Colleagues,

I’m trying to ascertain, in your respective institutions, where you direct non-employees with potential blood borne pathogen exposures for evaluation and care (including PEP, if indicated).

Our ED colleagues would like to “get out of the business” of seeing BBP exposures, and would prefer these exposures (irrespective of employment status) to be managed by our employee health clinic, to which we are pushing back, and trying to explore other options.

What we currently do at UIOWA is:

• Our own University of Iowa healthcare employees are evaluated during the day by our employee health clinic and after hours/weekends by a nurse call line (aka STICK-line) that follows an algorithm to determine source patient and exposed employee lab testing, risk assessment, and prompt dispensing of PEP meds if indicated though a collaborative practice agreement with our hospital pharmacy. We have previously published our experience with this program (DOI: 10.1016/j.ajic.2024.01.002 )
• University of Iowa health science students (e.g. medical/nursing/PT/rad tech students) are managed by the University’s Student Health service during the day and by ED after hours.
• Visiting/rotating non-UI health science students on electives are referred to Urgent Care/ED and are advised to contact their own institutional student health program.
• Contracted staff (e.g. travel nurses working in our hospital and clinics) are referred to Urgent Care / ED, and thereafter for follow up to occupational health clinic (subject to approval by the Agency’s work comp program).
• Visiting residents/fellows/faculty are referred to Urgent Care/ED and advised to contact their own institutional employee health program. Can be seen in occupational health clinic for follow up, subject to work comp authorization.
• Local EMS responders with BBP exposures are seen in Urgent Care or ED, and follow up is referred to occupational health clinic (subject to work comp approval).
• “Good Samaritan”/bystander exposures are seen in Urgent Care or ED and referred to PCP or ID clinic for follow up.

I’d appreciate any feedback regarding your processes. I’m sure other institutions have also struggled with how to manage employees vs. non-employees who may be exposed while caring for our patients but, due to work comp and other considerations, may have different (and potentially less timely) assessment and care following BBP exposures.

Pat

Patrick G. Hartley,  M.B., B.Ch., B.A.O., M.P.H.
Medical Director: University Employee Health Clinic
University of Iowa Carver College of Medicine
patrick-hartley@uiowa.edu