Post Exposure Management: What to Do When an Incident Occurs

by Gracie Hogue, BM

Over the years, we’ve received quite a few phone calls with desperate and worried persons on the other end of the line telling us that there has been a needlestick incident in their practice and they have no idea what to do next. This is definitely not a fun predicament to be in, but it’s important to keep your head and take the appropriate steps to ensure that you’re following OSHA’s standards. Don’t be intimidated by the forms and the protocol. You can do this. 

If you have one of the Modern Practice Solutions OSHA Manuals, then you have the checklist of what to do and all the forms you need in order. In case you don’t or you need a refresher, here’s what to do:

The Injured Employee should perform first aid to the wound, notify the practice’s Safety Coordinator, provide consent for a medical evaluation on the Post-Exposure Report, and seek medical evaluation immediately. 

The Employer and/or Safety Coordinator should make copies of the Post-Exposure forms in the OSHA Manual, obtain the source patient’s consent (if that person’s identity is known), obtain a Post Exposure Declination Statement if the Injured Employee refuses post-exposure management and/or medical care, file the documents in the employee’s confidential medical record, and make personal copies of the completed paperwork for the employee. Next, the Employer and/or Safety Coordinator needs to immediately direct the Injured Employee to the practice’s designated healthcare clinic for evaluation and follow up care. 

Here’s what the Safety Coordinator should provide to the practice’s designated healthcare clinic: 

1. Employee’s standard job description (job duties relevant to the exposure incident).

2. A copy of the POST-EXPOSURE REPORT.

3. Identity of Source Patient (if known) and bloodborne infection status (if known).

4. Copies of relevant Employee Medical Records such as HBV vaccination status.

5. Copy of OSHA’s Bloodborne Pathogens Standard.

The Practice then needs to obtain consent from the Source Patient and make arrangements for testing as soon as possible to determine HIV, HCV, and HBV infectivity. And yes, the Practice is responsible for the costs associated to the Employee’s exposure incident. The practice’s healthcare clinic’s correspondence related to the Injured Employee’s incident will need to be filed in the confidential Employee Medical Record or e-file. Then provide a copy of the healthcare clinic’s written opinion regarding the incident to the Employee.

As for the source patient:

If the Source Patient is unknown, the Injured Employee should directly proceed to seek treatment from the designated healthcare professional.

If the Source Patient is identified, the Employer/Safety Coordinator obtains a Source Patient/Individual Consent. Be sure to assure the Source Patient that the incident and their information will be treated with strict confidentiality. Send the source patient to the practice’s designated healthcare clinic to be tested for HBV, HCV, and HIV if serostatus is not already known.

It may feel overwhelming to handle an exposure incident, but if you are familiar with the Post Exposure Management section of your OSHA Manual and the checklist and forms there, you can get through the incident without too much anxiety.