Bloodborne Pathogens Exposure

Subject: Bloodborne Pathogens Exposure
Effective Date: December 2010
Review Dates: July 2015, September 2016

Purpose

The purpose of this plan/policy is to clearly communicate the appropriate response to bloodborne exposures such as needle sticks and eye splashes, or anytime human tissues are handled, by addressing post exposure first aid, source patient counseling and event reporting.

General Policy

This policy includes post exposure plans for all School of Dentistry sites of practice, including external and mobile rotations. School of Dentistry faculty, students and staff may provide patient care at non-UW School of Dentistry sites of practice. Copies of the post exposure plans for these non-School of Dentistry sites will be appended to this policy.

Implementation

I. Post Exposure Response

1. Provide Initial Treatment:

a. Eye or facial exposure

• Flush exposed eyes (while holding eyelids open) with water for 15 minutes soon as possible (prior to seeking medical care) using emergency eyewash stations if available.

b. Needle sticks and non-intact skin exposure

• Scrub exposed area thoroughly with warm water and sudsy soap for 15 minutes, perform first aid and seek medical care as soon as possible.

c. Notify the appropriate staff/faculty

d. Call the School of Dentistry’s Exposure/Incident Hotline at 206-351-2268.

The Counselor answering the phone will assist with specific directions for medical care and support. Outside of normal business hours (M – F, 8am – 5pm) students, staff and faculty should leave a detailed message and proceed with seeking medical care.

2. Seek medical care immediately

(Exposure/Incident Hotline Counselor will facilitate appropriate action. Details are included below for information).

a. Exposures on School of Dentistry Campus

• Between 8:00am and 3:15pm, Mon – Fri, report to UWMC Employee Health (NE 210).

• Between 3:15 and 5:00pm, Mon – Fri, call Upper Campus Employee Health at 206-685-1026 to talk with the Employee Health Nurse on duty.

• After 5:00pm Mon – Fri, go directly to UWMC Emergency Room (2NE).

b. Exposures at the Center for Pediatric Dentistry

• Seattle Children’s Hospital Dental Surgery Center RN staff will perform blood draws separately on the source patient and exposed provider or staff. The Center will utilize courier services to transport samples to UW Lab Medicine for testing.

c. Exposures at the following DECOD Treatment Sites: Snohomish Chalet, homebound patients in King/Pierce County, Mt. St. Vincent, Keiro Nursing Home and Seattle Rehab (partial day rotations that return to UW around 1pm)

• Between 8:00am and 3:15pm, Mon – Fri, report to UWMC Employee Health (NE 210).

• Between 3:15 and 5:00pm, Mon – Fri, call Upper Campus Employee Health at 206-685-1026 to talk with the Employee Health Nurse on duty.

• After 5:00pm Mon – Fri, go directly to UWMC Emergency Room (2NE).

Note: The attending will make sure the source patient is counseled over the phone by utilizing the exposure hotline and will follow the patient to the nearest hospital/clinic/ER.

d. Exposures at the following DECOD Treatment Sites: Mt. Vernon, Centralia, Yakima, Bremerton, Vashon Island, Walla Walla and Clarkston (full day rotations that continue until the end of the day).

Go to the assigned hospital in the area:

Mt. Vernon         Skagit Valley Hospital 1415 E Kincaid, Mt. Vernon, WA 98273

Centralia            Providence Hospital 914 S. Scheuber Rd, Centralia, WA 98531

Yakima                Yakima Valley Memorial Hospital 2811 Tieton Dr, Yakima, WA 98902

Bremerton         Harrison Memorial Hospital, 2520 Cherry Ave Bremerton, WA 98310

Vashon Island  Swedish Medical Center ER 16233 Sylvester Rd SW, Ste 120 Burien, WA 98166

Walla Walla     Providence St. Mary Medical Center 401 W Poplar St, Walla Walla, WA 99362

Clarkston          Tri-State Memorial Hospital 1221 Highland Ave, Clarkston, WA 99403

Note: The attending will make sure the source patient is counseled over the phone by utilizing the exposure hotline and will follow the patient to the nearest hospital/clinic/ER.

e. Exposures on Mobile Geriatric Rotation

• Between 8:00am and 3:15pm, Mon – Fri, report to UWMC Employee Health (NE 210).

• Between 3:15 and 5:00pm, Mon – Fri, call Upper Campus Employee Health at 206-685-1026 to talk with the Employee Health Nurse on duty.

• After 5:00pm Mon – Fri, go directly to UWMC Emergency Room (2NE).

