Management of Needlestick & Contamination Injuries - Royal ...

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Appendix CCONSENT FORM FOR POST EXPOSURE PROPHYLAXISPatient Number:Surname:Date of Birth:Consultant:First Name:STATEMENT OF HEALTH PROFESSIONALI have fully counselled the patient about Post Exposure ProphylaxisSigned…………………………………………………. Date ………………………………………..Name ………………………………………..............Job Description ………………….………..STATEMENT OF PATIENTI confirm that I have been counselled and I fully understand the relative risk of developing HIVinfection following occupational exposure to HIV positive material.I understand the risks of toxicity associated with Exposure Prophylaxis drugs.I am not aware that I have any liver or kidney disease. I am not pregnant. I confirm that I will takeprecautions to prevent becoming pregnant/fathering a child, whilst I am taking the drugs.I confirm that I will comply with regular virological, clinical and haematological procedures whilst Iam taking the drugs and at intervals for up to six months thereafter. I give consent for my blood tobe tested for the presence of HIV.I understand that these drugs are not licensed for Post Exposure Prophylaxis and are thereforeprescribed on a named patient basis.Signature of Patient ……………………………………….Date …………………………………..Name (PRINT) ……………………………………………..Signature of Witness ………………………………………Date …………………………………..Name (PRINT) ……………………………………………..RBCHOCCHEALTH\DATA\WS\POLICIES\NEEDLESTICKPOLICY\SHARPS POLICY\VERSION 6 LP 2011Page 22 of 33
Appendix DMANAGEMENT OF HIGH RISK EXPOSURE TO BLOOD OR BODY FLUIDSAccidental ExposureTake clotted sample from HealthcareWorker for serum storageDetermine risk factors of source patientComplete Appendix ANo risk factor identifiedSource patientHigh riskSource patient unknownSignificant injuryHIGH RISK injury andHIGH RISKPATIENT/ENVIRONMENTRisk assess clinicalenvironment i.e.circumstances ofexposure andepidemiological likelihoodof HIV in the sourceLow risk injury and lowrisk patient/environment? PEP/HBIG asapNotify Occupational Healthon next working dayReassure HEALTHCARE WORKER thatrisk of transmission of blood borne viruses isrelatively lowIf incident occurs outside normal working hours, future follow up and counsellingwill be offered by Occupational Health/GUM.Full guidance is offered in policy.RBCHOCCHEALTH\DATA\WS\POLICIES\NEEDLESTICKPOLICY\SHARPS POLICY\VERSION 6 LP 2011Page 23 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 and 12: must include: assurance of confiden
Page 13 and 14: 7.3.3 Exposed person vaccinated but
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: HIV TESTING: PRE TEST DISCUSSION?Af
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

Management of Needlestick & Contamination Injuries - Royal ...

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