Blood Borne Pathogen Exposures
Students who sustain a blood borne pathogen exposure during clinical coursework are to call Student Health (843-792-3664) during normal operating hours (Monday - Friday, 8:00 AM – 4:30 PM) to report the exposure. For exposures that occur at MUSC when Student Health Services is closed (after hours, weekends, or holidays), call the MUSC operator (843-792-2123) and have the Hospital Supervisor paged to your extension. If a Hospital Supervisor is not available, have the operator page Dr. Blumenthal to your extension.
Students who sustain an exposure during a rotation at a non-MUSC clinical site are to follow the protocol of that institution and can be seen at MUSC Student Health for any needed follow up (see Non-MUSC Off-Campus Clinical Sites below). Students who are in Charleston on an off-campus clinical rotation can call MUSC Student Health for consultation.
Blood Borne Pathogen Exposure Protocols specific to your location are provided below:
- MUSC Campus - Blood Borne Pathogen Exposure Protocol (pdf)
- MUSC Dental Students - Blood Borne Pathogen Exposure Protocol (pdf)
- MUSC Off-Campus Clinics Blood Borne Pathogen Exposure Protocol (pdf)
- Non-MUSC Off-Campus Clinical Site - Blood Borne Pathogen Protocol Exposure Protocol (pdf)
Immediate Protocol for All Blood Borne Pathogen Exposures includes:
1. TREATMENT OF EXPOSURE – IMMEDIATE:
- Percutaneous Injuries (punctures, lacerations) – Wash with Soap and Water for 5 minutes.
- Non-intact Skin (open abrasions, cuts). Wash with Soap and Water for 5 minutes.
- Mucous membranes (splashes to eyes, mouth, etc.): Flush extensively with water X 5 minutes.
2. REPORT THE EXPOSURE ASAP. For exposures on MUSC campus or MUSC-affiliated Clinics:
- Week Day Exposures: Monday – Friday, 8:00 AM – 4:30 PM – After reporting the exposure to your supervisor, call Student Health (792-3664). A Student Health provider will review the nature of the exposure and will assist in the appropriate management of the exposure.
- Afterhours exposures, weekends, holidays: Call the MUSC operator (843-792-2123) and have the Hospital Supervisor paged to your extension. If a Hospital Supervisor is not available, have the operator page Dr. Blumenthal to your extension.
3. LAB TESTING ON SOURCE: Make sure the source patient remains available to have their blood drawn and be sent for STAT labs (HIV, Hepatitis B Surface Antigen, Hepatitis C Antibody). HIV results on the source patient should ideally be known within 1-2 hours of the exposure, in the event antiviral treatment needs to be initiated.
- Complete Source Patient Lab Request Form for protocol labs – lab request form can be downloaded and printed from this site or Student Health can FAX the lab request to your to your location:
- Draw (1) Gold Top Serum Separator Tube (5 mL minimum volume).
- Label the blood specimen tubes with: Source Patient Name, DOB, and MRN.
- Place labeled specimen and lab request in a Biohazard Bag and immediately transport to MUSC Lab located on the 3rd floor of the Children’s Hospital, SPECIMEN RECEIVING (792-0707) Room # 319 or TUBE to #99.
4. DOCUMENTATION OF EXPOSURE after steps 1-3 completed
- Complete the MUSC Blood Borne Pathogen Assessment Form
- Complete the online MUSC ACORD form: https://www.carc.musc.edu/acord/
- Click on the link: “Online ACORD Form”
- Use your MUSC ID and password.
- For “Employer” there is a drop down menu - > Click “MUSC Student”
- Complete the ACORD Form
5. FOLLOW UP
- Student Health will notify the student with the results on the Source Patient. Rapid HIV results on the Source Patient are generally available within one hour of the specimen being received by the lab. Hepatitis B surface Antigen and Hepatitis C Antibody results are usually available within 24 hours.
Source Patient Baseline Labs (HIV,HBsAg, HCV) all negative: No further action is necessary.
The protocol for students who sustain an exposure to Blood Borne Pathogen (+) Source Patients includes:
- HIV + Source Patient – the risk of HIV transmission from a percutaneous exposure (needle stick, puncture wound, etc.) is estimated to be 3 in 1,000. The transmission risk of a blood splash to the mucus membranes (eye, nose, mouth) is lower (~ 1 in 1,000). The healthcare provider at Student Health will discuss with the student the benefits and risks of anti-viral medications, as well as the lab protocol for monitoring the student. If indicated, anti-viral medication should ideally be started on the exposed student within 2 hours of the exposure, and continued for 28 days.
- Hepatitis B Surface Antigen + Source Patient - For students who completed the hepatitis B vaccine series and have a post-vaccine immune antibody titer (HBsAb ≥ 10 mIU/mL), no further action is necessary. For students who have not completed the hepatitis B vaccine series or did not develop immunity after completing the vaccine series, Hepatitis B Immune Globulin (HBIG) should be given as soon as possible, and repeated 1 month later. Unimmunized students should additionally receive the Hepatitis B vaccine series.
- Hepatitis C + Source Patients: The risk of Hepatitis C transmission from a percutaneous injury is estimated to be close to 2%. There is not an antiviral medication protocol recommended for the period immediately following a hepatitis C exposure, but highly effective anti-viral medications are available to be initiated at an early point in the infection if needed. The exposed student will have labs monitored at regular intervals to detect whether or not hepatitis C transmission has occurred.
Resources For Further Information
- CDC: https://www.cdc.gov/niosh/topics/bbp/guidelines.html
- National HIV/AIDS Clinicians’ Consultation Center (PEP) Line: http://nccc.ucsf.edu/clinical-resources/pep-resources/