Health Care Worker : first aid and reporting incident (b) The manager/supervisor/ : initial risk assessment duty matron organising source patient testing contacting Occupational Health Service completion of accident/incident form (c) Clinician responsible for source patient : source patient consent and testing Consultant : giving results of test to source patient (d) Occupational Health Service : management of Health Care Worker including : detailed risk assessment provision of PEP where appropriate follow up and support N.B. Throughout this document the term Occupational Health means either the Occupational Health Service (daytime) or the Consultant Virologists (out of hours cover). 3

1. Definition of a significant exposure to blood or body fluids The phrase "blood exposure incident" is used throughout this protocol to refer to an incident in which there is : Percutaneous exposure Mucocutaneous exposure Contact of broken skin (needlestick or other contaminated sharp object causing injury, a bite causing visible bleeding or other visible skin puncture) (splashed into the eye, mouth) (e.g. cuts, abrasions, eczema) with either or Blood or material visibly contaminated with blood Body fluids which may pose a risk of transmission of blood borne viruses if significant occupational exposure occurs :- Amniotic fluid Cerebrospinal fluid Human breast milk Semen Vaginal secretions Pericardial fluid Pleural fluid Peritoneal fluid Saliva in association with dentistry (even if not visibly blood stained) Synovial fluid Unfixed human tissues and organs Exudative or other tissue fluid from burns or skin lesions These are significant exposures with a potential for occupational transmission of blood borne virus infection. Other exposures e.g. blood splashes onto intact skin do not pose a risk of transmission. 2. Immediate Action by Healthcare Worker 2.1 First Aid Following a blood exposure incident, the Health Care Worker should quickly : For a wound Encourage bleeding by gently squeezing the site Wash the wound in warm running water with soap. Dry and apply a waterproof dressing 4

For a splash in the eye Irrigate the eye copiously with water before and after removing contact lens if worn. For splash in the mouth Irrigate thoroughly with drinking water for at least five minutes, without swallowing this water. 2.2 Report the incident to the manager/supervisor immediately 2.3 Source patients in primary care, outpatients, A & E etc should be asked to remain in the department/clinic/surgery until the initial assessment and any blood sampling are completed. 3. Action by Manager/Supervisor The manager/supervisor or person in charge of the area where the incident occurred will:- (i) (ii) Check that appropriate first aid has been applied. Complete the initial assessment form (Appendix 1) to determine whether or not a significant blood exposure incident has occurred. If a significant exposure has not occurred, e.g. the incident is a clean sharp injury, no further action, except completion of an incident report form, is required. (iii) If a significant exposure has occurred, ask a clinician with current responsibility for the patient to complete Section 2 and to obtain a sample of blood from the patient for testing for blood borne viruses using the appropriate consent form see Appendix 2) If the patient is known to be HIV positive, do not wait for further information, contact Occupational Health immediately. (iv) Once Section 2 of the form is completed and a blood sample from the source patient has been taken, the manager/supervisor should contact Occupational Health who will complete a detailed risk assessment and advise on follow up. The manager/supervisor will need to have full details of the incident, including the completed assessment form, and the health care worker s details including contact information for Occupational Health if the person is not present. If obtaining the blood sample may be delayed, or if the patient refuses consent or cannot give consent for testing, contact Occupational Health. The initial assessment form should then be placed in an envelope marked "Occupational health Confidential" and the manager/supervisor should ensure that it is delivered promptly to the Occupational Health Department, which may be done by the HCW. If the source patient is unknown, inform Occupational Health of the incident now. 5

