Bloodborne Pathogen Exposure

Below are instructions and forms for handling a bloodborne  pathogen exposure.

 Clinical Areas & Patient Care Areas

  1. If exposure occurs during the hours of 7:30 am and 5:00pm, Monday-Friday, proceed to Employee Health & Wellness immediately.  Please bring a source patient label with you.
  2. If the exposure occurs after 5:00pm, Monday-Friday, during the weekend, or on a holiday, proceed to the Emergency Department immediately.  Please bring a source patient label with you.
  3. Have your immediate supervisor complete the Source Individual Testing Consent Form and have a physician sign consent.  The supervisor then needs to obtain the lab specimen.  If the source patient refuses testing, the supervisor is to have two physicians complete the Source Individual Testing Refusal Form
  4. Complete the Source Patient Lab Form and send the form with specimen to the lab.
  5. If seen in the Emergency Department, please follow up with a visit to Employee Health & Wellness on the next business day.  Please review the Post Exposure Information Sheet.
  6. Please have your immediate supervisor complete either the Supervisor's Accident Investigation Report (below) for GRMC employees, or the GRU Employee's Report of Accident/Injury for MCG employees.  Fax the appropriate report to Employee Health & Wellness at (706) 721-0882.

Georgia Regents Medical Center Employee - Emergency Department

  1. Evaluate exposure - if prophylaxis treatment is recommended per CDC guidelines
    a.  Complete:  Appendix A (below) (Policy #4.70.00), page 1 and 2 (prescription)
                         Management of Exposure to Bloodborne Pathogens
    (for pregnant healthcare worker - complete Appendix A-1 (below) (Policy #4.70.00), page 1 and 2)
    b.  Administer medication according to prescription
    Please ensure that the employee has enough medication available until the next open business day in Employee Health & Wellness   
  2. If exposure does not require prophylaxis treatment, please have the employee follow up with Employee Health & Wellness  on the next business day.  Please give the employee the Post Exposure Information Sheet
  3. Have employee complete:  Employer's First Report of Injury or Occupational Disease (WC-1) (below)
    Note:  GRU/Leased employees do not complete this form
  4. Have employee complete:  Authorization and consent to Release Medical Information (WC-207)
    Please ensure the employee completes in full and signs the bottom and dates
  5. Have employee sign:  Worker's Compensation Acknowledgement Form (below)
    Please witness this form with the employee present
  6. Collect urine drug screen, following chain of custody protocol
  7. Give the employee the Supervisor's Accident Investigation Report
     (below) Instruct the employee to have their Supervisor complete and fax to Employee Health & Wellness,
    (706) 721-0882
  8. Instruct the employee to follow up with a visit to Occupational Health Services on the next business day
  9. Fax to Employee Health & Wellness, (706) 721-0882, the following forms:
    a.  Appendix A or Appendix A-1, pages 1 and 2
    b.  Employer's First Report of Injury or Occupational Disease (WC-1)
    c.  Authorization and Consent to Release Medical Information (WC-207)
    d.  Worker's Compensation Acknowledgement Form

Georgia Regents University Employee - Emergency Department

  1. Evaluate exposure - if prophylaxis treatment is recommended per CDC guidelines
    a.  Complete: Appendix A (below) (Policy #4.70.00), page 1 and 2 (prescription)
                        Management of Exposure to Bloodborne Pathogens
    (for pregnant healthcare worker - complete Appendix A-1 (below) (Policy #4.70.00), page 1 and 2)
    b.  Administer medication according to prescription
    Please ensure that the employee has enough medication available until the next open business day in Employee Health & Wellness    
  2. If exposure does not require prophylaxis treatment, please have the employee follow up with Employee Health & Wellness  on the next business day.  Please give the employee the Post Exposure Information Sheet
  3. Have employee complete: GRU Employee's Report of Accident/Injury
  4. Instruct the employee to contact AMERISYS at (877) 656-7475 to report their claim
  5. Instruct the employee to follow up with a visit to Employee Health & Wellness on the next business day
  6. Fax to Employee Health & Wellness (706) 721-0882, the GRU Employee's Report of Accident/Injury

 

Bloodborne Pathogen Post-Exposure Source Individual Testing Consent Form
Source Patient Exposure Lab Form
Bloodborne Pathogen Post-Exposure Source Individual Testing Refusal Form

Protocol Sheet Appendix A
Protocol Sheet Appendix A-1
Campus Accident Report
First report of Injury
Supervisors Accident Report
WC Acknowledgement Form