Harbor:Occupational exposure

• 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 .edexposure 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
      • PEP must be prescribed to the Harbor Pharmacy to avoid generating a bill for the employee(patient)
• Message Jeremy Ramon at Employee Health after any exposure to ensure follow-up
• Additional info in "INDUSTRIAL ACCIDENTS" section below

See Also

• Harbor:Main
• Harbor:Occupational exposure (dot-phrases)
• Occupational Exposure
• HIV Prophylaxis (Occupational)

References

HUCLA