Blood splatter

[Beijos]

I was splattered in the face with blood yesterday on my unit. It got all over my face near my eyes, nose, on my mouth. I am pretty sure it got in my mouth as well due to the taste. Of all things I was doing a finger stick....which just amazes me that it happened considering I usually have to fight for a measly amount of blood from those. Anyway, immediately after I washed my face and mouth out, I went to the desk to ask what I am supposed to do. I am a brand new nurse. I couldn't find the policy and it was our charge nurse's first time being charge at the hospital because she is pretty new. She said call our manager since she did not know. Ironically, my manager is just as new as her and she said for me to call employee health. I called employee health right way, unfortunately they were closing. I asked them what I am supposed to do and they said I could come over tomorrow and that is all I needed to do. So I come in this morning and they give me a slip and tell me to go to the lab to get my blood drawn and that's it. I get to the lab and tell the tech I am a bit confused as to why I have not had to fill out any papers or answer any questions, etc. In addition, my slip does not have the exposure panel for employees checked either. Now they were checking all the same labs except for Hep B which I have been immunized for, but I thought it was odd and so did the tech. The tech told me to go back to employee health after my blood was drawn to see what the situation was. I asked them and they said that they did not consider me being exposed so I didn't have to fill anything out not even an incident report. I thought this was BS so I went over to my unit and filled one out anyway. I am concerned because although the likelihood that I got something is small, they don't even think it is possible. They aren't even having me do follow up draws at the very least. I was hoping someone would know when exactly they do follow up draws so I can get tested again even if they won't. I emailed my nurse manager and have attempted to call her again to see if maybe she could at least help me out but I am just waiting here for a response back and getting very upset. Please help.

[mpccrn, BSN, RN]

after an exposure......and you were exposed, you should have labs drawn as well as the patient to whose blood you were exposed to. if both test negative, follow up labs are usually not required. if you are still concerned, labs in 6 months on yourself should put your mind at ease.

[SICU Queen]

What happened to you IS an exposure, and should be handled just like a needle stick, or any other exposure, would be.

[fuffie]

Your facility should have a written exposure protocol. I have had exposures and typically, there are baseline labs done, MD can request testing of pt for Hep and HIV you should be counselled abt PEP(post exposure prophylaxsis) if pt is righ risk,ie has history of IV drug use, high risk behaviors. Usual follow up is 3 mos, 6 mos and 1 year. Document exposure through incident report. It concerns me that this information was not a part of new employee orientation and that those that should have the info didn't. It also concerns me that employee health had such a blase' attitude about it.

[rneducator456]

I would definately follow up and be a pest with the Manager.

You were exposed and an incident report should have been written and you given and kept a copy. In case you did not, get a notebook and write the date, time, unit, patient name, hospital id if possible. Also write down WHO saw the exposure, who you spoke to, lab person, manager names, and anyone elses name who you spoke to AND their responses.

Don't tell anyone you are 'writing this all down' just keep it filed in your home.

Look for the blood exposure policy in the unit (SOP) and of the hospital. It (should) be on the unit in a binder and incidents reports should be there also. If you can, make a copy for yourself and bring it with you when you meet the manager.

This is unfortunate that the managers were blaze' about it and just because they are ignorant of the policy is no excuse.

Once you have the policy in hand if the manager does not answer or respond I would go above her.

If there is NO written policy for blood exposure, look at the CDC

http://www.cdc.gov/niosh/topics/bbp/ site and

the 'National Institute of Occupational Saftey'

C:\Documents and Settings\user\Local Settings\Temp\Exp_to_Blood.pdf

Good Luck be Well

[luvkitties]

I was splattered in the face with blood yesterday on my unit. It got all over my face near my eyes, nose, on my mouth. I am pretty sure it got in my mouth as well due to the taste. Anyway, immediately after I washed my face and mouth out, I went to the desk to ask what I am supposed to do.

So sorry about what happened...you must have been terrified :icon_hug: For your NM and EHS to be so complacent with what happened and how it's (not) being handled is ridiculous.

I work nights, so as you can imagine, not much is open. If I had been in your situation, I would have first went to the nearest sink/wash station and flushed my whole face and mouth with water for several minutes. Then I would have went to the ER.

I would also demand to be tested for BBP's (mainly HIV and Hep C) and have someone attempt to get consent from the source patient.

This is your health and your life; don't let clueless, complacent idiots influence the outcome.

[glamgalRN]

omg I can totally relate to you! I'm a new nurse too and got a drop of blood on my arm from an accucheck from a patient with hep c and HIV. I immediately got alcohol pads and wipped the blood off and washed my arm. Then I asked my preceptor what to do and she gave me the "do whatever you feel is best" kind of answer. So after work I went down to the ER and the told the triage nurse what happened and she tried to make me feel better by pointing out two two drops of blood that were on her scrub pants and told me she gets blood on her all the time and it's no big deal. At that point I felt embarrassed that I overreacted but it's just sooooo scary. When the docs came in they told me I really shouldn't be worried and if I want I can go to employee health to get my blood drawn. I realize hiv and hep c are transmited from blood to blood contact but I can't help but worry!

