Post-Exposure Management

An exposure incident is defined as contact with blood or body fluids to which universal precautions apply caused by:

  • Needlestick
  • Knife blade, or other sharp instrument (burr, etc.)
  • Splash to open skin or mucous membrane

As a student, faculty, or staff member of Case Western Reserve University, there is a formal procedure for you to follow after an exposure incident. An exposure incident is defined as contact with blood or body fluids to which universal precautions apply caused by needlestick, knife blade (or other sharp instrument), or splash to open skin or mucous membrane.

First Aid

  • Flush the area of contact or penetration with copious amounts of water and wash with soap if skin surface is affected
  • Notify the person in charge of your clinical activity
  • Follow the protocol for the facility at which you are located
  • Contact University Health and Counseling Services at healthservice@case.edu or by calling the Needlestick Hotline at 216.368.6635. Be prepared to provide your name, social security number, telephone number or email, date and time of the incident, and what treatment has been administered.

Protocols

As a student, faculty or staff member at Case Western Reserve University or OCPM, there is a formal procedure to follow after an exposure incident.

Protocols for Dental Students

  • Report the incident IMMEDIATELY to the Infection Control Officer or the Associate Dean for Clinical Affairs.
  • After filling out an initial report, report to UHCS. Please do not wait, come in immediately after the incident.
  • Have the Infection Control Officer or the Associate Dean for Clinical Affairs talk to the source patient. They will ask the patient to have his/her blood drawn for testing of HBV (Hepatitis B Virus), HIV (the virus known to cause AIDS), or other infectious diseases unless the patient's serostatus is already known to be positive for HBV or HIV. In that case, it will not be necessary to obtain a sample of the patient's blood. Information concerning the patient's serostatus will be provided to the student.
  • The student will have counseling, evaluation, and recommendation for treatment at UHCS or physician of choice.

Protocols for Medical Students and Physician Assistant Students

The student on a clerkship or clinical elective in one of the affiliated hospitals should contact the designated individual, usually infection control personnel or an infectious disease staff member, for up-to-date medical advice at the time of the occurrence.

Cleveland Clinic

  • Call the employee Post-Exposure Hotline at 216.445.0742 to report your incident and be triaged.
  • Obtain an occupational injury form (F4533) from your supervisor. Complete the form and return it to your supervisor for mailing to the Cleveland Clinic Safety Office, Eb5, ext. 42908.
  • Have your blood drawn for testing at the Center for Corporate Health Clinic on the 2nd floor of the Walker center or at desk L-2, which is open 24 hours. Please remember to bring your employee identification badge or a photo ID (driver's license).
  • Call 216.445.6200 to schedule a return appointment at the Corporate Health Clinic within one to two weeks of your initial visit. At this appointment you will receive the results of your serology as well as the results of the source patient if known. Follow-up results are only given in person to protect confidentiality. 

University Hospitals of Cleveland

  • Immediately wash area and wipe with antiseptic. Flush mucous membranes for at least 3 minutes if affected.
  • Complete Employee Incident Form.
  • Examine source patient's chart and assess for risk factors:
    • multiple sex partners (same sex or opposite)
    • homosexuality
    • blood transfusions, organ transplant before 1985
    • IV drug use, skin popping
    • abnormal liver enzymes
  • Employee Health will follow-up if source patient has been discharged or if no known patient was involved.
  • Proceed with form and information about source (if available) to Employee Health on days. Evening/weekend exposures, go to the triage nurse in the Emergency department. 

Metro Health Medical Center

  • Fill out an incident report.
  • If working days, report to Employee Health. If working evenings/weekends, report to the medical house officer on call. The medical H.O. will rate you on a risk scale. The following morning, you are to report to Employee Health.
  • Employee Health will draw your blood and also order a blood draw for the source patient.
  • Employee Health will give results and the appropriate intervention/treatment will be initiated.

Students who experience a needle stick injury or occupational exposure at an affiliated hospital should also contact the 24-hour needle stick hotline maintained by UHCS at 216.368.6635 or send an email message to healthservice@case.edu.

