Get the right number after exposure

by Noel Kelsch, RDHAP
[email protected]

I got a call the other morning while I was in a meeting. The person left this message: "Hi, Noel. I attended your course last year and was wondering if you could tell me what to do when you get a needlestick. Someone in our office got one and we don't know what to do." I did not get the message until late afternoon. When I called back they were "waiting for my call." The time to find out what to do for a sharps injury and bloodborne pathogen exposure is long before an incident occurs.

Exposure includes both percutaneous injuries (cuts, needlesticks), or contact of mucous membrane or nonintact skin (dermatitis, chapped lips, abraded areas) with blood, saliva, tissue, or other potentially infectious body fluids. Exposure incidents might place dental health-care personnel at risk for hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV) infection, and therefore should be evaluated immediately following treatment of the exposure site by a qualified health-care professional.

The Centers for Disease Control and Clinicians' Post Exposure Prophylaxis Hotline (PEPline) have given health-care professionals simple steps:

If you experienced a needlestick or sharps injury or were exposed to blood or other body fluid of a patient during the course of your work, immediately follow these steps:

• Wash needlesticks and cuts with soap and water
• Flush splashes to the nose, mouth, or skin with water
• Irrigate eyes with clean water, saline, or sterile irrigants
• Do NOT apply caustic agents or inject antiseptics or disinfectants into the wound.
• Report the incident to your supervisor
• Immediately seek medical treatment. (The medical relationship should be established ahead of time and not at the time of the event. The person should be experienced in providing antiretroviral therapy, and familiar with the unique nature of dental injuries so that he or she can provide appropriate guidance on the need for antiretroviral prophylaxis.1)

The employer must follow all federal (including OSHA) and state requirements in documenting and reporting occupational injuries and exposures.

The document should include:

• Date and time of exposure.
• Details of the procedure being performed, including where and how the exposure occurred, whether the exposure involved a sharps device, the type of device, whether there was visible blood on the device, and how and when during its handling the exposure occurred. (It is helpful to take the device to the medical providers' office so they can see if it is hollow, sharp, etc.)
• Details of the exposure, including the type and amount of fluid or material and the severity of the exposure. For a percutaneous injury, details should include the depth of the wound, the gauge of the needle, and whether fluid was injected. For a skin or mucous membrane exposure, the estimated volume of material, the duration of contact, and the condition of the skin (e.g., chapped, abraded, or intact) should be included.
• Details about the exposure source, such as whether the patient was infected with hepatitis B virus (HBV) and his or her hepatitis B e antigen (HBeAg) status; whether the patient was infected with hepatitis C virus (HCV), or human immunodeficiency virus (HIV); and if the source was infected with HIV, the stage of disease, history of antiretroviral therapy, and viral load, if known. If this information is not known from the medical record, then the source patient should be asked to obtain serologic testing for HBV, HCV, and HIV.
• Details about the exposed person (e.g., hepatitis B vaccination and vaccine-response status).

After exposure treatment must also be documented, including:

• Details about counseling, post-exposure management, and follow-up.

All of this must be kept in a confidential file.

PEP, a number to remember!

If you or your medical provider have questions about appropriate medical treatment for occupational exposures, 24-hour assistance is available from PEPline at 888-448-4911.

They will provide health-care professionals with up-to-the-minute HIV clinical information and individualized, expert case consultation. This will help evaluate the risks involved and the treatment considerations.

PEP will take the following into consideration before developing an individualized follow-up and treatment plan:

● Type of exposure

• Percutaneous injury
• Mucous membrane exposure
• Nonintact skin exposure
• Bites resulting in blood exposure to either person involved

● Type and amount of fluid/tissue

• Blood
• Fluids containing blood
• Potentially infectious fluid or tissue (semen; vaginal secretions; and cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids)
• Direct contact with concentrated virus

● Infectious status of source

• Presence of HBsAg
• Presence of HCV antibody
• Presence of HIV antibody

● Susceptibility of exposed person

• Hepatitis B vaccine and vaccine response status
• HBV, HCV, and HIV immune status

The PEP line has a great poster for your office. It is available at http://www.cdc.gov/niosh/topics/bbp/PEPline_poster.pdf.

Something worth reading

The CDC put together a great little booklet called "Exposure to Blood, What Healthcare Personnel Need to Know," available at http://www.cdc.gov/ncidod/dhqp/pdf/bbp/Exp_to_Blood.pdf.

This free downloadable tool goes over the risks of occupational exposure to bloodborne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), and suggests actions to be taken when such exposures occur.

It is vital to know what to do, where to go, and who to call before a sharps injury or pathogen exposure incident happens. Making the entire office involved and aware of the protocol could save a life.

1. Beltrami EM. The risk and prevention of occupational human immunodeficiency virus infection. Seminars in Infection Control 2001;1:2-18.

Noel Brandon Kelsch, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamine and drug use. She is a past president of the California Dental Hygienists' Association.