DEPARTMENT OF ANESTHESIOLOGY SPECIFIC INJURY / ILLNESS PROCEDURES

The following information applies to ALL housestaff - residents and fellows and non-billing PDAs.

• Injury/Incident:  IF THE INJURY IS NOT AN EMERGENCY REQUIRING IMMEDIATE TREATMENT, YOU MUST HAVE APPROVAL FROM WORKERS' COMPENSATION BEFORE YOU ARE TREATED FOR YOUR INJURY/INCIDENT. If you are injured while in the hospital or clinics between 8:00 am and 5:00 pm, Monday through Friday, and it is not an emergency contact Joanie Nyland at 265-0077.  If the injury occurs after hours you can go to the Emergency Department then report to Joanie during work hours. You can also call Workers' Comp at 392-4940, if Joanie is not available.
• According to the Director of Shands Employee Health Dept. (now called Occupational Health) the Shands Occ. Health department is not authorized by the UF Workers Compensation Program or the College of Medicine's Health Insurance/Managed Care plan to treat residents for injury or incident (other than Blood and Body Fluid Exposure).  An incident/injury report should be completed ASAP (within 24 hours) with your training program office and/or the patient care area in which your incident/injury was involved.  
   
• Blood & Body Fluid Exposure (Revised 8/1/2003- The policy has changed and is now the same for both residents an faculty):  If a Shands Physician (resident or faculty) has an "exposure", the following policy should be followed:

  The following medical care guidelines apply to UF faculty, staff, residents, graduate/teaching/student assistants, and other students with potential bloodborne pathogen exposures.  Because some treatment regimens for bloodborne pathogen exposures must be started within one to two hours of exposure, the following guidelines have been established to ensure prompt and appropriate care for those who have sustained a potential exposure -- needlestick, sharps injury, or mucous membrane splash.

  Faculty, staff and non-student OPS employees (RESIDENTS): You must report all potential bloodborne pathogen exposures to your supervisor (Residency Training Office) AND do the following:
  

• If you are stuck by a needle or sharp object, or have any type of Blood and Body Fluid Exposure, you must call 1-866-477-OUCH immediately.  This is a 24/7 service available 365 days per year that will instruct you on the appropriate action.  It will also implement the Workers Compensation document which means that YOU will NOT be billed for your followup treatment. This policy applies to:
  • UF Employees
  • UF Students
  • UF Medical and Dental Residents
  • UF Fellows and Post Docs
• It applies to all types of exposure including:
  • Needle Sticks
  • Scalpel Injuries
  • Splashes
• This system provides:
  • Dedicated Phone Line
  • Operator Answered
  • Rapid Access to Medical Provider during business hours
  • After hours and weekends ALL persons will be directed to the closest Emergency Room
• This system will also:
  • Arrange Lab Testing for both the patient involved AND the person exposed\
  • Provide Post Exposure Treatment as necessary
  • Collect history of Exposure and Source
  • Provide Follow-up Directions and care at either:
    • SHCC at Shands
    • SHCC Occupational Medicine
• Payment for services will be:
  • UF Employees, Faculty, Anesthesiology Residents and Fellows:  Workers’ Compensation
  • Students – Self pay vs. Individual Insurance

FOR A PRINTABLE BROCHURE OF THIS POLICY, CLICK HERE.

SPECIAL NEW INFORMATION REGARDING HIV TESTING:  From Dr. William Winter, Department of Pathology

The Shands laboratory has run out of the reagent that is needed to run the rapid HIV-1 antibody SUDS test (SUDS = Single Use Disposable System). THEREFORE IN A CASE OF HEALTH CARE WORKER EXPOSURE TO BLOOD OR BODY FLUIDS, STAT TESTING OF THE SOURCE OF THE BLOOD OR BODY FLUID EXPOSURE FOR HIV-1 ANTIBODY IS NOT AVAILABLE AT THE PRESENT TIME.

The SUDS test for HIV-1 antibody had been used to test sources when health care workers were exposed to blood or body fluids. The FDA has not allowed the manufacturer to ship reagent since October 2000 and our lab has run out of the SUDS reagent. We regret that we can not offer the rapid HIV-1 antibody test at this time; however, this is a national problem that affects all 50 States and there is no other FDA-approved, rapid HIV-1 antibody kit on the market. Once we receive reagent we will reinstitute stat HIV-1 antibody testing in cases of health care worker exposures.

