Labour Broker, Payroll Administrator & Nursing Agency
P O Box 74028, Lynnwood Ridge, 0040 Tel (012) 804 8039 Fax (012) 804 4862
POLICY: PROCEDURES TO FOLLOW IN EVENT OF HEALTH CARE WORKERS EXPOSED TO BLOOD & BLOOD STAINED BODY FLUIDS Background:
The Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) are serious public health
threats and Skills Hire is committed to encouraging an informed and educated response to issues
and questions concerning these infections.
HIV is transmitted much less readily than HBV. Health workers frequently have to deal with
patients’ blood and other body fluids, and risk HIV & Hepatitis infection when they are
• needle-stick injuries (pricking yourself with a used needle)
• cutting yourself with sharp objects contaminated with body fluids
• exposure of non-intact skin to blood or body fluids
• splashes of body fluid into your eyes or mouth.
It is very important to start post exposure prophylactic treatment within 6 hours of injury. If not
done, it is still valuable to start up to approximately 24 hours after the injury.
How to Protect yourself:
• Wash your hands thoroughly with soap and water before and after
contact with patients, and immediately after touching body fluids.
• Wear gloves when touching broken skin, mucous membranes, body
fluids and instruments that have been in contact with body fluids.
• For examinations and cleaning, use clean gloves.
• For surgery and deliveries, use sterile gloves.
• Change gloves after each patient contact. If sterile gloves are washed
and re-sterilised for re-use, invisible tears can occur, so wear two pairs for procedures involving contact with body fluids.
• Don’t eat, drink or put anything in your mouth that might have
• Wear a mask if there is a chance of body fluids splashing into your
• Wear protective glasses if there is a chance of body fluids splashing
• Wear a plastic apron or gown during procedures where body fluids
• Remove dirty clothes and linen as soon as possible and place them in
• Clean up spilt blood immediately and wipe the surface with
• Use paper towels, then place these in a disposal bag for incineration.
• De-contaminated and sterilise instruments immediately after use. De-
contaminate instruments in disinfectant solution such as Jik.
• Wipe surfaces with disinfectant (e.g. Biocide, Milton or Jik mixed 2:1
with water) after each examination or procedure and before the next.
• Contaminated waste, like used swabs, should be disposed of safely
• Put used disposable needles immediately in a container for “sharps”
• Don’t re-sheath (cap) needles. When “sharps” containers are full, close
them securely and dispose of them. Never re-use a sharps container.
• Put re-usable needles in de-contamination solution immediately after
• Place laboratory specimens in a leak-proof container.
• Once used, keep the sharp end of needles or blades pointing away
from you, but be careful not to stick anyone.
SKILLS HIRE (PTY) LTD PROCEDURE WHEN ACCIDENTALLY EXPOSED TO: Needle stick injury:
1. Encourage bleeding from a wound caused by sharp objects by applying pressure to the
2. Wash it with soap and running water for two minutes.
4. Report incident immediately to Person in Charge of unit.
6. Proceed to the area where prophylactic treatment may be administered (Trauma Unit). 7. The following will take place immediately:
• Filling in forms requesting relevant testing
• Receiving an appropriate supply of antiviral tablets (HIV prophylactic
AZT AND 3TC must be administered if the source person is positive.
Nothing if the source person is negative
Give AZT only, if the source person is unknown.
(Skills Hire prefers to regard the source person as positive until shown to be negative, and hence recommends AZT and 3TC is given.) 8. The following will take place the next day:
• Filling in forms requesting relevant testing
Baseline testing is done to determine the HIV status of the injured
If your baseline indicates that you were already HIV positive prior
to the incident, no prophylactic treatment will be given since
If you refuse to undergo baseline testing, no prophylactic
treatment will be given as the responsibility for and the expense of the treatment can only be justified if baseline testing objectives
indicates HIV negative status prior to the incident.
• Receiving an appropriate supply of AZT tablets with your informed consent
(one month if source person is unknown and with the inclusion of 1 month of 3TC if source person is known to be HIV positive).
You will be expected to undergo pre-test counseling, filling in request forms requesting relevant
testing, undergoing testing and return to receive results. Non-compliance will result in Skills Hire not being accountable for the costs incurred.
9. Follow up the source person (being tested) by ensuring your Line Manager contacts the
Person in Charge of the source person who makes the necessary arrangements for:
Responsibility of the person in charge of the source person
• To attempt to persuade the source person to make themselves available for:
Testing for HIV, Hepatitis B & C and Syphyllis (VDRL)
• If the HIV status of the source person found to be HIV positive, treatment will not be
administered to the source person. Post test counseling procedures will be followed.
• The blood results of the source person will determine if the exposed person’s treatment will
The results of the test should remain confidential to the source person, the tester and the medical personnel involved in the process. Thereafter:
• If the source person’s results are HIV positive, ensure one month supply of AZT tablets are
administered and include one month supply of 3TC in the treatment for the exposed
• If the source person is unknown, administer AZT and 3TC for one month.
• If the source person is HIV negative, discontinue treatment.
• If the source person’s results are Hepatitis B positive, proceed with Hepatitis B
immunization and possible immunoglobulin and other relevant treatment as well as counseling of the exposed person.
