1. First aid
2. Quantify risk
3. Post procedure prophylaxis
4. Quality assurance
Stop the procedure
- ensure patient and prodeduralist is safe
- take over care if required
- express blood from wound
- wash wound immediately with soap and water (2% chlorhexidine wash
- identify source patient and test for HIV, Hep B and C
- test exposed staff member
- type injury – depth, type, location, barriers to transmission (double, single gloved), blood on needle
Notify patient and family
- open disclosure
- consent for testing
Occupational health involvement
- initiate the injury reporting system used in workplace (in hours vs out of hours)
- counselling required with specific risk depending on depth of injury, whether there is visible blood on needle, needle placement in vein or artery, lower risk if solid needle vs hollow
- document the exposure in detail
- advice on: safe sex and no blood donation until testing complete
- discuss with ID
- HIV +ve -> post-exposure prophylaxis within 2 hours
- Hep B +ve -> Hep B immunoglobublin
- Hep C +ve -> no treatment recommended currently
Systems analysis to look at prevention of further events
- document thoroughly
- identify factors that may have lead to exposure and could prevent further exposures
- a unit policy may be appropriate
- follow up post exposure testing @ six weeks, 3 months and 6 months +/- 1 year
- if post exposure prophylaxis prescribed -> monitor for toxicity
- take precautions (safe sex) to prevent exposing others until follow up testing complete
- review of technique with proceduralist
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.