Harbor:Occupational exposure

• 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)
• 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:
  • Send employee directly to Employee Health office for evaluation
    • Except if employee has sustained 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
  • Create and use "Occupational Exposure" dot-phrases to guide evaluation, assess risk, need for testing, and indications for obtaining ID/HIV consult
  • If exposure warrants rapid HIV test on the source patient, then must give source patient opportunity to opt out of HIV test

See Also

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

References

HUCLA