• If the source person’s results are Hepatitis C positive, proceed with counseling the the
exposed person and refer to their preferred health care provider.
• If the source person’s results are VDRL positive, proceed with relevant treatment and
Syphyllis (VDRL) – 6 weeks and 3 months
AZT safety monitoring – 2 weeks, 1 month
Arrange for follow up on appropriate changes to treatment depending on results of the above.
The Hospital must notify Skills Hire of the incident, together with the following documentation
Employer’s report of an accident (W.CL.2 (E)
SKILLS HIRE (PTY) LTD NEEDLESTICK INJURY PROTOCOL
Should an employee of Skills Hire sustain a needle stick or any related injury whilst on duty, please ensure that the following is adhered to:
CLIENT/HOSPITAL POLICY STATEMENT
DOCUMENTATION TO BE COMPLETED
Employer's report of an Accident (W.CL.2 (E))
Checklist for Sharps Injury/Exposure to Blood/Body Fluids Form.
Consent to Anti Retroviral Prophylaxis Treatment Form.
Anti Retroviral Prophylactic Schedule Form.
Refusal of Treatment Form (If necessary)
Prescription for Anti Retroviral Medication.
SKILLS HIRE (PTY) LTD INCIDENT REPORT FOLLOWING OCCUPATIONAL EXPOSURE TO BODILY FLUIDS SKILLS HIRE (PTY) LTD CHECKLIST FOR SHARPS INJURY/EXPOSURE TO BLOOD/BODY FLUIDS
2 Incident reported to Sister in charge of the Ward?
3 Incident reported to Sister in charge of the Hospital?
4 Casualty File been opened in employee's personal name?
6 Has the employee signed consent for HIV testing?
7 Have bloods been drawn from the employee for HIV and Hep B?
8 Have other baseline bloods been drawn as specified in the Anti Retroviral Schedule.
9 Has the patient's private doctor been informed of the incident?
10 Has the patient's doctor deemed it necessary for the patient's blood to be drawn and
11 Has the patient consented to blood being drawn and tested?
12 If the employee refuses to have bloods drawn or to commence the starter pack, has
the Indemnity form been completed and signed?
13 Has a prescription for Anti Retroviral drugs been issued? (Copy to be retained for
14 Has the doctor prescribing the Anti Retroviral Drugs given the employee the relevant
information regarding the medication and follow up treatment and consultations?
15 Has the Anti-Retroviral Prophylactic Schedule been filled in?
16 Has The employee been instructed to complete the entire course of Anti Retroviral
Has the "EMPLOYER'S REPORT OF AN ACCIDENT" (W.CL.2 (E)) form been
18 completed and filed in the Skills Hire WCA file?
19 Has the Skills Hire office been notified of the incident? EMPLOYEE AT RISK NURSING MANAGER
SKILLS HIRE (PTY) LTD CONSENT TO ANTI RETROVIRAL PROPHYLAXIS AGAINST HIV SEROCONVERSION FOLLOWING OCCUPATIONAL EXPOSURE TO BODY FLUIDS
I understand that the efficiency and long term toxicity of Zidovudine (AZT/Retrovir), 3 TC
(Lamivudine) and Indinavir (Crxivan) are unknown and Indemnify Skills Hire against any
claim of whatever nature which may be made against them related to the Prophylaxis.
I wish and consent to receive the following Anti Retroviral Prophylaxis against
seroconversion to positive human immune deficiency viral antibody status:
I consent to the necessary blood investigations required during the prophylactic regime.
I undertake to complete the full course of Prophylaxis, the side effects of which have been
explained to me, unless this is counter-indicated by medical opinion.
I accept full responsibility for continuing with the treatment and follow up.
SKILLS HIRE (PTY) LTD ANTI RETROVIRAL PROPHYLACTIC SCHEDULE
RESPONSIBLE FOR SUPERVISING PROPHYLAXIS:
DATE SIGNATURE OF PROPHYLAXIS SUPERVISOR SKILLS HIRE (PTY) LTD INDEMNITY FORM REFUSAL OF HIV / HEPATITIS B BLOOD TESTING AND ANTIRETOVIRAL PROPHYLACTIC TREATMENT
1. I hereby refuse to have bloods drawn for HIV and Hepatitis B.
2. I hereby refuse to receive Antiretroviral Prophylaxis against sero-conversion to
positive Human Immune Deficiency viral antibody status.
I accept full responsibility for my decision and indemnify Skills Hire against any claim of whatever nature which may be made against them.
Widespread accumulation of [3H]testosterone in the spinal cord of a wild bird with an elaborate courtship display J. DOUGLAS SCHULTZ AND BARNEY A. SCHLINGER*Department of Physiological Science and Laboratory of Neuroendocrinology, Brain Research Institute, University of California, Los Angeles, CA 90095-1527 Communicated by Peter Marler, University of California, Davis, CA, June 22, 1999 (rece
Advances in Quality and Outcomes; An STS National Database Event September 29, 2005 Congenital Heart Surgery Database Case Study: TOF 10 mos old Hispanic female referred for definitive repair. Birth history : Born at 30wk gestation weighing 3.2kg. Shortly after birth patient became tachypneic and cyanotic with oxygen saturations in the 60’s. An initial echo showed a malali