If you have a needlestick or splash injury while at work at any site here are the instructions for what to do. These directions apply regardless of whether you are injuried a TCH site or offsite (say at Crossroad or another hospital). You still report and have testing done for offsite injuries through TCH (FM) or UCMC (FMP).
Steps After Injury for straight Family Medicine Residents:
1. Stop what you are doing IMMEDIATELY.Thoroughly wash the area with soap and water. If there is a break in the skin or wound, you should apply some alcohol, chlorhex or other virucidal agent. If your eyes or mucosa are exposed, you should flush with copious water. Tell the patient what has happened. If you are on a resident team, you should tell your senior resident. The supervising faculty should also be notified. Do not wait until morning, call now. After you do the above, you need to perform each of the following steps right away, but you do not need to rush.
2. Report injury to TCH Injury Hotline open 24/7 by calling 1-866-665-2917. They will take down your information and have you give a recorded verbal injury report quickly summarizing what happened. While on the phone, clarify who will place the order for the lab test: them or one of the medical team. (see below)
3. Obtain the TCH Needlestick Packet. These are available in the main hospital lab on C level or you can download it here. This packet has all the required accident reports, lab orders, HIV consents & list of recommended precautions
4. If possible, have another member of the medical team inform pt of injury. When you speak to the hotline above, clarify who will enter the orders for the lab testing. The following labs should be ordered STAT on the patient: HBsAg, Anti-HBs Quant, Anti-HBc, HCVAb, LFTs. Inform the patient’s nurse of what has happened as well and s/he will no doubt expedite the blood draw as much as possible. If the patient refuses a blood draw, call Nursing Supervisor at 513-585-1047 and notify the lab that consent was not obtained. If the patient is offsite ask Injury Hotline (again 866-665-2917) for instructions for how to get patient's blood tested.
5. Go to TCH Hospital Patient Registration. If you do not know how to get there, go to the ER and a member of the TCH staff can show you how to get to registration. Take your packet with you. You should also take the patient information from the source patient if available (grab a sticker off their chart if you are at TCH). You will have to register with the hospital in order to get your bloodwork done.
6. Go to the TCH Main Hospital Lab on Level C. Take your packet and information from Registration and give the lab order form to the technician who will draw your blood (usually HIV, your antiHBV sAg titers, HCV & LFTs). They recommend you stay at the hospital for 2 hours after your labs are done as you should receive a call with Rapid HIV results within this time in order to start post-exposure prophylaxis if needed.
7. Complete Employee Accident Report. This is a paper that is part of the packet. This has to be done and turned into Employee Health/Disability Management (2nd Floor of TCH MOB; P: 513-585-4555; F: 513-585-4856) within 24 hours of injury. They will then send a copy to Dr. Bernheisel for him to review and sign.
8. Complete Bloodborne Pathogen Report. This paper is also part of the packet. This is very similar to Employee Accident Report and also needs to be turned into Disability Management within 24 hours.
9.The injury line will notify you of Rapid HIV testing results within 2 hours. Employee Health/Disability Management will communicate to you the remaining test results within 2-3 business days. . They will instruct you on any further testing that is needed. If source patient's labs are negative they will most likely offer you a 6 month follow-up HIV testing with no other testing required.
10. If your source patient is HIV positive, the Point of Injury line will direct you to the emergency roomto discuss postexposure prophylaxis. Employee Health/Disability Management will follow up with you with respect to follow up testing/prophylaxis for HCV and HBV.
11. If you have concerns at any point in the process, you are within your rights to ask employee health to cover a visit to an Infectious Disease specialist or other specialist who can ensure the appropriate steps are being taken. If you have immediate questions, you can call the national exposure hotline: PEPline (888-448-4911), open daily 9a-2a EST.
Steps After Injury for Family Medicine Psychiatry Residents:
1. Stop what you are doing IMMEDIATELY.
Thoroughly wash the area with soap and water. If there is a break in the skin or wound, you should apply some alcohol, chlorhex or other virucidal agent. If your eyes or mucosa are exposed, you should flush with copious water. Tell the patient what has happened. If you are on a resident team, you should tell your senior resident. The supervising faculty should also be notified. Do not wait until morning, call now. After you do the above, you need to perform each of the following steps right away, but you do not need to rush.
2. Report injury to UC Employee Injury Hotline by calling 513-585-8000
If you are at UCMC: The hotline will instruct you to call 584-3700 and select option #2 and ask for a blue packet to be tubed to you. The packet is 7 pages long and will include the forms for obtaining your blood along with forms for collecting the patients blood for initial testing.
If you are at an outpatient site: The hot line will instruct you on how to obtain the blue packet and instruct you on where and how to obtain the necessary blood collections.
If you are at an outside hospital from UCMC (for example: The Christ Hospital): The hot line will instruct you to use the protocol for that hospital to begin the process of collecting your blood and the patients blood, but all follow-up on the labs will be through UCHealth. The Hotline will also follow up on the results from the outside hospital.
3. Complete a UCHealth Accident Report
Complete this form no matter where the event occurred.
4. If your source patient is HIV, HCV or HBV positive, you should call the national exposure hotline: PEPline (888-448-4911), which is open daily from 9 am – 2 am EST. For an HCV+ source patient, they will guide you on the testing you should receive, as there is no postexposure prophylaxis. For an HIV or HBV positive source patient, they will guide you on the postexposure prophylaxis you should/could pursue and testing you should receive.
5. If you have concerns at any point in the process, you are within your rights to ask employee health to cover a visit to an Infectious Disease specialist or other specialist who can ensure the appropriate steps are being taken.