Is this considered exposure?

  1. I had an HIV patient who's new dialysis catheter bled out all afternoon. We held pressure for 2 hours until we could get FFP's in him.. Well anyways one of the nurses got some blood on her shirt and a little bit on her arm. She had no open sores or areas of dry skin of any kind. She promptly washed up and cleaned her shirt with virex... Should this be written up as an exposure? What would u do if it happened to you?

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    About TigerGalLE

    Joined: Feb '07; Posts: 805; Likes: 1,005
    Staff nurse; from US
    Specialty: ICU, Med/Surg


  3. by   PageRespiratory!
    Technically speaking, intact skin is considered an effective barrier. However different institutions have differnent definitions of "exposure". You might want to check your employers policy. I feel its better to be safe than sorry.
  4. by   TazziRN
    I would not consider that an exposure but the facility might have a different definition.
  5. by   flightnurse2b
    i would check with your nursing supervisor... i think it would be better to fill out an incident report just to be safe...
  6. by   EmmaG
    Quote from allison2008
    i would check with your nursing supervisor... i think it would be better to fill out an incident report just to be safe...
    I think one should be filed. If it turns out to be unnecessary, no harm done... but if it isn't filed and something does come of this at some point down the line, she'll have no record of the exposure and probably no coverage under WC if any treatment or followup is needed.
  7. by   ElvishDNP
    I had nearly the exact same thing happen to me as a newbie. I had a pt whose AV access ruptured (it was abscessed and to be repaired in the AM) who had HIV. I ran in and without thinking about it slammed my bare hand down on top of his bleeding arm. The pt (very sweet guy) yelled at me & told me to go put on some gloves while he held pressure.

    I filed an incident report but OH at that facility didn't consider it an exposure. I'd still file a report if there's any doubt. My skin was intact and everything was fine.
  8. by   Xbox Live Addict
    At my work, exposure is gauged in terms of "source" (whether the source of the blood/fluids was known to be negative, positive, or unknown test status) and "port of entry." In order to be a high-risk exposure incident, both the source and the port of entry have to be high-risk. If either one is low-risk, it is a low risk exposure. Check with your facility's official policies, and err conservatively if you have any doubts.

    Low-risk source - known negative test status
    High-risk source - known positive test status or unknown test status.

    Low risk port-of-entry - intact skin
    High-risk port of entry - mucous membranes, eyes, breaks in skin
  9. by   TrudyRN
    File an IR, keep a copy. They tend to get "lost". What if she gets sick later? They'll try to deny her WComp claim for her not filing an IR.
  10. by   tvccrn
    How does she know her skin is intact? She's a nurse and most nurses I know have dry skin to some degree. She may think her skin in OK, but there may be microopenings that she isn't aware of. To be safe, I would treat it as an exposure, that way she is covered in the future should something come up.

  11. by   antidote
    You should: ask your nursing supervisor

    I would: file this as exposure. As a poster said above, we can't be too safe about micro-openings in the skin or something she wasn't aware of. Perhaps she just said that so no one would be worried about it and move on? I would have this filed as exposure and be sure to keep a copy.
  12. by   classicdame
    complete a variance report. If nothing else the process for preventing such an occurance ought to be reviewed. Better to be safe than sorry.
  13. by   GeauxNursing
    question for OP: bleeding out around the cath? like where it was inserted? you dont mean out the ports, right? makes me think of LifeSites. does anyone remember these? surgically placed ports into the chest for dialysis access? You punch the needles through the skin til they "click" into place in the LifeSite. i think they were banned or, they stopped making 'em. anyhoo, one pt just started bleeding out of his/her sites one day, I mean BLEEEEEDING. couldn't stop it. gauze after gauze after gauze. it was really scary. he/she finally clotted up after about 20 minutes. now has a graft in their chest. the COOLEST thing to stick. ever.
    i digressed. oops.
  14. by   traumaRUs
    To the OP - definitely do an incident report but don't worry about it.

    Jorisu - yes, I actually have three pts with LIfe-Sites- all have been on dialysis for >8 years and all are in sad shape. However, they work, so we use them. They are also folks who have no other chance for access.