Transcript Slide 1

Blood and body fluid
exposures
Source patient testing in WizOrder
and exposure reporting
Vanderbilt Occupational Health Clinic 2004
When a healthcare worker is
exposed to a patient’s blood
or infectious body fluids, the
stakes are high.
Vanderbilt Occupational Health Clinic 2004
What is the chance
that an exposure will
cause disease?
Vanderbilt Occupational Health Clinic 2004
Risk of infection after a needlestick
from an infected patient

Hepatitis B - 30%
or 1 in 3 needlesticks

Hepatitis C – 1 to 10% (best estimate
1.8%)
or 1 in 100 needlesticks

HIV - 0.3% (0.09% for splashes)
or 1 in 333 needlesticks
(1 in 1000 splashes)
CDC - MMWR 1998
Vanderbilt Occupational Health Clinic 2004
The risk is higher if
the wound is deep,
 the needle was hollow-bore, or
 the patient has a high viral load.

Vanderbilt Occupational Health Clinic 2004
Time is of the essence
Antiviral therapy given
within the first 2
hours reduces the risk
by 80%.
Vanderbilt Occupational Health Clinic 2004
You can help
•If your patient is the source of a
needlestick or splash, you may be asked
to order source patient testing
•Source testing now includes a rapid HIV
test
•Results are available within an hour.*
*If ordered 11pm – 7am Sat. or Sun. it will be run at 7am the next morning
Vanderbilt Occupational Health Clinic 2004
WizOrder instructions
In Wiz, type keyword "exposure" or "source"
or "needlestick"
 Select “Evaluate source patient whose
blood/body fluids caused exposure."
 Accept all tests in the order set:
 Rapid
HIV antibody
 Hepatitis C antibody
 Hepatitis B profile

When this order set is used, the patient
will not be billed
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Insert screenshot of Wiz
Step 1: Type “source”
(or “needlestick” or
“exposure”)
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Step 2: Select
“evaluate source
patient”
The necessary lab
tests are bundled
together
Vanderbilt Occupational Health Clinic 2004
Accept all orders in the
set. The patient will not
be billed.
Vanderbilt Occupational Health Clinic 2004
****Important****
Make sure the exposed employee goes
to Occupational Health or the ED,
regardless of the HIV results.
Vanderbilt Occupational Health Clinic 2004
What does the employee need?





baseline labs (NOT the same tests as the source patient)
counseling about risk
possibly prophylactic medication
a follow-up plan
documentation of the exposure
DO NOT order labs or prescribe
medication for exposed
employees!
Vanderbilt Occupational Health Clinic 2004
Who can order lab tests
on the exposed worker?
Only Occupational Health and the ED!
 Confidentiality:

 These
lab results are stored in a separate
database, not visible in StarPanel except to
Occupational Health.

Billing:
 Employee
labs are billed differently, not the
same account as the source patient
Vanderbilt Occupational Health Clinic 2004
Why should the worker seek care if
the patient is HIV negative?

Counseling:
 Not
all patients with HIV have antibodies yet
– counseling is still needed to make an
informed decision.
 Hepatitis C found in 2% of source patients

Documentation:
 The
exposure must be documented and
baseline labs drawn to qualify for Worker’s
Compensation which would pay for any care
that the worker may need.
Vanderbilt Occupational Health Clinic 2004
When should I go to the ED instead
of OHC?
Go to Occupational Health during office
hours
 7:30am – 5:30pm, Monday – Friday
 When Occupational Health is closed, go to
the Emergency Department and identify
yourself as an employee who has had an
exposure

Vanderbilt Occupational Health Clinic 2004
The ED drew my blood - why follow
up with Occupational Health?
The initial evaluation establishes if you
had disease BEFORE the exposure
 OHC does follow-up testing to see if you
develop disease AS A RESULT OF the
exposure
 Occupational Health will track down
source patients if further testing is needed
 When ordered correctly, only Occupational
Health can obtain your results

Vanderbilt Occupational Health Clinic 2004
In addition….

Occupational Health
 tracks
how all exposures occur at Vanderbilt,
 identifies unsafe products and practices
 identifies high risk jobs and departments who
need additional training
 works with Infection Control and the Value
Analysis Committee to implement safety
improvements
Vanderbilt Occupational Health Clinic 2004
Report every
exposure
Vanderbilt Occupational Health Clinic 2004
Report your injury

Reporting gives us the information we
need to prevent future injuries

Even if your source was low risk, the next
exposed worker might not be so lucky

Reporting is our tool to identify dangerous
products and practices, so we can act to
make Vanderbilt a safer place to work
Vanderbilt Occupational Health Clinic 2004
Interventions
A safer disposal system:
 Needlesticks were happening while
disposing of needles,
 Sharps boxes had unsafe design
 A hospital-wide change of sharps boxes
reduced the injury rate.
Vanderbilt Occupational Health Clinic 2004
Safer devices:
 Butterfly needles were most frequent
injury type
 Purchase of new, safer butterfly needles,
reduced the injury rate further
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Results: This program reduces
needlestick injuries
Injuries from hollow bore needles at VUMC
350
300
250
200
150
100
50
0
FY
93
FY
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FY
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FY
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FY
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FY
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FY
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FY
00
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FY
01
FY
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FY
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Take home points
Order source patient labs in WizOrder through
the appropriate order set
 A rapid HIV test will be done on source patients
 Send exposed employees to Occupational
Health, or to the ED after hours, for evaluation.
DO NOT TREAT EXPOSED EMPLOYEES
YOURSELF!!
 Report ALL exposures, even if the source is HIV
negative so we can keep lowering the risk at
Vanderbilt

Vanderbilt Occupational Health Clinic 2004