Entry-level PharmD students must complete a bloodborne pathogen training and test prior to the start of their Advanced Pharmacy Practice Experience. The training and test is a self-directed program.
The following information is provided to School of Pharmacy students and students in other health care professions by University Health Services.
Exposure to bloodborne pathogens can occur in many ways. Although needlestick and other sharps injuries are the most common means of exposure for health care workers, bloodborne pathogens also can be transmitted through contact with mucous membranes and non-intact skin. While hospitals and clinics must provide for the evaluation and management of exposures that occur in their employees, they are under no obligation to provide the same services to a student doing a clinical rotation at their facility. Some clinical sites are very helpful to students in this situation, others are not. We’ve put together these guidelines to assist you in the event that you sustain a bloodborne pathogen exposure.
So, what’s an “exposure?”
An exposure incident means a specific eye, mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials.
What are “infectious materials?”
Blood, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, amniotic fluid, saliva in dental procedures, any body fluid visibly contaminated with blood, mixtures of fluids where you can’t differentiate between body fluids, unfixed human tissue or organs (other than intact skin), and certain cell, tissue or organ cultures and mediums./p>
Learn your facility’s procedures.
To whom do you report (e.g., the employee health service); who coordinates the evaluation of the source patient; how YOU get care; who coordinates the follow up; who pays?
If you have an exposure incident:
1. Notify your preceptor or clinical instructor
2. Notify the facility’s coordinator for employee health and/or infection control issues
3. Contact your instructor/preceptor or your school or program office;
4. Contact University Health Services for advice, facilitation, follow-up:
Agustina Marconi, MD, MPH
Clinical Medicine (general number)
Hours: 8:30 AM-5:00 PM weekdays
After hours clinician on-call (608) 265-8200
Hours: 5:00-9:00 PM weekdays
12:00-9:00 PM weekends
Health Services staff are experienced in the management of exposures and in the issues that surround them. University Health Services (UHS) provides prepaid primary care for students enrolled at UW–Madison, but we do not cover services provided elsewhere. Therefore, where it is not practical to come to the UHS clinic for care, the expense of services is the responsibility of the student or the student’s insurance.
While the exact implementation of procedures will vary from place to place, here are some common themes that will be part of the management of an exposure incident.
Take Care of the Injury or Exposed Area.
Prompt and thorough cleaning of the blood spill or splash or of the injury is a KEY step in preventing blood-borne infection. How’s your tetanus protection?
Report the Incident.
Another health professional will assist you, and the proper steps will be followed to collect the information that is needed to manage the exposure and to care for you.
Assess the exposure incident: is this a significant exposure?
There is a specific definition of significant exposure; it takes into account the type of body fluid, the integrity of the skin surfaces, and the mechanics of the injury. Facilities use an incident report as a tool in evaluating such situations. Some thought should be given to understanding how the incident happened and how it could be prevented in the future. That might not be the first thing on your mind, but it should be part of the process sometime.
Evaluate the Source Patient for bloodborne pathogens. This typically includes HIV antibody, hepatitis B surface antigen or panel, hepatitis C antibody.
One should not rely on medical or social history to assess the risk of bloodborne infections. A uniform practice of testing every source patient is the standard. This requires the patient’s consent for testing. Ideally, you should not have to obtain the consent yourself, and there should be a mechanism in place for that to be done. This should be done as promptly as possible. Time is of the essence, especially with short hospital stays, or exposures in outpatient settings. Since exposures often take place in the surgical or delivery room area, the source patient’s ability to give consent for testing may be delayed.
Your Own Testing and Treatment (HIV antibody, hepatitis B immune status, hepatitis C immune status, postexposure promphylaxis).
All testing should be “on the record” to be of benefit to you as a baseline in a risk management sense. The results of recent anti-HBs testing may be sufficient. Chemoprophylaxis with immune globulin or antiviral medications may be recommended in some situations.
Follow-Up (Repeat serology, schedule varies, your own test results should be given to you).
The need for follow-up tests is determined largely by the source patient’s availability for testing and the results of such tests. This is why reporting the incident is so important. HIV results usually are provided only in a personal visit.