4. Action by Clinician responsible for the Source Patient Once the manager/supervisor has identified that a significant exposure has occurred, the clinician responsible for the source patient will : (i) (ii) (a) Complete section 2 of the initial assessment form to identify any known risks of BBV transmission Obtain the source patient s consent for blood testing for HIV, Hepatitis B and Hepatitis C. Obtaining Consent and Blood Sample from the Source Patient The clinician obtaining consent for blood sampling from the source patient should not be the person who sustained the blood exposure. The clinician should approach the source patient, preferably in an environment which would facilitate disclosure of risk factors, and explain that a member of staff may have been exposed to a small amount of their blood or body fluids and that, in this situation, the hospital/practice routinely seeks the patient s consent to test their blood for blood borne viruses in order to offer appropriate treatment to the HCW. An information sheet for the source patient gives the details. (Appendix 3) The clinician should not disclose the identification or identifying information of the Health Care Worker concerned. The source patient should be asked to consent to testing for blood borne viruses using the standard consent form (Appendix 2) and information sheet (Appendix 3). If the patient requires further advice which the clinician cannot give, assistance from a more senior colleague or the Consultants in Virology, Infectious Diseases or Genitourinary Medicine should be sought. If the patient requires further specialist advice on HIV testing, the hospital/ practice HIV testing counsellors or GUM health advisers should be contacted (via Forge Centre Telephone No. 0114 226 1142). If the patient refuses consent for testing, a note should be made on the assessment form which should be returned to the manager/supervisor for action. If the patient consents, a blood sample should be taken and sent to the laboratory. The consent form should be stored in the patient s notes. The blood sample required is 5-10mls of clotted blood (gold top tube) from adults. For SCH only, the sample required is 2ml clotted blood (white top tube). Appendix 5 shows how the laboratory request form should be completed. Once the blood sample has been obtained, the initial assessment form should be returned to the manager/supervisor who will then contact Occupational Health and send the form to the Occupational Health Service, usually via the HCW. The clinician should ensure that the patient s consultant is informed as soon as appropriate, as the finalised result of the source patient blood test will be given to the patient s consultant (or GP in primary care settings). 6

The request form should specify that testing for Hepatitis B, Hepatitis C, and HIV is required. If the source patient is known to be positive for one of these viruses, this information must be included in the clinical details section of the form. (b) Source Patient Testing : Special Considerations Source Patients unable to give consent The provision of the Mental Capacity Act 2005 will apply where there is doubt about the patient s capacity to consent. If the source patient is unable to give consent, i.e. is unconscious, lacks capacity to consent or has died, the Consultant Occupational Physician or the Consultant Virologist, if the Consultant Occupational Physician is unavailable, should be consulted for advice about further management. Testing without consent of the source patient, including stored blood, is illegal under the Mental Capacity Act 2005 and the Human Tissue Act 2004. Neonates Where the source patient is a neonate, the risk assessment will need to be based on the mother s risk factors for blood borne viruses If antenatal screening results are not available and if the HCW has sustained a significant injury, the mother should be asked to provide a blood sample for testing for blood borne viruses. The baby s blood will not be tested Children Children (under 16) will be tested as for adults but with the consent of the parent/guardian, and the child may consent if deemed able to give informed consent. The consent of the treating consultant paediatrician/surgeon is required before the parent/guardian is approached. Young Adults (16-18) This age group can consent to source patient testing for themselves but it may be appropriate to involve the parent/guardian in the pre-test discussion, depending on the patient s wishes. In patients over 16 years of age, the provisions of the Mental Capacity Act 2005 will apply where there is doubt about the patient s capacity to consent. Management of Refused Consent If the source patient refuses consent, no testing will be carried out, even on stored blood. Refusal to consent to source patient testing will not affect the patient s subsequent care and does not constitute evidence of infection. 7

Decisions relating to the management of the Health Care Worker in situations where source patient samples cannot be obtained will be made on the basis of available information by the Consultant Occupational Physician or Consultant Virologist. Duration of Consent The patient s consent to be tested will only apply for the specific incident for which it is obtained. If the same patient is subsequently the source of another blood exposure, advice from the Consultant Occupational Physician or Virologist should be obtained on the need for further testing. If a further test is advised, consent will need to be obtained again. 5. Arrangements for Laboratory Testing of Source Patient s Blood Sample 1) The following general principles apply: Laboratory needs to be alerted to the need for such a testing. Samples arriving in the lab without a prior alert will be deemed non-urgent irrespective of history stated on the request form Samples needing to be transported to the Northern General Hospital lab. For locations other than the Northern General Hospital, arrange a taxi through the ward/area manager to take these to NGH Microbiology (Mon-Friday 9am-5pm) or to NGH Haematology Reception (out of hours). 2) Actions required: 1. Make the alerting call (see table for details) 2. Make arrangements to transport sample (see table for details). If a taxi has to be arranged, ensure the driver knows where to drop the sample Weekdays 9am to 5pm Weekdays after 5pm, Weekends, Bank Holidays Sample to be transported to Alerting call to be made to NGH Microbiology Reception Virology registrars ext 66477 / 15870 or bleep NGH 537 NGH Haematology Reception Microbiology BMS on-call through NGH switchboard Table x : Arrangements for sample reception and alerting calls 3) Testing Schedule: a) Mon - Friday 9am to 5pm Tested immediately One extra run at 8pm Samples arriving in the laboratory after 5pm are passed to the on-call Microbiology BMS. 8

