In Case of Needle Stick Injury

1. Wash and clean injury/flush mucous membranes immediately.
2. Assess risk
   1. Characterize exposure
   2. Evaluate exposure by medical history (see attached questionnaire)
   3. Evaluate and test exposed individuals
3. Perform Quick HIV test - this test is usually available at your nearest hospital ER. The rapid HIV test should be performed on the Source Patient.
4. Decide whether or not HIV post-exposure prophylaxis is needed with your healthcare provider
5. F/U with a healthcare worker for any pending labs, unknown source patient lab results, or any further questions. Appointments can be made at the LSU Campus Clinic, 478 S. Johnson St, 504-412-1366.

 

The below actions shall be immediately taken following blood or body fluid exposure:

Incident/Accident Reporting: https://www.lsuhsc.edu/admin/pfm/ehs/iaform.aspx

Bloodborne Pathogens - Exposure Control Plan: https://www.lsuhsc.edu/admin/pfm/ehs/docs/EHS300.04%20-%20Bloodborne%20Pathogens%20Exposure%20Control%20Plan.pdf

• Administer initial first aid and wash the affected area (e.g., needlestick or cut) with soap and hot water. 
• If exposure is by splash of infectious materials to the nose, mouth, or eyes, the affected area should be flushed extensively with water, saline or sterile irrigating solution.
• Immediately notify your on-site supervisor (Faculty, Resident, Faculty Site Coordinator) of the incident.
• Document the routes of exposure, the biological material of exposure, and how the incident occurred. Your on site supervisor can assist with the documentation.
• If available, obtain consent from the source patient to conduct a rapid HIV test.  If HIV postexposure prophylaxis is medically indicated it should be initiated promptly, preferably within 1-2 hours after the exposure incident. 
• Seek immediate medical care at the nearest clinic facility.
  • If the exposure occurs at an LSUHSC on-campus facility, report directly to Student Health Clinic located on the 3^rd floor of the Seton Building (478 S. Johnson Street)
  • If the exposure occurs outside of an LSUHSC on-campus facility:
  • During working hours, as able, seek care within the hospital/clinic in which you are currently being trained.
  • It is your responsibility to be familiar with the procedures of the hospital/clinic at which you are training.
  • Students in their rotations that experience exposure at an off-site location should be prepared to report to the institution’s infection control office. This is usually the institution’s employee health service.
  • For those training within a facility without access to immediate care, seek care at the nearest emergency care facility (Emergency room or Urgent Care).
• Once initial medical care is obtained, the student’s on-site supervisor shall notify Student Health at 504-412-1366 or studenthealthstaff@lsuhsc.edu for guidance on follow-up actions. A DA3000 form should be completed: https://www.lsuhsc.edu/admin/pfm/ehs/iaform.aspx 
• The Student Health page contains detailed guidance on student blood or body fluid exposure. 

Blood Monitoring Schedule

Initial Draw:

On Source Patient
Rapid HIV test - 4th generation combination p24 antigen-HIV antibody (Ag/Ab) test is preferred; if not available, do HIV antibody
Hep B Surface Antigen
Hep C Antibody or Hep C RNA (Hep C viral load)

On Healthcare Worker
HIV Antibody (rapid test if applicable)
Hep B Surface Antibody

Hep B Surface Antigen

Hep B Core Antibody total

Hep C Antibody

CBC, CMP, urine pregnancy test if planning to take post exposure prophylaxis medications.

• Ideally, initiate medication within 30-90 minutes of exposure, but at least within 72 hours
• Follow up with healthcare provider within 72 hours. Call the LSU Campus Clinic, 478 S. Johnson St, 504-412-1366 for an appointment.

 

• HIV Post-Exposure:
• If 4^th generation combination HIV p24 ag/ab testing used, follow up lab testing at 6 weeks, then 16 weeks is sufficient.
• If 4th generation combination HIV p24 ag/ab testing not available, perform HIV antibody testing for at least 6 months as follows:
  • At 6 weeks: HIV antibody
    At 3 months: HIV antibody
    At 6 months: HIV antibody
    At 1 year: HIV Antibody (recommended if source patient was co-infected with Hepatitis C)

• PEP Meds -- Isentress 400 mg twice daily and Truvada once daily for 28 days

  Pregnant Women: Combivir and Kaletra

• Hep C Post-Exposure: If HCV RNA test available, as early as 3 Weeks Post-Exposure:
  • HCV RNA. If negative, no further testing needed
  • If HCV RNA test not available, test for Hep C Ab w/reflex to HCV RNA as early as 4-6 months post-exposure