UHCS can provide ongoing information and advice following the acute incident.

If the exposure occurs in a school laboratory you should do the following:

  • Notify the Instructor in charge of the laboratory.
  • Call UHCS Needlestick Hotline 216.368.6635. If the exposure occurs during usual business hours, report to UHCS for appropriate medical care. If the Health Service is closed, call 216.368.2450 and ask to speak with the nurse on-call for directions.

Protocols for Nursing Students

An exposure is to be reported within 2 hours of exposure to the Instructor and UHCS.

The student may choose to follow the procedure at site where the exposure happened or report to UHCS for care.

Cleveland Clinic

  • Call the employee Post-Exposure Hotline at 216.445.0742 to report your incident and be triaged.
  • Obtain an occupational injury form (F4533) from your supervisor. Complete the form and return it to your supervisor for mailing to the Cleveland Clinic Safety Office, Eb5, ext. 42908.
  • Have your blood drawn for testing at the Center for Corporate Health Clinic on the 2nd floor of the Walker center or at desk L-2, which is open 24 hours. Please remember to bring your employee identification badge or a photo ID (driver's license).
  • Call 216.445.6200 to schedule a return appointment at the Corporate Health Clinic within one to two weeks of your initial visit. At this appointment you will receive the results of your serology as well as the results of the source patient if known. Follow-up results are only given in person to protect confidentiality. 

University Hospitals of Cleveland

  • Immediately wash area and wipe with antiseptic. Flush mucous membranes for at least 3 minutes if affected.
  • Complete Employee Incident Form.
  • Examine source patient's chart and assess for risk factors:
    • multiple sex partners (same sex or opposite)
    • homosexuality
    • blood transfusions, organ transplant before 1985
    • IV drug use, skin popping
    • abnormal liver enzymes
  • Employee Health will follow-up if source patient has been discharged or if no known patient was involved.
  • Proceed with form and information about source (if available) to Employee Health on days. Evening/weekend exposures, go to the triage nurse in the Emergency department. 

Metro Health Medical Center

  • Fill out an incident report.
  • If working days, report to Employee Health. If working evenings/weekends, report to the medical house officer on call. The medical H.O. will rate you on a risk scale. The following morning, you are to report to Employee Health.
  • Employee Health will draw your blood and also order a blood draw for the source patient.
  • Employee Health will give results and the appropriate intervention/treatment will be initiated.

As part of the confidential medical record, the circumstances of exposure and a description of the source of the exposure will be recorded by UHCS.

UHCS will assume pertinent post-exposure management including medical treatment and counseling.

Any student who has had an accidental needle stick injury or mucosal exposure to blood or body fluids will bring to UHCS the following information:

  • Patient's name
  • Patient's hospital
  • Patient's date of birth
  • Patient's diagnosis
  • Patient's location

UHCS will contact the infection control nurse at source patient's hospital to obtain any further information on testing needed.

Protocols for KSU-CPM Students

Students, who in the course of their clinical experiences or laboratory work, experience a needlestick injury or occupational exposure should contact the 24-hour needle stick hotline maintained by UHCS: 216.368.6635.

The student should notify the Clinician in the clinic as well as Dr. Robinson who will talk with the source patient and get the necessary lab work done. Dr. Robinson will discuss source patient lab results with the student.

UHCS can provide ongoing information and advice following the acute incident.

If the injury occurs at The Richmond Heights General Hospital: Report to the Emergency Room at the hospital for care.

Protocols for Other Students, Faculty & Staff

Faculty, staff and other students who in the course of their laboratory work, experience a needle stick injury or occupational exposure should contact the 24-hour needle stick hotline maintained by UHCS: 216.368.6635.

The faculty, staff or student should notify their supervisor of the accident immediately.

If the accident occurs Monday - Friday from 8:30 - 4:30, the person injured should report to UHCS for treatment of the injury IMMEDIATELY after the occurrence. Please do not delay being evaluated.

If the accident occurs after normal business hours, call the needlestick hotline maintained by UHCS at 216.368.6635 and follow the directions given on the message or call 216.368.2450 and ask to speak with the nurse on-call.