Management of Needlestick & Contamination Injuries - Royal ...

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initiating the above and or the on call GUM physician. If the source is unknown advicemay also be sought on the management of the case.A 6ml clotted blood sample (red top) must be obtained from the injured or exposedperson and stored in the Microbiology Department at Poole for future testing ifnecessary. NB. Whenever samples are taken from the exposed person where possiblegive details of the hepatitis B vaccination history on the request form.7.3 Procedures for acting upon Hepatitis B source needlestickAction required:Source HBsAg Negative: no further action necessary.Source HBsAg Positive7.3.1 Exposed person already received a full course of Hepatitis B Vaccine• If hepatitis B antibody (anti - HBs) level known to be > 100 iu/ml and a booster dosehas been given 5 years after the primary course, no further action is needed (longterm immunity can be assumed).• If it is more than 5 years since the primary course was given, but the 5 year boosterdose has not been given, it must be given now.• If the post primary vaccination course antiHBs level is unknown but the course hasbeen completed in the last 6 months check the Anti-Hbs level, if the course hasbeen completed more than 6 months Hepatitis B Booster is indicated with are-check of the anti-HBs level 2 months later.7.3.2 Exposed person not vaccinated• Start course of hepatitis B vaccine.• Hepatitis B immunoglobulin (HBIG) must be given as soon as possible afterexposure and certainly within 48 hours. This must be given at a different site to theHepatitis B vaccine. HBIG is available from Pharmacy. HBIG must be given as soonas possible after exposure and preferably within 48 hours. It is of no value later thanone week after exposure. (Any concerns seek advice from microbiologists)RBCHOCCHEALTH\DATA\WS\POLICIES\NEEDLESTICKPOLICY\SHARPS POLICY\VERSION 6 LP 2011Page 12 of 33
7.3.3 Exposed person vaccinated but not completed full course• Hepatitis B Booster is indicated with a re-check of the anti-HBs level 2 months later.Refer to OHD when re-opens7.4 Procedures for acting upon Hepatitis C source needlestickThere is no specific prophylaxis or vaccination available against Hepatitis C. There istherefore no immediate action, which needs to be taken following exposure to a possiblesource with Hepatitis C infection. However exposed health care workers must bemanaged as follows:7.4.1 Known Hepatitis C infected source• On initial assessment which may be in ED if out of hours obtain baseline serum forstorage from health care worker• Obtain clotted blood sample (serum) for HCV RNA testing at 6 and 12Weeks (during OHD follow up)• Obtain serum for HCV antibody (anti-HCV) at 12 and 24 weeks (during OHDfollow up)7.4.2 Hepatitis C status of source unknown• Obtain baseline serum for storage from health care worker refer to OHD as soon as itre opens for follow up.7.5 Incidents outside of normal working hours7.5.1 Clinical Site Team• Outside of normal working hours the Clinical Site Team shall provide advice on themanagement of Inoculation Incidents. The Clinical Site team shall:• Ensure the healthcare worker is facilitated through the EMERGENCYDEPARTMENT, Triaged within 30 minutes of attendance in order that whereindicated PEP can be commenced within the hour from exposure.• Attempt to determine any risk factors of source patient.• Approach the source patient and explain the incident. Obtain verbal consent fortesting and document accordingly. Guidance for the clinician can be found atAPPENDIX B HIV TESTING: PRE TEST DISCUSSION• Ensure an AIRS form is completed for all incidents.7.5.2 Out of hour’s advice on HIV issuesThe on call HIV Consultant must be contacted. There is always a consultant on call fortelephone advice regarding Needlesticks and Contamination incidents and PostExposure Prophylaxis (PEP) contactable through switchboard. Emergency Departmentare able to initiate PEP also.7.5.3 EMERGENCY DEPARTMENTRBCHOCCHEALTH\DATA\WS\POLICIES\NEEDLESTICKPOLICY\SHARPS POLICY\VERSION 6 LP 2011Page 13 of 33
Page 1 and 2: Management of Needlestick& Contamin
Page 3 and 4: CONTENTS:SectionsPage Nos1.0 Flow c
Page 5 and 6: 2.0 POLICY STATEMENTRoyal Bournemou
Page 7 and 8: 4.2 Sharp Injury Prevention and Man
Page 9 and 10: • All sharps boxes must be sited
Page 11: must include: assurance of confiden
Page 15 and 16: Unconscious patients, or those with
Page 17 and 18: CRITERIA HOW WHERE WHEN LEADReview
Page 19 and 20: Appendix ANeedlestick/Sharps Incide
Page 21 and 22: HIV TESTING: PRE TEST DISCUSSION?Af
Page 23 and 24: Appendix DMANAGEMENT OF HIGH RISK E
Page 25 and 26: Appendix F7.0 ADVICE AND SUPPORT FO
Page 27 and 28: 6. Minutes of Meetings6.1 The Secre
Page 29 and 30: 10. AuthorityThe Committee is autho
Page 31 and 32: Regular Reports Provided to Health
Page 33: 7. Does this document affect anindi

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