Note: Attending will make sure the source patient is counseled over the phone by utilizing the exposure hotline and follow the patient to the nearest community health clinic or public health dept clinic for testing.

f. Exposures on RIDE and Service Learning Rotations

The Student Bloodborne Pathogens (BBP) Policy for RIDE (Regional Initiatives in Dental Education), RUOPs (Rural/Underserved Opportunities Program), and Service Learning Rotations (SLRs), (see Student Bloodborne Pathogens Policy, Appendix A) is given and explained to students as part of training just prior to their rotation. As part of the affiliation agreement between the rotation sites and the UWSOD, the sites must have a BBP policy in place that is introduced to the student at the orientation on his/her first day. If an incident occurs while a student is on rotation, the site is required to give the student access to their identified exposure counselor and receive emergency medical care and counseling as needed. The site must also identify the source patient status and notify the student accordingly.

g. Cost for Student Post-Exposure Medical Care

Students treated at UWMC Employee Health will not be billed. Treatment provided anywhere other than UWMC Employee Health will be billed to the student’s insurance and any remaining patient responsibility will be handled by the HSIP staff via email at myshots@uw.edu or by phone at 206-616-9074.

II. Source Patient Counseling

The School of Dentistry assigns bloodborne exposure counseling responsibilities to a limited number of School employees in order to assure full time coverage during clinic operating hours.

These individuals voluntarily agree to serve as Exposure Counselor and are trained and certified by Employee Health with annual re-certification requirements. The individuals assigned to this role may change at any given time dependent on changes in employment status, work duties and willingness to serve. Exposure counseling may only be performed by these individuals; no other School of Dentistry workforce members are authorized.

The cost of source patient testing performed at UWMC ER is covered by the University. Cost and billing of source patient testing performed outside UW must be coordinated by the external site/rotation.

1. Source Patient Counseling Training/Certification:

Exposure Counselors must be trained and certified by Employee Health before performing exposure counseling duties. The training includes but not limited to:

a. One hour orientation by the Employee Health nurse or designee and includes the following topics:

• Review of WAC 296-823-16010 requirements for source patient testing explanation of what testing is being requested.

• Instruction on consenting source patient including pre-test screening and obtaining consent.

2. Source Patient Counselor Responsibilities:

a. Maintain and follow Exposure Control Plan implemented by UW School of Dentistry according to OSHA/WISHA standards.

b. Guarantee students/providers who may be at risk of exposure to bloodborne pathogens are provided with and have access to Personal Protective Equipment (PPE).

c. Perform exposure counseling as needed for the School of Dentistry utilizing and adhering to the Employee Health Bloodborne Exposure Source Patient Testing Checklist and Guidelines.

d. Provide Post-Exposure evaluation and follow-up if needed.

e. Notify the following personnel directly via email following exposure counseling so that the Employee Health Clinic Manager is prepared to receive paper work and test results.

Suzanne Mason, Employee Health Clinic Manager (sfmason@u.washington.edu)

Sandra Phillips, Health and Safety Director (sandyp@uw.edu)

f. Send all required exposure counseling paperwork (checklist, consent form, lab slip) to:

Employee Health Attention: Clinic Manager
Box 354410

g. Attend quarterly meetings with Exposure Counselors, lead by the Safety Manager and Director.

h. Maintain mandatory certification/training annually through UW Employee Health.

i. Maintain accurate recordkeeping and documentation of incident.

j. Participate in post-exposure training (to be determined).

3. School of Dentistry Exposure/Incident Hotline 206-351-2268:

Note: All digits must be dialed as this is a cell phone number.

The exposure hotline will be used in the School of Dentistry to ensure a counselor is accessible for exposure incidents within 15 minutes of initial exposure.

a. The exposure hotline will be the sole method of contacting a School of Dentistry exposure counselor directly.

b. Counselors will be assigned weekly (M – F, 8am – 5pm, excluding holidays) to the exposure hotline for immediate response to onsite and offsite exposure incidents involving staff, faculty, and students. Outside of normal business hours, individuals involved in incidents should proceed to the assigned emergency department where patient source counseling will be conducted.

c. Calls made to the exposure hotline during normal business hours will be addressed as follows:

• Calls for onsite exposure incidents will trigger an exposure counselor to respond within 15 minutes of call to location within school.

• Calls for offsite exposure incidents are required to assist with completion of source patient counseling in addition to identifying what facility the patient will be directed to for lab testing.

d. The exposure counselor will communicate essential information during initial call to include but not limited to:

• Instruct staff or student to ensure the patient does not leave the clinic or location of incident.

• Directing staff or student member to wash site for 15 minutes and perform first aid as needed.

• Ensuring staff or student document incident in Occupational Accident Reporting System (OARS).

III. Post Exposure Event Reporting

Washington State Department of Labor and Industries requires employers to record work related injuries and illnesses. Supervisors should make a detailed report about each incident, even if only a minor injury or near miss, resulting in no injury.

  • Report all workforce events involving students, staff and or faculty through OARS at: http://www.ehs.washington.edu/ohsoars/index.shtm
  • Supervisors are responsible for completely filling out the OARS report, including corrective action. The corrective action response should include confirmation that the workforce member involved in the exposure received post-exposure training/re-education.

Appendices:

Appendix A, Student Bloodborne Pathogens Policy

Dean of UW SOD:

Joel Berg, Dean of the UW School of Dentistry

Appendix A

Student Bloodborne Pathogens Policy (PDF)

UW BBP policy