• Hep B Post-Exposure - If source patient tests negative for Hep B surface antigen, no follow-up Hep B testing is necessary for the healthcare worker.
• If source patient tests positive for Hep B surface antigen, for exposed person who do not have HBV immunity, a test for Hep B core Ab (total) is drawn, followed by administration of HBIG x 1 and the first Hep B vaccine (the first of three shots administered over six months) for postexposure prophylaxis. For persons who do not respond to HepB vaccine (Hep B non-responders), a Hep B core Ab should be ordered. HBIG is administered at time of exposure then again one month later. The standard adult dose of HBIG is 0.06 mL/kg administered intramuscularly. HBIG can be administered simultaneously with HepB vaccine but at a different injection site.

https://www.cdc.gov/mmwr/preview/mmwraspx/rr6210a1.htm

 

Source Risk Assessment Questionnaire

Have you ever tested positive for HIV? Yes/No
Have you ever tested positive for Hepatitis B or Hepatitis C? Yes/No
Have you ever had a sexually transmitted disease? Yes/No
Did you receive a blood transfusion or blood products between 1978 and 1985? Yes/No
Have you ever used needles to inject street drugs? Yes/No
Have you ever shared needles to inject street drugs? Yes/No
Have you ever had sex with another person with HIV and AIDS? Yes/No
Are you a male who has had sex with male partners? Yes/No
Have you had sex with a person who injects street drugs? Yes/No
Have you ever traded sex for money, drugs, food or housing? Yes/No
Have you had unprotected sex (of any kind) within the last 10 years with someone other than your spouse? Yes No
Have you ever been sexually assaulted? Yes/No
Have you had occupational exposure to blood or body fluids such as a needle stick within the last 10 years? Yes/No
Do you have a sex partner with any of the above risks for HIV? Yes/No
Are you or may you be pregnant? Yes/No

Comments:

Signature: ___________________________________________

Date: ___________________________________________

Reviewed By: ___________________________________________

 

NEEDLESTICK BENEFIT

Administered by Blue Cross and Blue Shield of LA

 Needlestick injuries that expose students to blood-borne pathogens are an important public health concern and Blue Cross Blue Shield of Louisiana offers a separate Needlestick benefit, which is available on the Basic Blue Plan or as a standalone option. This benefit provides coverage for Eligible Students for testing and prophylactic treatment of blood borne diseases following at risk contact with blood or other bodily fluids from human or animal sources. The contact may include, but is not limited to, needlesticks. This benefit will cover 100% of the Blue Cross and Blue Shield of Louisiana Allowable Charge for the physical evaluation, Physician office visit, student health clinic, outpatient facility, Hepatitis and HIV Antibody and Antigen tests, and an initial round of Hepatitis B vaccine.

Place of Treatment - According to the Blue Cross Blue Shield of Louisiana Schedule of Benefits, the only claims eligible for 100% coverage are claims submitted with ICD-10 Codes W46.1XXA, W46.1XXD, W46.1XXS, Z57.8 and Z77.21 regardless of the place of treatment. Medical students be sure to tell the examing provider that one or more of these diagnosis codes must be used to cover your visit.

This Benefit Plan does not cover any Inpatient Admission, additional or follow-up testing or treatment not specific to needlesticks, antiviral or antibiotic treatments or pharmacy benefits outside of those specifically listed under the Prescription Drug Benefit section below.

In the case of a needlestick injury, please visit BCBSLA's website at www.bcbsla.com for all in-network providers and facilities. Students who have Medicaid as their primary insurance must present both their needlestick card and their Medicaid card to ALL medical providers. 

 

Blue Cross Blue Shield of Louisiana Insurance Company
Louisiana State University Needle Stick Standalone Benefit Summary

Coverage is provided for eligible students for testing and prophylactic treatment of blood-borne diseases following at-risk contact with blood or other body fluids from human or animal sources. This contact may include but is not limited to needle sticks. This benefit is not subject to any co-payment or annual deductible requirement.

Services must be received at: Louisiana State University Health Sciences Center Student Health Center (LSUHSC Student Health Center), Children's Hospital New Orleans, Our Lady of the Lake, Baton Rouge General Hospital, Women's Hospital in Baton Rouge, Ochsner Hospital, Ochsner Baptist, Baton Rouge General Occupational Health, LabCorp, Our Lady of Lourdes Rapides Medical Center,University Medical Center New Orleans, Lafayette General in Lafayette, Walter Moss Medical Center, Leonard Chabert Medical Center, Lallie Kemp Medical Center, Bogalusa Medical Center, Touro Infirmary, East Jefferson General Hospital, and West Jefferson Medical Center. Any services provided outside of these providers are excluded from coverage.