b) Weekends / Bank Holidays Two runs: 1pm and 8pm Samples received after 8pm will be tested the next day as per the testing schedule above. In the morning remember to alert the virology registrars (Monday - Friday) or on-call Microbiology BMS (Weekends/Bank Holidays) as appropriate. 4) Results: Laboratory only conveys results to Occupational Health or consultant virologist so please do not phone the laboratory for this purpose - Occupational Health Clinician or Consultant Virologist will contact the HCW directly when the result is available. If further advice on source blood sampling is needed please contact the Medical Virologist. 6. Further Action by Manager/Supervisor : Informing Occupational Health When information relating to known risks in the source patient has been gathered and a blood sample has been obtained (or refused) the manager/supervisor should contact Occupational Health as follows: During normal working hours (Monday to Friday 08.30 to 16.30) Contact the Occupational Health Service and arrange for the employee to go immediately there to be seen. The employee should take the assessment form with them. Out of Hours The Consultant Virologist on call is contacted out of hours via Northern General Switchboard. Occupational Health may want to talk to the Health Care Worker direct, but the Manager/Supervisor should make the initial call, with all relevant information to hand. If the Health Care Worker is not present, the manager/supervisor should have contact details to give to Occupational Health. If the source patient is HIV positive and on call Occupational Health advice is not available, ask the Royal Hallamshire Hospital switchboard for the on call Consultant in Genitourinary Medicine or Infectious Diseases. 9

7. Action by the Specialist Occupational Health Nurse/Occupational Physician/Consultant Virologist The Occupational Health Nurse/Physician/Consultant Virologist will complete a detailed risk assessment of the injury/incident in accordance with the internal Sheffield Occupational Health Service protocol. Further action will depend on the detailed risk assessment and may include the provision of post exposure prophylaxis for HIV or HBV, as indicated. Management of Source Patient s Blood Test Results (a) The results of the source patient s blood tests will initially be given by the laboratory service to the Occupational Health Clinician or Consultant Virologist. If any of the results are positive, the BMS will discuss this with the Consultant Virologist, who will liaise with the Occupational Health Clinician as appropriate. (b) For the Health Care Worker On receipt of the source patient s blood test results, Occupational Health will contact the Health Care Worker to inform them of the results and to advise on further action. The Health Care Worker is given this information in medical confidence: They must not disclose it to anyone else, even if the results are negative and must be particularly sensitive to the fact that the source patient will not yet be aware of the results, and will not be given those results until the laboratory has confirmed them, which may take up to three working days. (c) For the Patient Confirmatory tests by the laboratory for positive results may take up to three working days; liaison between the Consultant Occupational Physician, treating Consultant and Consultant Virologist will be needed to ensure that appropriate information is given to the patient. If the injured Health Care Worker is the source patient s consultant, it may be necessary for alternative arrangements to be made for informing the patient; this will be individually determined by the clinician and the Consultant Occupational Physician. 10

8. Action by the Clinician : Informing the Source Patient Responsibility for informing the source patient of the results of their blood tests lies with the consultant responsible for them (or their general practitioner for incidents in primary care) and should not be delegated to junior staff. The clinician informing the source patient of their blood test results will: If the result is negative Inform the patient that this is so, re-assure the patient that there are no implications for long term e.g. for insurance after a negative HIV test Ask them if they want the test recording in their notes and follow their wishes If the results are positive Inform the patient (parent/guardian) Arrange appropriate support and counselling Arrange referral for assessment and treatment (Infectious Diseases) Inform the patient s GP, subject to the patient s agreement 9. Follow up of the Health Care Worker This is the responsibility of the Occupational Health Service and will be carried out in accordance with the Sheffield Occupational Health Service internal protocol. 11