Post-exposure prophylaxis (PEP) should be started within 2 hours of exposure if PEP is indicated. Unfortunately at the present time the laboratory can not provide an HIV-1 antibody result on the source within that time frame because the routine HIV-1/2 EIA (enzyme immune assay) test takes at least 2 hours to run. Therefore in managing blood and body fluid exposure, it is not appropriate to wait for the results of the routine HIV-1/2 EIA test to determine if PEP is indicated because this will exceed the window of time available to start PEP if PEP is indicated. The routine HIV-1 antibody EIA test is run Monday through Friday once daily.

To minimize the health care worker's exposure time to PEP, if PEP is indeed begun following an exposure, the laboratory will run the routine HIV-1/2 antibody test on the source the next morning following exposure. We will put on extra HIV-1/2 EIA test runs on weekends if needed. To schedule such a run, please contact the pathology resident on-call. Samples form exposure sources should be submitted to the laboratory by 8 AM to be reported by 2 PM.

In summary: When a health care worker is exposed to body fluids, we recommend consultation with the appropriate provider (e.g., Shands Occupational Health and Safety for Shands staff , faculty and housestaff or the Emergency Room on nights and weekends). The United States Public Health Service published their guidelines for management of health care workers in MMWR 47(RR-7);1-28 (Publication date: 05/15/1998) (Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexposure Prophylaxis). These guidelines can be found on the web at: 

http://www.cdc.gov/mmwr/preview/mmwrhtml/00052722.htm

We appreciate your attention to this matter. Please direct any specific questions via email to Christy Ulm ulmcc@shands.ufl.edu

• Fitness for Duty:    Shands Infection Control Policy (PM 03-06) includes guidelines in which Shands Occupational Health will assess a resident's fitness for duty.  Treatment will be the resident's responsibility; however, Shands Occupational Health will evaluate the following diseases/problems for housestaff:  Chickenpox, conjunctivitis, dermatitis, diarrhea, Hepatitis A, B, C, Herpes Simplex, Herpes Zoster, Impetigo, Influenza, Measles, Mumps, Pulmonary TB, Rubella, Scabies, Staph - aureus, Streptococcus Group A pharyngitis, Cellulitis, URI and Viral Illness with rash or lesions.  If you use this service, your fitness for duty will be documented.  Upon your return to work, you will be required to return to Shands Occupational Health Department for documented clearance to return to work.  You may also use any of the Shands Clinics to make these determinations/recommendations for "fitness for duty".
• TREATMENT:   Each resident will be required to make arrangements for their own care/treatment of any disease, illness or medical problem.  Shands Occupational Health does not provide these treatments. 
  
  Also, please be aware that you should not be writing your own orders, prescriptions, lab requests, etc.  PAYMENTS / REIMBURSEMENTS WILL  ALL BE DENIED BY YOUR HEALTH INSURANCE CARRIER OF SUCH A SELF-WRITTEN ORDER, PRESCRIPTION, LAB OR ANY OTHER SELF-IMPOSED HEALTH CARE CLAIM.
• NEW INFORMATION REGARDING NEEDLE SAFETY ISSUES:

  The Needlestick Safety and Prevention Act (HR 5178)

              On November 6, 2000, President Clinton signed into the law the Needlestick Safety and Prevention Act.  This law authorizes the federal Occupational Safety & Health Administration (OSHA) to revise the 1991 Bloodborne Pathogens Standard to require the use of safety-engineered sharps devices.  This revised standard becomes effective April 18, 2001. 

              Provisions of the new law include:

• Requiring health care employers to provide safety-engineered sharp devices and needleless systems to reduce the risk of occupational exposure to HIV, Hepatitis C, and other bloodborne pathogens.

• Expanding the definition of “engineering controls” to include sharps with engineered sharps injury protection.  This encompasses a broad array of devices that make injuries involving a contaminated sharp object less likely.  The expanded definition now not only includes needleless IV systems and safety needles, but devices such as safety IV angiocatheters, non-glass capillary tubes, blunted suture needles, and retractable scalpels.

• Requiring exposure control plans to reflect these changes in technology.

• Requires each facility to maintain a sharps injury log with detailed information on percutaneous injuries, including the type and brand of device involved in the exposure incident, department where the exposure occurred and an explanation of how it occurred.

• Requiring participation of non-managerial (frontline) healthcare workers when identifying, evaluation, and selecting safety engineered sharp devices, and documentation of this process in the exposure control plan.

Use of safety devices is required NOW.  The new federal law applies to any facilities where employees may be exposed to blood or other potentially infectious material, including hospitals, long-term care facilities, and clinical laboratories.

Shands at UF already has numerous safety-engineered devices available.  The Shands UF Infection Control Policy Manual (PM-03-01—Exposure Control Plan, Addendum 1 to Appendix B) contains a list of approved safer needle devices available through Hospital Stores. 

To review the Federal Register which has the full text of the new law:  www.osha.gov. 

        Revised 7/04