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An exposure incident is defined as mucous membranes, broken skin, or a puncture that comes into contact with blood or other potentially infectious material, that results from the performance of an employee's duties.   If you think you have been exposed, you should decontaminate, seek medical treatment and report to your supervisor. An immediate confidential medical evaluation and follow-up should also be conducted by a physician.

There is a TWO HOUR RULE for incident reporting and within this time the necessary forms should be completed as soon as possible after incident.  However do not delay any medical treatment that you need in order to fill out paperwork.   Once you have sought medical treatment you should continue treatment and reporting, according to your employer’s policies and procedures

Health Care Workers or any other person in the health care setting exposed to HBV or HIV infected material should be offered appropriate and expedited post exposure treatment. Health Care Workers who are at high risk of exposure to HIV should be encouraged to consider in advance, whether in the event of an occupational exposure to HIV, they would wish to take preventative treatments. This is to ensure minimum time lapse from exposure to first line anti-retroviral treatment in order to maximise prevention of HIV or HBV infection.

Each employer should draw up an exposure control plan which contains a guide for prevention, treatment and follow up from an accidental exposure to a bloodbourne pathogen.   Each NHS Trust should designate one or more doctors to whom health care staff may be referred to immediately for advice if they have an exposure incident. Local policies should specify a responsible party for provision of post-exposure treatment and follow up.

Recommended sources for expert advice may include consultants in virology, microbiology, infectious diseases, HIV disease and public health medicine. Doctors in Occupational Health services should be considered for this role. Ensure that the Occupational Health service will be able to expedite the delivery of infection preventing medications in prescribed time required for utmost effectiveness.  The Occupational Health Service should advise managers and staff on the management of injuries sustained at work, like needle stick injuries, and in cases where entitlement to NHS or industrial injuries benefits is under consideration.

Information, counselling and psychological support should be made available to any employee who reports an exposure and potentiates the risk for BBV infection.   This may include asking the exposed employee to provide a baseline sample for storage and follow up samples for testing as appropriate for HIV, HBV or HCV infection and advice about treatment.  While early testing may be appropriate a 6 month test after the exposure will usually exclude the possibility of transmission of these infections.

The designated physician(s) must maintain awareness of the latest developments in post-exposure treatment guidelines including the use of hepatitis B vaccine.   This includes the use of anti-retroviral drugs following the occupational exposure to HIV infection. Any action taken after an employee has had an exposure incident should take account of the interests of both the worker and the source patient.

An appropriate person should be available outside of normal working hours to advise and treat employees who sustain significant occupational exposures. This designated person must be provided with a written version of the Health authority, Health Board or NHS Trusts’ policy on the management of exposures.