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SHEFFIELD HEALTH COMMUNITY APPENDIX 1 INITIAL ASSESSMENT OF POTENTIAL BLOOD EXPOSURE INCIDENT SECTION 1 of this form should be completed by the manager/supervisor/person in charge of the area where the incident occurred. It identifies whether or not a significant incident has occurred. Section 1 : Initial Risk Assessment NAME OF EMPLOYEE :..... D. O. B.... JOB :... LOCATION :..... DATE OF INCIDENT :. TIME :.... Has this employee sustained the following (tick boxes) Yes No Percutaneous exposure (needlestick or other contaminated sharp object causing injury, a bite causing visible bleeding or other visible skin puncture) Mucocutaneous exposure, including the eye and/or mouth Contact of broken skin, e.g. abrasions, cuts, eczema If the answers to all the questions above are NO, a significant exposure has not occurred. You will still need to complete an incident report form, e.g. for a clean sharps injury. If the answer to any of the three boxes above is YES please continue with this assessment. Was the exposure to : blood or material visibly contaminated with blood or body fluids which may pose a risk of transmission of blood borne viruses : Amniotic fluid Cerebrospinal fluid Human breast milk Semen Vaginal secretions Pericardial fluid Peritoneal fluid Pleural fluid Saliva in association with dentistry (even if notvisibly blood stained) Synovial fluid Unfixed human tissues and organs Exudative or other tissue fluid from burns or skin lesions If the answer to any of the above is yes a significant exposure has occurred. Is the source patient known? If Yes, you need to contact a clinician currently responsible for the source patient s care, who will give more information and obtain a blood sample from the source patient see section 2. Tear here If the source patient is not identified, contact Occupational Health now (see over). MANAGER/SUPERVISOR S SIGNATURE :.. NAME (Block Capitals) :. DATE :. TIME :. 13

SECTION 2 To be completed by a clinician currently responsible for the source patient if a significant blood exposure has occurred. SOURCE PATIENT NAME :.. D.O.B...... ADDRESS :..... HOSPITAL NO:. OR HOSPITAL LABEL (For GUM patient : GU number alone is sufficient) SOURCE PATIENT S CONSULTANT/GP (if primary care)..... In order to assess the risk of transmission of blood borne viruses, please identify : Is this patient known to be : Yes No HIV positive a Hepatitis B carrier Hepatitis C antibody positive If HCV antibody +ve, is the patient HCV PCR positive? Is the source patient known to have any risk factors for blood borne virus carriage? If the source patient is HIV positive or there are risk factors for blood borne viruses, please ensure that Occupational Health (see below) is contacted immediately about this incident. Please seek the patient s consent for blood testing for HIV, Hepatitis B and C using the patient information sheet and standard consent form. Source patient consent given Yes No Blood sample sent to lab Yes Time Date. (See Blood Exposure Protocol for instructions) SIGNATURE OF CLINICIAN :... NAME (Block capitals) BLEEP/EXT. NO... Thank you please give this form and the source patient consent form to the manager/supervisor or the Health Care Worker. It will be taken to the Occupational Health Service and remain confidential. Section 3 : Subsequent Action by Manager/Supervisor Your should now, either : 1. During normal working hours (Monday to Friday 08.30 to 16.30) Contact the Occupational Health Service and arrange for the employee to go there to be seen. They should take this form with them. OR 2. Out of normal working hours. Contact the on call Consultant Virologist via the Northern General switchboard. If the source patient is HIV positive and the on call Consultant Virologist is not available ask the Royal Hallamshire Hospital switchboard for the on call Consultant in Genitourinary Medicine or Infectious Diseases. 3. Ensure a Trust Incident Form is completed. AR.Incidents Form (April 2011) 14

