Today we speak with Tanicia Haynes, nurse practitioner at Vanderbilt Occupational Health, about what to do if an employee has a blood and body fluid exposure.
Shaina Farfel: Welcome to this addition of the Vanderbilt Health and Wellness Wellcast. I am Shaina Farfel with Occupational Health. Today we are speaking with Tanicia Haynes, Nurse Practitioner, at Vanderbilt Occupational Health Clinic.
Hi, Tanicia. Thank you so much for being with us today.
Tanicia Haynes, N.P.: Hi. Thanks for having me.
Shaina Farfel: Today, we wanted to talk about blood and body fluid exposures, also known as BBFs, you may hear them referred to as that. Here at Occupational Health, I know we see a lot of employees, sometimes daily, for blood and body fluid exposures; and we just want people to know and the employees to know that they are common things that happen, but we also want you to know what to do about them when they do happen because we do get a lot of questions from folks. So, Tanicia, can you tell us the definition of a blood and body fluid exposure?
Tanicia Haynes, N.P.: The definition of a blood and body fluid exposure would be contact that someone has with blood or body fluids from an individual that could be potentially infectious for HIV, for hepatitis B or C, and those body fluids or blood has to come in contact with another person's mucosal membranes, through mouth, nose, eyes or potentially through contact with the skin whether it be through open skin or with a needle stick or a sharps injury.
Shaina Farfel: What should a Vanderbilt employee do if they think that they may have had a blood and body fluid exposure?
Tanicia Haynes, N.P.: The first thing an employee should do is first aid to the injury site. Whether that be a needle stick, you need to try and make sure that puncture wound is allowed to bleed and then wash your hands with soap and water or wash the area with soap and water. If there is contact with mucosal membranes to the eyes, nose or mouth, then you want to flush the area for 15 minutes. The next thing that you need to do is identify the source patient. So, whoever the exposure comes from you want to make sure you have the medical record number for that patient, name of that patient and before anything is done as far as coming over to see us, we always want to make sure that you guys are trying to order the labs for that person. Those labs are run on a STAT basis with the HIV testing that we want to do. There is an order set in eStar for the source patient, so it is a very quick and simple way to order the labs. Anyone can order the labs whether it be the nurse that sees the patient, whether it is one of your colleagues as you want to come over and see us, a provider can order those patient's labs and there is no need to wait on those labs. If you are a nurse on the floor, you do not have to wait for a provider to order the labs. You can go ahead and send the labs to be ordered and you can send them for cosign to that provider just so that things are done on a timely basis because we do want to know those labs pretty quickly to know what we need to do for the employee that has been injured. Lastly, the employee needs to come over and see us over at Occupational Health and then you sit down with a provider and you guys discuss risks of exposure and what we do from here on out. If Occupational Health is not open at the time of the injury, so if it is outside of our business hours, then you would go over to the emergency department and you would see one of the providers there and get the same care.
Shaina Farfel: What too would happen if it were someone who was like off campus? Could they call Occupational Health?
Tanicia Haynes, N.P.: For offsite exposures, you could certainly call over to the clinic, if it is during business hours. There are other locations that you could be seen at for work injuries, and you could call the clinic at any point. We always have a provider that is on call through the weekends and late at night. If you have any questions about exposures, even if you are not sure if it is an exposure, you can always call and speak with one of our providers at any point during the day. If it is a question of, did it happen? Should I go get seen? If it is a question of, I am out in Murfreesboro and it is a Saturday, where do I go? You could just call our clinic and you will get connected through our call service to one of the providers here.
Shaina Farfel: Okay. That is really helpful. I think some people may be wondering, you mentioned an order set in eStar. How exactly would they find that? Another question we get commonly is, would the source patient get billed for these labs that we are ordering?
Tanicia Haynes, N.P.: So, in order to find them, depending on if you are in an ambulatory clinic or if you are in an inpatient setting, you can look in Smart Sets or search within the ordering system for “source” and there should be a panel that comes up and that includes the labs that we check for HIV and for hepatitis B and C. It is best to go with that panel because then you know that we have ordered the correct labs on the patient because there are different hepatitis B tests and there are different hepatitis C tests and there is specific ones, we are looking for with these exposures so using that panel or that order set is the best idea. The patient does not get billed for these services. You go ahead and you order them through the chart like you normally would any other lab or order that goes in, but on the back end we do find out who those patients were, and we are in coordination with billing so that those patients do not get billed for these exposure labs.
Shaina Farfel: Those are great answers and I think will be really helpful to folks. So, big take away. Definitely want the employee to, as best they can, get that source information and start ordering those labs as soon as possible. What happens next? What is the risk of transmission to the employee for each of these types of infectious exposures? I know it depends a little bit on the type of exposure.
Tanicia Haynes, N.P.: So, it kind of depends on the injury for one. With hollow-bore needle stick injuries, the risk of transmission from an HIV-positive patient to someone who is HIV negative is about 0.3%. So, not very high. With hepatitis C, the risk is about 1%. With hepatitis B though, that is kind of our heavy hitter with blood and body fluid exposures, and it can be transmitted up to 30% of the time, but that is part of the reason why we want employees to be vaccinated, why we want to know what your immunity status is so that we know are you protected if you were to be exposed to hepatitis B or are you not protected and we need to do some additional care steps with you. With splashes to the eyes, mouth, nose, mucosal membranes, those tend to run a little lower of a risk. HIV is typically only transmitted about 0.1% of the time with those. There is not great stats with hepatitis C and hepatitis B for those exposures, but again we would assume that it would be lower just because of the way the injuries occur.
Shaina Farfel: Once an employee has had that consultation, what is the general recommendation for follow-up after these types of exposures and again I know it may depend?
Tanicia Haynes, N.P.: For these exposures, we will have the employee come in and talk with one of the providers. We get information about how the injury occurred. We order some baseline testing for HIV, for hepatitis B, for hepatitis C and then we look at our source patient's information from the labs that they have run, and we typically have a six-week follow up. We will repeat an HIV test and we also repeat a hepatitis C test where we are looking to see if the person is now making virus, that the employee is making virus after the exposure, and then we also have a four-month follow up testing where we repeat an HIV test and we can at times repeat a hepatitis C antibody at that point as an additional check after someone has been exposed to someone else's body fluids.
Shaina Farfel: Thank you so much for sharing this information today. I think it will be really helpful to our employees. As I said here at Occupational Health, we do see this happen daily for folks, so it is a common occurrence. You can always go to Occupational Health's website for more information, and I will be posting some links below this podcast as well. Thank you again, Tanicia.
Tanicia Haynes, N.P.: Thank you.
Shaina Farfel: Thanks for listening. If you have a story suggestion, you can use the Contact Us page on our website at www.vumc.org/health-wellness.