[MCOH-EH] [EXTERNAL] Re: BBP protocols

[Swift, Melanie D., M.D., M.P.H.]

Yes, occasionally when the source does not have an identifiable or accessible PCP or care provider, the Occ Med provider evaluating the exposed worker may need to facilitate source patient testing. The source patient needs HIV Ag/Ab, HCV RNA (by PCR), and if the worker is not known to be HBV immune, the source needs HBV surface ANTIGEN (not antibody). The pharmacist's employer will hopefully have a mechanism for you to bill the source patient's lab work directly to them. The patient shouldn't be charged for cooperating with source testing.

Technically, unless an occupational infection occurs, it's OSHA recordable but not a Work Comp claim - there may be no treatment required and no diagnosis. Some companies who are self-insured for WC choose to cover it under WC; other companies just pay from some other internal funding source. Even if WC covers the baseline evaluation of the employee, they would not likely pay for testing the source lab. That's really the employer's responsibility.

Thanks,

Melanie

From: MCOH-EH <mcoh-eh-bounces+swift.melanie=mayo.edu at mylist.net> On Behalf Of Enass Awad
Sent: Monday, November 11, 2024 5:06 PM
To: MCOH-EH <mcoh-eh at mylist.net>
Subject: [EXTERNAL] Re: [MCOH-EH] BBP protocols

Good afternoon:
 In my opinion, I'd the source patient had consented to having their blood drawn and was informed of the incident , then I don't see a problem.

While it sounds like an overall low risk exposure , it does help to know the source patient's infectious disease profile and if they have blood drawn in a timely fashion, it helps guide the decision about whether or not the exposed employee can or should get PEP for HIV.

  A lot of testing and / or treatment sometimes for BBP
is based on individual risk factors and the exposed employee's anxiety level about the incident !!

Enass.

Enass Awad A/Rahman,MD,MPH,FACOEM
Occupational and Employee Health Clinic
UC Davis Health
2221 Stockton Boulevard
Sacramento,CA,95817



"We can enrich the world if we choose to embrace our similarities; we can destroy the world if we choose to emphasize our differences."


On Mon, Nov 11, 2024 at 11:51 Lesoski, Darryl via MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>> wrote:
We had an odd request by a large chain grocery store pharmacy and want to ask for your input.  THANKS ahead of time.

Pharmacy personnel gave an influenza vaccination, then stuck herself with the needle after administrating the vaccine.

Employer Nurse at corporate had BOTH the exposed and source brought to our office wanting us to draw blood on the source in order to fully evaluate the potential BBP exposure and use of prophylaxis treatment.

How would you handle such a request?   What guidance do you use for any type of needlestick and/or BBP exposure?

I would appreciate your insight and opinion as I am a bit (OK - a lot troubled!!) by such a request.   THANKS.  Darryl


Darryl Lesoski, MD, MPH, FACOEM

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Munson Medical Center
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