APPENDIX 2 SHEFFIELD HEALTH COMMUNITY CONSENT FOR SCREENING FOR BLOOD BORNE VIRUSES, FOLLOWING A BLOOD EXPOSURE TO A HEALTH CARE WORKER To: DOB (YOU MAY AFFIX A HOSPITAL LABEL IF AVAILABLE) (SOURCE PATIENTS NAME) (ADDRESS) A Health Care Worker involved in your care has sustained an exposure to your blood or body fluids which may put them at risk if you are infected with Hepatitis B, Hepatitis C or HIV. In order to ensure that the Health Care Worker receives appropriate treatment, we need to test your blood to find out if you are infected with these viruses. If you have any reason to believe you may be infected with Hepatitis B, Hepatitis C or HIV, or wish to discuss the implications of having your blood tested for these conditions please ask the doctor before signing this form. The medical staff responsible for your care will discuss the risks in confidence with you, if you wish. The results of these blood tests will be given to you by the team responsible for your care. They will also be given to our Occupational Health Service to help them care for the health care worker. Your care will be unaffected whether you agree or refuse to undergo this test. I understand that I am being asked to undergo blood testing for Hepatitis B, Hepatitis C and HIV. I understand that the results of this test will be given to me and will remain confidential. I consent to my blood being tested for Hepatitis B, Hepatitis C and HIV. SIGNED DATE NAME IN CAPITALS Name of Doctor/Nurse Manager requesting consent (caps) SIGNED DATE Tear here This form should be filed in the patient s clinical record. 15

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APPENDIX 2A SHEFFIELD HEALTH COMMUNITY (USE IF PATIENT IS A CHILD UNDER 16) CONSENT FOR SCREENING FOR BLOOD BORNE VIRUSES, FOLLOWING A BLOOD EXPOSURE TO A HEALTH CARE WORKER To: DOB (YOU MAY AFFIX A HOSPITAL LABEL IF AVAILABLE) (SOURCE PATIENTS NAME) (ADDRESS) A Health Care Worker involved in your child s care has sustained an exposure to your blood or body fluids which may put them at risk if you are infected with Hepatitis B, Hepatitis C or HIV. In order to ensure that the Health Care Worker receives appropriate treatment, we need to test their blood to find out if they are infected with these viruses. If you have any reason to believe your child may be infected with Hepatitis B, Hepatitis C or HIV, or wish to discuss the implications of having their blood tested for these conditions please ask the doctor before signing this form. The medical staff responsible for your child s care will discuss the risks in confidence with you, if you wish. The results of these blood tests will be given to you by the team responsible for your child s care. They will also be given to our Occupational Health Service to help them care for the health care worker. Your child s care will be unaffected whether you agree or refuse to undergo this test. DECLARATION BY PARENT / GUARDIAN I understand that I am being asked to allow my child to undergo blood testing for Hepatitis B, Hepatitis C and HIV. I understand that the results of this test will be given to me and will remain confidential. I consent to their blood being tested for Hepatitis B, Hepatitis C and HIV. SIGNED DATE NAME IN CAPITALS RELATIONSHIP TO CHILD Name of Doctor/Nurse Manager requesting consent (caps) Tear here SIGNED This form should be filed in the patient s clinical record. DATE 17

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APPENDIX 3 Tear here nurses and counsellors available to speak to you in more depth about the implications of a positive result. Do I have to agree to give a blood sample? No, you do not have to agree to do this and whatever your decision, your care will not be affected in any way. However, please remember that it is important that you know if you have any of these viruses so that we can begin to give you the treatment you need to stay well. And of course the sooner we have the test results the better we can care for the healthcare worker who may be at risk. Sheffield Health Community Information for patients Giving consent for a blood test 19

