Harbor:Occupational exposure: Difference between revisions

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*Charge RN has the exposure packet (needs to be filled out to avoid employee getting the bill)
*Use autotext ".edexposureharbor" for documentation template and guidance text on when to consult HIV service
*Source patient: Employee's supervisor should tell the source patient's provider to order Rapid HIV, Hep B Surface Antigen and Hep C RNA “HCV RNA RT_PCR Quantitative-PHL” using "Blood or Body Fluid Exposure - Source Patient" orderset on source patient (consent not needed if lab already has blood sample to add on test).
**If source patient refuses HIV, it can be added on to a pre-existing blood specimen but the results may not be shared with the patient
*Employee: ensure employee has Hep B vaccine; '''no blood testing of the employee in the ED''' for privacy reasons
*Call HIV service if source patient Rapid HIV is positive or is untestable AND was a clinically meaningful exposure (see occupational exposure template https://www.wikem.org/wiki/Harbor:_Macros_and_Autotext#Occupational_Exposure)
*If HIV Service recommends PEP, ED will prescribe initial prescription and the patient will follow-up at Employee Health next day
*Message Erika Sweet at Employee Health after any exposure to ensure follow-up
*Additional info in "INDUSTRIAL ACCIDENTS" section below
==Harbor Management==
*'''Exposure during weekdays (non-holidays), from 7:00a-3:30p:'''
*'''Exposure during weekdays (non-holidays), from 7:00a-3:30p:'''
**Send employee directly to Employee Health office for evaluation
** Send employee directly to Employee Health office for evaluation unless the employee has sustained an injury that warrants ED evaluation (i.e. laceration)
***Except if employee has sustained injury that warrants ED evaluation (i.e. laceration)
**Goal time from exposure to Employee Health office < 15 minutes
**Goal time from exposure to Employee Health office < 15 minutes
*'''Exposure during all other times:'''
*'''Exposure during all other times:'''
**Employee with potential blood-borne pathogen exposure should be evaluated in ED
** Employee with potential blood-borne pathogen exposure should be evaluated in ED
**Create and use [[Harbor:Occupational_exposure_(dot-phrases)|"Occupational Exposure" dot-phrases]] to guide evaluation, assess risk, need for testing, and indications for obtaining ID/HIV consult
*** Charge RN has the exposure packet (needs to be filled out to avoid employee getting the bill)
**If exposure warrants rapid HIV test on the source patient, then must give source patient opportunity to opt out of HIV test
*** Use autotext ".edexposureharbor" for documentation template and guidance text on when to consult HIV service
***Source patient: Employee's supervisor should tell the source patient's provider to order Rapid HIV, Hep B Surface Antigen and Hep C RNA “HCV RNA RT_PCR Quantitative-PHL” using "Blood or Body Fluid Exposure - Source Patient" order set on source patient (consent not needed if lab already has blood sample to add on test).
**** '''If source patient refuses HIV, it can be added on to a pre-existing blood specimen but the results may not be shared with the patient''' (HIV=gold top ... as is chem, LFT, TSH)
***Employee: ensure employee has Hep B vaccine; '''no blood testing of the employee in the ED''' for privacy reasons
***'''Call HIV service if the source patient's Rapid HIV is positive or is untestable''' AND was a clinically meaningful exposure (see occupational exposure template https://www.wikem.org/wiki/Harbor:_Macros_and_Autotext#Occupational_Exposure)
***If HIV Service recommends PEP, ED will prescribe initial prescription and the patient will follow-up at Employee Health the next day; '''first dose can be given in the ED'''
*Message Jeremy Ramon at Employee Health after any exposure to ensure follow-up
*Additional info in "INDUSTRIAL ACCIDENTS" section below
 


==See Also==
==See Also==

Revision as of 16:59, 16 March 2025

  • Exposure during weekdays (non-holidays), from 7:00a-3:30p:
    • Send employee directly to Employee Health office for evaluation unless the employee has sustained an injury that warrants ED evaluation (i.e. laceration)
    • Goal time from exposure to Employee Health office < 15 minutes
  • Exposure during all other times:
    • Employee with potential blood-borne pathogen exposure should be evaluated in ED
      • Charge RN has the exposure packet (needs to be filled out to avoid employee getting the bill)
      • Use autotext ".edexposureharbor" for documentation template and guidance text on when to consult HIV service
      • Source patient: Employee's supervisor should tell the source patient's provider to order Rapid HIV, Hep B Surface Antigen and Hep C RNA “HCV RNA RT_PCR Quantitative-PHL” using "Blood or Body Fluid Exposure - Source Patient" order set on source patient (consent not needed if lab already has blood sample to add on test).
        • If source patient refuses HIV, it can be added on to a pre-existing blood specimen but the results may not be shared with the patient (HIV=gold top ... as is chem, LFT, TSH)
      • Employee: ensure employee has Hep B vaccine; no blood testing of the employee in the ED for privacy reasons
      • Call HIV service if the source patient's Rapid HIV is positive or is untestable AND was a clinically meaningful exposure (see occupational exposure template https://www.wikem.org/wiki/Harbor:_Macros_and_Autotext#Occupational_Exposure)
      • If HIV Service recommends PEP, ED will prescribe initial prescription and the patient will follow-up at Employee Health the next day; first dose can be given in the ED
  • Message Jeremy Ramon at Employee Health after any exposure to ensure follow-up
  • Additional info in "INDUSTRIAL ACCIDENTS" section below


See Also

References

HUCLA

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