Health Care Associated Infections

Healthcare-associated infections (HAIs) are infections caused by a wide variety of common and unusual bacteria, fungi, and viruses during the course of receiving medical care.  Wherever patient care is provided, adherence to infection prevention guidelines is needed to ensure that all care is safe care. This includes traditional hospital settings as well as outpatient surgery centers, long-term care facilities, rehabilitation centers, and community clinics.

Nursing professionals are at risk for exposure to infections and blood borne pathogens including the human immunodeficiency virus (HIV) through needles or other sharp instruments contaminated with blood or through splashes of blood onto the mucous membranes of the eye, nose, or mouth or skin. Therefore, universal precautions must be used in all appropriate clinical situations. There are no exceptions to this policy.

Procedures to prevent infection must be implemented in a timely manner for all exposures. Post-exposure prophylaxis (PEP) should begin in 1-2 hours. It may not be effective if started longer than 24-36 hours after exposure.

Procedure

All students must have current health insurance and should carry with them the phone number to call to receive emergency services that are reimbursed by their insurance.

1. Post-exposure: immediately wash cuts and needle sticks with soap and water. Flush splashes to the nose, mouth, or skin with water. Irrigate eyes with clean water or saline.
2. Report the exposure immediately to your clinical faculty and to the health care agency supervisor and ask to be referred immediately to the agency person responsible for managing exposures (occupational health nurse, infection control specialist, emergency department supervisor). The faculty will assist the student in getting immediate care through a provider for whom they have insurance. The faculty is responsible for seeing that an incident report using the agency's form is completed.
3. There is no time to lose following exposure. You need to be immediately seen by a health care provider. You must have counsel regarding the risks of your exposure and weigh the risks and benefits of treatment. Balancing risks is challenging. It is recommended that HIV post-exposure treatment begin within 1-2 hours.
4. Within 24 hours, excluding the weekend, please file an incident report with the Asst. Dean of Undergraduate Program’s office.
5. You should be tested for HIV antibody as soon as possible after exposure and then at 6 weeks, 12 weeks, and 6 months. You should be assured that your test results will remain confidential. If the patient source of the blood does not have a previous diagnosis of AIDS or HIV, the patient should be told of the health care worker's exposure and an informed consent obtained for taking an HIV antibody test. They do have the right to refuse.
6. If you are taking PEP, you should have your blood drawn for a CBC and hepatic/renal function at baseline and at 2 weeks.
7. You should report any severe flu-like illness that occurs during the 12 week follow-up period--this is the usual time for HIV infection to develop. Likewise, most infected people will seroconvert by 12 weeks.
8. During the first 12 weeks of exposure, until your blood test demonstrates that you remain free of HIV infection, you should refrain from sexual intercourse or inform your partner and practice safe (but not risk free!) sex with latex condoms used consistently. In addition, women should not breast-feed during this time.

References

https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/post-exposure-programs-in-the-event-of-occupational-exposure-to-hiv-hbv/