Giving Consent for a Blood Test We would like to ask your consent to take a blood sample and have written this leaflet to explain why, and to provide you with information about what giving your consent will mean. Why do we need a blood sample? We need a blood sample from you because a healthcare worker, who has been looking after you, has been accidentally exposed to either your blood or other body fluids. By exposure we mean that the blood or body fluids of a person carrying an infection comes into contact with the blood or body fluids of someone who does not. Such exposure will put their health at risk if you have any of the following viruses: Hepatitis B Hepatitis C HIV We would like a blood sample from you so we can check whether or not you have any of the above. If you know that you do have Hepatitis B, Hepatitis C or HIV, then please tell us as soon as possible as it will enable us to act quickly to protect the health of the healthcare worker who has been exposed. We may still need to check if you have the other viruses. Am I likely to have any of these viruses? None of these viruses are common amongst Sheffield s population but it is possible to have them without knowing it or feeling ill. Hepatitis B and HIV are commonly contracted through sexual contact with an infected person, Hepatitis C through contact with the blood of an infected person. Certain people are more likely to have the viruses than others and these include: Men who have sex with men The female partners of men who have sex with men Past and present drug users who inject and share injecting equipment People who have had sex with someone from a country where HIV is more common, such as parts of Africa, Asia and Easter Europe If you are in one of these risk groups, then please tell us which of these groups applies to you. What happens if I agree to give a blood sample? If you agree, we will take some blood and test it for hepatitis B, hepatitis C and HIV. We will send the results of these tests to your consultant and to our Occupational Health service who will be caring for the healthcare worker who has been exposed. The doctor who is looking after you will give you the results of the test. What happens if the result is negative? If the test results come back negative, then your doctor will talk to you about whether you want these tests and the results recorded in your notes. If your results are negative, you do not have to tell anyone you have had the test, including insurers. What happens if the result is positive? If you do test positive for any of the viruses, then we will make sure that you receive the support, further tests, investigations and treatments that you may need. What if I am unsure about whether to give a blood sample? We understand that in agreeing to give a blood sample you are agreeing to finding out if you have Hepatitis B or C or HIV. This can be a very difficult decision to make, so if you would like more information and support this can be provided. The doctor asking for your consent will be able to answer most of your questions, and we have specialist 20

APPENDIX 3A Tear here have specialist nurses and counsellors available to speak to you in more depth about the implications of a positive result. Do I have to agree to let my child give a blood sample? No, you do not have to agree to do this and whatever your decision, your child s care will not be affected in any way. However, please remember that it is important that you know if they have any of these viruses so that we can begin to give them the treatment they need to stay well. And of course the sooner we have the test results the better we can care for the healthcare worker who may be at risk. Sheffield Health Community Information for parents/guardians Giving consent for a blood test 21

Giving Consent for a Blood Test for your child We would like to ask your consent to take a blood sample from your child and have written this leaflet to explain why, and to provide you with information about what giving your consent will mean. Why do we need a blood sample? We need a blood sample from your child because a healthcare worker, who has been looking after your child, has been accidentally exposed to either their blood or other body fluids. By exposure we mean that the blood or body fluids of a person carrying an infection comes into contact with the blood or body fluids of someone who does not. Such exposure will put their health at risk if your child has any of the following viruses: Hepatitis B Hepatitis C HIV We would like a blood sample from your child so we can check whether or not they have any of the above. If you know that your child does have Hepatitis B, Hepatitis C or HIV, then please tell us as soon as possible as it will enable us to act quickly to protect the health of the healthcare worker who has been exposed. We may still need to check if they have the other viruses. Is my child likely to have any of these viruses? None of these viruses are common amongst Sheffield s population but it is possible to have them without knowing it or feeling ill. Hepatitis B and HIV are commonly contracted through sexual contact with an infected person, Hepatitis C through contact with the blood of an infected person. Certain people are more likely to have the viruses than others and these include: Men who have sex with men The female partners of men who have sex with men Past and present drug users who inject and share injecting equipment People who have had sex with someone from a country where HIV is more common, such as parts of Africa, Asia and Easter Europe Transmission from infected mother to baby can also occur. What happens if I agree to let my child give a blood sample? If you agree, we will take some blood and test it for hepatitis B, hepatitis C and HIV. We will send the results of these tests to their consultant and to our Occupational Health service who will be caring for the healthcare worker who has been exposed. The doctor who is looking after your child will give you the results of the test. What happens if the result is negative? If the test results come back negative, then your doctor will talk to you about whether you want these tests and the results recorded in your child s notes. If their results are negative, you do not have to tell anyone they have had the test, including insurers. What happens if the result is positive? If they do test positive for any of the viruses, then we will make sure that you and they receive support and further tests, investigations and treatments that they may need. What if I am unsure about whether to give permission for my child to give a blood sample? We understand that in agreeing to this you are agreeing to finding out if your child has Hepatitis B or C or HIV. This can be a very difficult decision to make, so if you would like more information and support this can be provided. The doctor asking for your consent will be able to answer most of your questions, and we 22