Maybe you should go to your PCP and get blood drawn there? Or demand that employee health draw your blood in a few months? I'm not really sure what to tell you, I just want you to know that you're not alone, I feel your pain! ::hugs::

[Straydandelion]

Are you in the US? This exposure plan is required to be on file at most places that exposure is likely.

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051

[Beijos]

First of all, yes I am in the US....Second....

So this is what happened:

My manager forwarded on my email to the manager of employee health, which ironically was the woman who was rude to me and said it wasn’t an incident and made me cry (I’m a cry baby). Well, I heard nothing back all yesterday from my manager. I went in to work today and tried to find my manager but she was out for a class. So I was upset that I hadn’t heard back from her. I didn’t know what to do so since everyone was telling to me go the house supervisor I did. The supervisor was nice to me but it was like pulling teeth to still get something done. Finally she called the manager in employee health and the lady said it was ok to draw the labs of the patient (which is one of the things I wanted to be done the day before but for some reason or another my crying wasn’t enough for her to give in). The house sup told me that I had to walk over the unmarked labs over to employee health and they would send them. So I started feeling like this was fishy again but apparently it is because of HIPPA or that is what I was told. I was just getting paranoid that this was somehow going to be swept under the rug considering they were the ones that didn’t consider this an incident. So…I get over there and say I have to see the manager to give her personally the labs. At this point I couldn’t help but get angry. I very b*tchily asked why this couldn’t be done yesterday. Then the manager said it could have….ummm yeah right. I asked why didn’t they when I asked why they couldn’t do anything else, etc… No reasonable answer…that makes sense really was given. Then she started lecturing me for contacting the house supervisor for this incident claiming if I would have came over today she would have gladly done stuff for me. Again, yeah right….just like she gladly did it yesterday? She also said that she told my manager yesterday that I could have the sources labs taken if I wanted as well. Now this could be true, considering I haven’t spoke with my manager, but I would think she would have called or at very least emailed me back to tell me this. After the conversation went on the manager did get a bit more polite with me, although to be quite honest I wasn’t feeling too friendly at all. I told her she needed to be a bit more sensitive to others. After everything, I will get follow up labs if I wish in Jan, April and October. In addition, I should find out tomorrow about the source. So in the end, I am happy that I got my follow ups and the patients labs drawn. But I did have to be what I consider to be a mega-b*tch to get my way and I don’t think it had to be that way….and I’m sure I’ll be hearing about someday down the road like in perhaps annual review. But hey…like I believe someone said before, it’s my life we are talking about here. Oh one other thing…I did also get lectured on how I still did not have an exposure in her opinion. In addition, she told me never to consider urine, vomit, sputum, or feces as body fluids unless it has visible blood in it. According to her that is the CDC’s rules….I couldn’t believe that either. I don’t know how many times I’ve sent down a stool for an occult as a student and I could not see visable blood but I could tell it probably did have it in it mostly by color/smell….and it would be positive. So whatever….I’ll still freak out if I get vomit in my eyes.

Third....thanks to all who replied.

[vamedic4, EMT-P]

First and foremost - leave a paper trail of what happened. WRITE AN INCIDENT REPORT. If your facility doesn't have a specific form, then you need to write down exactly what happened on a sheet of paper, type it up, whatever. Use the patient's full name and date of birth and/or medical record number. This way you know exactly which patient it was.

Turn one sheet in to Employee Health, one to your manager, and keep a few for yourself. Their policy should be one where your blood is drawn, the pt.'s blood is drawn and tested for HIV/HBV, and then you should be followed up with visits to Employee Health at 3 and 6 months, then again at a year. That's how we do it, anyway.

I've had several things like that happen to me...putting the cap on a bullet after drawing blood, the cap didn't want to go on, blood splashed in my face and eyes. Nasty.

Get to employee health as soon as they are open. Fill out any required forms. Keep copies for yourself. If they don't have forms, freehand it.

Best of luck.

Oh, and to add..it doesn't sound as if your management truly has a clue. Better safe than sorry. If you have to drag someone in to do their jobs, do it. As you said, it's your life, and your livelihood. In this case, you come first.

vamedic4

The part about unmarked labs from the patient is BS too. Always label your specimens. Always. HIPPA doesn't come in to play in the above scenario - at all. Imagine if we were all Jane and John Smith...that would make for a nightmare. Label = good. No label/name=bad. People who don't understand that = stupid.

[rneducator456]

Hello ,

I became curious when I read the part you stated you were told " you did not have an exposure because urine, vomit, sputum, or feces is not an exposure unless it has visible blood in it" and it was "CDC's rules."

I am outraged so I looked this up in the OSHA website.

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051

According to OSHA an Exposure Incident is defined as "a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties."

Other potentially infectious material is defined as (1) The following human body fluids: semen, lady partsl secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.

may or may not include blood.

If you work in a hospital the standards are set by OSHA as far as what to do during an exposure

Be Well! good for you