UAB Student/Visiting Scholar Clinical Rotation Blood/Body Fluid Exposure Guidelines

Updated 8/22/2017

This guideline outlines recommended actions following any blood/body fluid exposure to UAB enrolled students or visiting scholars during a clinical rotation.

Students and scholars may be exposed to blood/body fluids in the course of their clinical duties at a UAB facility or at a non-UAB facility where a student is involved in a practical experience for credit at UAB. As all blood and body fluids are considered infectious, regardless of the perceived status of the source individual, all students and scholars must follow OSHA guidelines for universal precautions toprevent contact with blood or body fluids at clinical rotation sites. This includes use of gloves, eyewear, and protective clothing, as well as proper care of sharp objects and other precautionary measures. These guidelines are printed on UAB Medicine safety cards; students should keep a
safety card with them and consult it in the event of exposure.

Definitions

For purposes of this guideline,

1. A “student” is defined as any student enrolled at UAB in a clinical (non-research) setting.
2. A “visiting scholar” is any student, graduate student, post-doctoral student, instructor, or practitioner participating in UAB clinical (non- research) activities for a short-term period.
3. An “exposure” is generally defined as a percutaneous injury (e.g., a needle stick or cut with a sharp object) or contact of mucous membrane or non-intact skin with blood, tissue, or body fluids, whether or not there is visible blood.

Procedure

In the case of any needlestick injury or other accidental blood/body fluid exposure, students and scholars should immediately take appropriate measures as follows:

1. Remove and properly dispose of all contaminated personal protective equipment. Wash the exposed area thoroughly with soap and running water. Use antibacterial soap if possible. If blood/body fluid was splashed in the eye(s) or mucous membrane, flush the affected area with running water for 15 minutes. Remove and dispose of contacts if worn.

2. It is mandatory for students to report all exposures to the host institution and UAB Employee Health as soon as they occur. Contact UAB Employee Health, Monday-Friday 7a.m.-4:30p.m. (closed 12p.m-1p.m.) at 205-934-3675. After hours, between 12p.m.-1p.m. on weekdays, on weekends, holidays and in case the department is closed due to inclement weather call Hospital Paging at 205-934-4311 and ask for the Needlestick Team Member on call.

3. It is mandatory for students to report all exposures to a preceptor /clinical supervisor and UAB program faculty member as soon as they occur.

4. It is mandatory that an incident report be filed at the host institution (if applicable) and at UAB by the student’s program faculty member (https://riskmgt.hs.uab.edu/incident.html). UAB Employee Health can assist the student with questions or concerns.

5. It is mandatory that the student or visiting scholar gather the following information:

a) Identify the HIV, Hepatitis B and Hepatitis C status of the source patient. If a source patient’s serological status is unknown, the student, scholar, or preceptor/clinical supervisor should contact the source patient’s attending physician and request that the physician obtain a specimen for STAT serologic testing. Recommended testing of the source patient includes a Rapid HIV, HBsAg, and HCV antibody. It is critical to ensure that the hosting institution draws labs from the source patient in a timely manner (within 2-4hours). The student should report the results of the serology testing to UAB Employee Health immediately.
    • If serologic testing cannot be obtained on the source patient, seek guidance from the host institution and call UAB Employee Health for further instructions. (See Employee Health contact number and after hours information noted below).
    • If the source patient’s Rapid HIV, HBsAG, and HCV antibody is negative, it is not recommended (per CDC guidelines) for the student or scholar to have baseline or follow-up serology drawn. Do Not go to the ER unless immediate medical attention due to injury from the exposure is necessary.
b) If the exposure warrants blood work from the student or scholar due to positive serology results from the source patient, baseline serologic and vaccination evaluation of the student or scholar should including the following:
    • HIV Antibody, HCV Antibody and any additional labs, as determined by the healthcare provider of the host institution or after consultation with UAB Employee Health, should be drawn.
    • Hepatitis B vaccination and Hepatitis B titer status. If unknown an HBsAb and HBsAg should be drawn.
    • Tetanus vaccination status.

After taking appropriate immediate measures as outlined above, students or scholars should seek further evaluation and care based on where the incident occurred:

For exposures occurring on the UAB campus (UAB Hospital, Kirklin Clinic, UAB outpatient clinics, Non-research labs) or at any institution within a 60 mile radius of the UAB campus. It is mandatory that the student or visiting scholar:

    • Report to UAB Employee Health Monday-Friday (7:00 a.m.- 4:00 p.m.), located on the 1st floor, UAB Spain Wallace S123 (205-934-3675). The department is closed 12p.m.-1p.m. for lunch.
    • After 4:00 p.m., between 12p.m.-1p.m., on weekends, holidays, and in case the Employee Health Department is closed due to inclement weather, call Hospital Paging (205-934-3411) and ask the operator to page the Needlestick Team Member on call. Report to UAB Employee Health the next business day.
    • Continue to communicate with Employee Health regarding all follow-up care.

For exposures occurring at a non-UAB hospital or clinic greater than a 60 mile radius from UAB campus it is mandatory to:

    • Inquire about the institution’s exposure policy. If the host institution or physician’s office offers to provide medical care and recommended testing, have an initial evaluation and follow-up performed there in accordance with the host institution’s policy. Continue to communicate with Employee Health regarding all follow-up care.
    • If the host institution refuses to provide medical care and recommended testing, notify UAB Employee Health at (205-934-3675) immediately for further instructions and contact your program faculty member to complete a trend tracker incident report at https://riskmgt.hs.uab.edu/incident.html. You may be required to report to a local emergency room for initial treatment and/or medical treatment in case of injury.
    • If the hosting facility provides initial treatment, but refuses to provide long-term follow-up care, gather all completed documentation, serologic results from post-exposure, including the patient’s lab work, and notify UAB Employee Health. UAB Employee Health will provide the long-term follow-up care at no charge.

It is very important for blood/body fluid exposures to be reported according to the current guidelines. All students or scholars in a clinical (non-research) placement will be covered for costs incurred in assessing and/or treating potential or actual exposures providing they adhere to this procedure as outlined. This includes costs incurred for any appropriate services rendered (e.g., ER evaluation, including but not limited to lab work, post-exposure prophylactic therapy, immunizations provided onsite or during follow-up at UAB Employee Health), whether on campus or at a non-UAB hospital or clinic.

For treatment costs incurred at or outside of a UAB facility, please forward all invoices/bills (must be detailed/itemized), documentation of exposure/incident report as soon as they are received to:

UAB Hospital Employee Health
Suite SW123
619 19th Street South
Birmingham, AL 35249
Phone: 205-934-3675
Fax: 205-975-6900

For questions, UAB Employee Health may be reached by phone at 205-934-3675 during normal
business hours or by email at employeehealth@uabmc.edu.