Body Fluid Exposure Tips (for Providers) Updated 12/18/2024
Occupation Medicine Clinic (OMC):
Monday-Thursday 8A-4P & Friday 8A-12P.
Occupational Medicine at 909-433-0842 or Employee Health at 909-558-8797 during the week during business hours.
Angela Angelo, (Interim Exposure Control Nurse for Employee Health Services): Ext. 50262 (contact info in exposure packets also)
Call 24/7 (855) 500-5584 Nurse Advice and Injury Reporting Hotline
Currently the initial visit post-exposure would be Advanced Urgent Care (AUC) when outside of OMC’s hours.
Documentation:
Document the relevant information for all cases of Blood Born Pathogen Exposure/Needle Stick. (Include source patient history of blood borne pathogen infection, if known, and employee tetanus and HBV vaccination status)
This information include:
· Hep-B assessment, indication, and whether or not the vaccination/Immunoglobulin was administered.
· Tetanus assessment, indication, and whether or not the vaccination was administered
· PEP risks/benefits discussed, per risk assessment employee has experienced a low/high risk exposure; whether PEP is indicated, and whether PEP accepted and was ordered.
(The exposure report that is contained in the yellow exposure folders asks all the pertinent questions to evaluate the exposure and adheres to OSHA’s BBP Standard.)
History to include:
- Date and time of the exposure incident
- Type of sharp involved in the exposure incident
- Description of the exposure incident, include job classification of the exposed employee, work area where incident occurred, procedure that the exposed employee was performing
at the time of the incident, how it occurred, and body part involved in the exposure incident.
High risk if:
§ Large hollow-bore needle
§ Device visibly contaminated with the patient’s blood before exposure
§ deep puncture
§ device used in an artery or vein
Low risk if:
§ solid bore with no visible blood
§ superficial injuries not breaking skin
Potentially infectious body fluids include:
Blood, CSF, synovial fluid, pleural fluid, pericardial fluid, amniotic fluid, semen, or vaginal secretions.
Non-infectious body fluids include:
Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomit, if these are not visibly contaminated with blood.
PEP
Provide education, evaluation, and recommendation with regards to PEP medications, Isentress (Raltegravir 400mg PO BID) and Truvada (emtricitabine 200mg + tenofovir 300mg PO qday),
· Recommended not to order more than a few days of HIV PEP supply (usually 3-day supply) at their first visit to ED/AUC while result of the source is pending, since most of the time source is negative, not requiring any PEP treatment and therefore, the ordered medications will be wasted. These medications are expensive, and we should try to order it when is necessary.
· If source is available and tested per protocol, the result will be available within 24-72 hours.
· Recommend ordering full course of PEP (28 days) at first visit to the LLU AUC/ LLU OMC/ ED Murrieta only if the source is known to be positive or if the source is not available for testing.
· Otherwise, our exposure nurse at Loma Linda and Murrieta will review the source lab result within 24-72 hours after visiting the LLU AUC/ LLU OMC/ ED Murrieta inform the patient about the source result.
· Exposure nurse recommend patient to stop PEP if source is negative for HIV, or to follow up with occupational medicine immediately if the source is positive for HIV to receive the rest of the treatment and schedule their follow up visits.
· To make it more convenient and unified, we are using a smart phrase “BBPEASSESS” for all blood born pathogen exposures and should be available to all provider using EPIC at LLUH. This smart phrase (voluntary use) has all necessary information and documentation for exposure cases.
PEP prescriptions should be sent to the LLU Outpatient Medical Center pharmacy and start first dose in LLUH AUC/ LLUH OMC/ ED Murrieta. Most common side effect include GI symptoms (i.e. stomach upset, nausea) which typically resolves after the first week of treatment initiation, you may provide supportive therapy with anti-emetics as needed. PEP is also safe in pregnancy and breastfeeding. Prior to starting PEP if exposed employee consents to treatment, obtain following labs CBC, CMP, and pregnancy test (if applicable). HIV Ag/Ab, Hep C Ab, Hep B sAg are performed as part of exposure labs.
**LLU Outpatient MC pharmacy is open 8A-8P on weekdays and 8A-5:30P on weekends.
Per ID, there is a higher prevalence of undiagnosed HIV in the San Bernardino area so if the source is unknown HIV with high risk exposure, consider PEP. It is better to treat if unsure since the medication safety profile outweigh the risks. “Nearly 1/5 of the people living with HIV in our county are unaware of their status, so it's hard to use the history of 'no history of HIV' in this situation.”
You may reach out to ID on weekdays between 9A-5P or National Clinician’s PEPline at 888-448-4911. MDCalc has HIV Needle Stick RASP score to guide with PEP decisions as well.
Treat student’s exposure the same as employee’s exposure. Students do not automatically get referred to SHS and should be referred to Employee Health’s Exposure Control RN just as the employees should. EHS will review all available results and contact the student with the appropriate follow-up as applicable.
**Students should be referred to Student Health 909-558-8770**