Phlebotomy Blood-Borne Pathogen Exposure Procedure and Injury Report Form

In The Event Of Exposure To Patient Blood Or Other Bodily Fluids, Immediately

• Wash needle sticks and cuts with soap and water.
• Flush splashes to the nose, mouth, or skin with water.
• Irrigate eyes with 1000 ml (~4 cups) of clean water or sterile saline.

Steps

1. Report exposure to the onsite clinical preceptor immediately.
2. Manage exposure as indicated above. Seek treatment in the Emergency Room (ER) Only If Directed.
3. Report the incident to the clinical instructor and charge nurse/clinical facility supervisor, and request assistance with completing All incident report-related documentation for the student and source patient. Clinical facility protocol and documentation must be completed as defined by the student’s clinical facility. The student's name must be linked to the source patient for student follow‐up.
   1. Mission: Complete the Bloodborne Pathogen Exposure procedure.
   2. Haywood: Follow “Workpoint Wellness BBP Exposure Student Procedure.”
   3. Pardee: Complete Facility Exposure Packet.
   4. Advent: Complete Facility Exposure Packet to include standing orders and risk of transmission/infection pages (risk of transmission pages are to be delivered to the associate health).
   5. VA Medical Center: Report the incident to the front desk charge nurse and report to employee health on 3‐ WEST to complete all incident report-related documentation.
   6. Other: Refer to “Step 3” above. Provide the facility with this document for follow‐up.
4. Report to Mission’s “My Care Now” (MCN) located at 310 Long Shoals Road in Arden, NC, within 24 hours post‐incident for baseline labs (Exposure Profile-Exposed). If the incident occurred at a Non‐Mission facility, provide the MCN care provider with the contact information at the bottom of page three for source patient lab follow‐up. The MCN representative should follow up with the student within 36 hours of the baseline lab visit. MCN hours of operation: Monday through Sunday, 7:00 a.m. to 7:00 p.m.
5. Complete an A‐B Tech Injury Report and Relation Insurance Claim form with the designated A‐B Tech clinical instructor at the time of injury. Students must be as detailed and specific as possible in the injury report narrative for appropriate follow-up and insurance coverage. Once completed, the student must give both documents to their instructor.

MCN Will Need To Make A Copy Of The Ab‐Tech Injury Report Upon Student Arrival.

6. Students must use their personal health insurance to pay for baseline lab services. In the event the student’s personal health insurance requires a co‐pay or deductible, the student is to provide a copy of the AB‐Tech Student Accident Insurance policy brochure as secondary insurance coverage. Students with personal health insurance must have immediate access to their personal health insurance information at all times. Students must have immediate access to the Student Accident Insurance policy brochure at all times. Students should refer to their signed “Acknowledgement of Risk, Liability and Consent Agreement for further information.”
7. Students without personal health insurance must provide a copy of the AB‐Tech Student Accident Insurance policy to pay for baseline lab services. The student should refer to their signed “Acknowledgement of Risk, Liability, and Consent Agreement” for further information. Students must have immediate access to the Student Accident Insurance policy brochure at all times.

Additional Instructions For Students And Instructors

Student Notes

• Students should have the Exposure Profile-Exposed (testing for HBV [Hepatitis B] antibodies, HCV [Hepatitis C] antibodies, and HIV [Human Immunodeficiency Virus]) promptly within 24 hours of exposure. Post‐exposure prophylaxis (PEP) treatment may or may not be recommended depending on the source patient’s risk status. It is suggested that the student inquire about the source patient's risk status at the time of injury. If it is recommended that a student conduct follow‐up lab work and/or the student chooses to begin PEP, it may not be as effective if started more than 48 to 72 hours post‐exposure. MCN can write PEP prescriptions.
• It is up to the student to obtain follow‐up lab testing and/or fill PEP prescriptions and seek reimbursement later (refer to Health Risk Acknowledgement Release of Liability for Clinical Experiences). There are community resources available to those in need of assistance with out-of-pocket costs. Refer to the “Regional BBP Exposure Follow‐Up Care” document.
• If an injury requires an ER visit, the student will report to the designated ER, followed by MCN for baseline labs. Refer to Step 4. Billing will be directly through that facility using steps six and seven as a guide (substitute ER for MCN) for emergency care only. All ER services will be filed using the student’s personal health insurance and/or student accident insurance policy information (as outlined in steps six and seven). Students must have access to their personal health insurance information and/or Student Accident Insurance policy brochure at ALL times.
• In the event a student receives follow‐up care at their own expense or a bill related to the exposure of the record, the student is responsible for contacting Beth Green, Director of Facilities Support at 828‐398‐7150 to apply for reimbursement through the college’s student accident insurance. The student will be required to provide additional paperwork, such as itemized receipts, to facilitate that process.

On‐Site Instructor Responsibilities

• Coordinate all student activities post‐exposure steps 3 through 5.
• Ensure that MCN is able to make a copy of the student injury report.
• Coordinate with the charge nurse/clinical facility supervisor to make sure they have everything necessary to complete the facility incident report and related documentation. Inquire about the source patient's risk status to facilitate appropriate student follow‐up.
• Notify A‐B Tech Police of the injury at the time of injury at 828‐279‐3166.
• Notify the clinical coordinator or program chairperson at the time of injury.
• Contact the respective employee health “contact” at the clinical site of exposure incident to notify of injury (see chart below). Inform the respective employee health contact that an MCN representative will be contacting them for the source patient's lab results using the student’s name to link to determine follow‐up recommendations for the student. The MCN phone number is 828‐213‐4444.
• Submit the completed A‐B Tech Student Injury Report and Relation Claim form to Beth Green within 24 hours. The AB‐Tech Police can deliver this paperwork to Mrs. Green if Mrs. Green is unavailable.
• Make a copy of both the injury report and claim form, provided there is time, and submit to the department chairperson or clinical coordinator for student filing. The AB‐Tech Police will obtain a copy of the injury report from Mrs. Green.