APPENDIX 4 SHEFFIELD HEALTH COMMUNITY GUIDANCE NOTES FOR CLINICIANS OBTAINING BLOOD SAMPLES FROM "SOURCE PATIENTS" FOLLOWING BLOOD OR BODY FLUID EXPOSURE TO A HEALTH CARE WORKER These notes are designed to help you to understand the process of obtaining a blood sample from the source patient in this situation. Please note that this is not the procedure for obtaining consent for testing for blood borne viruses in the course of clinical investigation of a patient. 1. If a HCW has received an exposure to blood or body fluids by sharps injury, splashing etc., the manager / supervisor is required to complete an initial assessment form which identifies whether a significant incident has occurred. 2. If a significant exposure has occurred, a blood sample from the source patient is needed to check for Hepatitis B, Hepatitis C or HIV. The requesting clinician must specify all three viruses on the laboratory request form. 3. You will need to obtain the patient s consent (or consent of parent/guardian if under 16) for this blood test, using the patient information leaflet and consent form as provided. Please do not tell the patient the identity of the Health Care Worker. Please read the section in the protocol about obtaining consent, particularly if you are unsure whether the patient can give informed consent. Do not under any circumstances obtain a blood sample without the patient s consent for this purpose. (or parent/guardian if under 16) If you are the person who has had the exposure, please ask one of your colleagues to obtain the patient s consent and blood sample. 4. If you are aware that the patient is HIV positive, has been clinically diagnosed with HIV, or is a Hepatitis B carrier, please ensure that the incident is reported immediately to the Occupational Health Service. In obtaining the patient s consent (or parent/guardian if under 16), it may help you to know the following: It is important for people who are infected with HIV, HCV or HBV to know this because asymptomatic infection is possible and treatments are available for both these conditions. HIV is not the same as AIDS and many people now survive for many years with appropriate treatment. 1. The incidence of HIV, Hepatitis B and Hepatitis C in people with no risk factors is still low in Sheffield, although it is rising. 23

2. Heterosexual sex is an important route of infection with HIV in Sheffield now, especially in those who have been exposed in countries of higher incidence, such as sub-saharan Africa and some parts of Asia and Eastern Europe. 3. Blood testing of the source patient is routine in this situation; all source patients are asked to consent to blood testing. No judgements about potential risk on grounds of ethnicity, sexuality or behaviour are made. 4. Information is only disclosed to those who need to know; the Occupational Health Service and the clinicians caring for the source patient. 5. The results of the test are given immediately to the Occupational Health Service to enable them to manage the incident. The finalised laboratory report, after the test has been validated, will be sent to the patient s consultant (or GP in primary care settings) who will inform the patient. There may be a delay of up to three days between the test and finalised reports, as positive tests must be checked and validated before the patient is told. 6. The Association of British Insurers has confirmed that negative HIV tests are of no significance for insurance purposes. Modern insurance forms ask about positive tests only. Applicants for insurance do not have to disclose that they have been tested if the result is negative. 7. The result of a negative test does not need to be recorded in the patient s notes. Further Information 1. If the patient requests more information than you are able to provide, please contact the specialist HIV Health Advisors in Genitourinary Medicine or the Forge Centre team who will give more detailed advice. In the case of children under 16 further information is available from the Consultant Immunologist at Sheffield Children s Hospital (67869) or the Specialist Nurse in Immunology at Sheffield Children s Hospital. 2. If you are unsure about this procedure or have any worries about competence of the patient to consent, or what to do if the patient is unconscious or otherwise impaired, please contact the Occupational Health Service. (Occupational Health Department, NGH 14161 or RHH 13360 or NGH switchboard for the on-call Occupational Health Clinician.) Blood Sample Guidance April 2011 24

APPENDIX 4a Completion of Laboratory Request Form for Source Patient at STH, SHSC and Primary Care Bloggs Joseph Complete this section as usual, it is essential to state as a minimum, Surname, Forename, DOB, Hospital number, Consultant in charge and location of the patient Source Patient : Contamination incident If the source patient is known to be positive for HBV, HVC or HIV please state this here HIV Ab, HBsAg and HCV Ab VB 25

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APPENDIX 4b Completion of Laboratory Request Form for Source Patient at Sheffield Children s Hospital HIV Ab, HBsAg and HCV Ab VB Complete this section as usual, it is essential to state as a minimum, Surname, Forename, DOB, Hospital number, Consultant in charge and location of the patient Source Patient : Contamination incident If the source patient is known to be positive for HBV, HVC or HIV please state this here 27

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PD2990a (11/2011)