"Nuts & Bolts 2" - A Guide to the Clinical Years Section 2: Vital Information for Clinical Clerkships Table of Contents Needlestick & Exposure Hotlines HIV Post-Exposure Prophylaxis Hotline (PEPLine) Assessing the significance of exposures to blood-borne pathogens can be difficult and selecting drug regimens to treat exposure to HIV post-exposure prophylaxis (PEP) can be challenging. The National Clinicians' Post-Exposure Prophylaxis Hotline (PEPline) was established to give 24-hour/day advice to clinicians who manage occupational exposures and to healthcare workers who are exposed to blood and bodily fluids. The line is staffed by expert clinicians at SFGH and is headed by Dr. Ronald Goldschmidt, professor of family and community medicine. The Health Resources and Services Administration (HRSA) and the Centers fund the PEPline for Disease Control and Prevention (CDC). HIV-positive health care workers can also seek advice if they are concerned about exposing a patient to HIV. For complete details on these programs visit them at http://www.ucsf.edu/hivcntr/ HIV PEPLine ...............................(888) HIV-4911 What should you do if you are exposed to blood or bodily substances during a clerkship? Call the needlestick hotline or beeper at your hospital. If you are in Fresno, or another out-of-town hospital, you should follow the standard procedure at your location. This will usually mean calling the nurse in charge of infection control. Report exactly what has happened and follow the appropriate protocol. Alternatively, you can call the UCSF needlestick hotline or access the above Web site. If you need blood testing, the needlestick beeper/hotline operator will facilitate it. You may continue to receive counseling and treatment from the infection control team at your site, but you may also need follow-up testing in several weeks when you are no longer at that hospital. The Student Health Services will treat any students who become ill while registered at UCSF, no matter what the source of their illness. In addition, disability insurance has been provided at a minimal cost to all medical students in the state of California. The University provides such disability insurance coverage for any student or house staff member who acquires HIV infection as a result of job-related exposure in a University-affiliated hospital. This group policy is underwritten by The Guardian and can be converted to an individual policy upon graduation. If you think you have been exposed to the Human Immunodeficiency Virus (HIV) or hepatitis B (HBV), you should immediately contact: SFGH - VAMC 24 Hour Needlestick Hotline................(415) 469-4411 •Immediate treatment and referral •Confidential baseline testing, counseling, and follow-up •Source patient testing UCSF - Mt. Zion HIV/HBV Needlestick/Exposure Hotline ............(415) 719-3898* Report all needlesticks and bloodborne pathogen exposures to the hotline. Services provided by Employee Health Services include counseling, source testing, vaccines, on treatment and follow-up evaluation when indicated. * Use a touch tone phone, wait for the beep, enter your phone number, press # key. HIV Assessment and Prevention Services..........(415) 206-8972 • Pre- and post-test counseling for patients • Multilingual services • Trouble-shooting HIV tests • HIV counseling training For Placements at Non-UCSF Facilities: Facilities such as Kaiser, CPMC, and Highland, for example will perform source patient testing when an exposure is reported at their sites. Generally, you need to notify your supervising faculty who will advise you of the number to call to report exposures. It will probably be Employee Health or Infection Control Services. You may get treated through the ED at the site where you were when the exposure occurred. When you do, your student health insurance will be billed and you will need to notify Student Health and handle the paper work etc. involved in this, as you would for any medical treatment. Alternatively, you may page the UCSF Needlestick hotline for phone evaluation of your exposure and PEP recommendations. If you elect to take PEP, you may get it through the Hotline at UCSF. This would entail returning to UCSF pharmacy for medications and follow-up visits. The inpatient pharmacy is open 24 hours. Driving or taking a taxi to UCSF would be at your expense, but PEP and follow-up would be provided at no cost. The best way to prevent HIV and Hepatitis C infection is to avoid exposures such as needlesticks, lacerations, and splashes to eyes, mouth or non-intact skin. Medical students often report splashes to their eyes or mouth during procedures in which they were "just observing." This is especially true in L&D. Recommendations: 1) Always wear a facemask with eye shield at C-Sections and vaginal deliveries (even if you are the only one in the room wearing such). 2) Don't wear contact lenses if you can help it. If you can't, keep a backup pair of glasses or contacts with you in case you are advised to remove and possibly toss out contaminated soft lenses. Soft lenses cannot be decontaminated and should be replaced if blood is splashed to one's eye. 3) DOUBLE GLOVE in surgical settings such as L&D. Get used to this now at the start of your medical career. 4) SAFETY DEVICES ARE MANDATORY for phlebotomy, IVs, ABGs, blood cultures, and injections. So look for and ask for safety devices or Engineered Sharp Injury Protection devices at any facility. Know how to and do activate the safety feature. If you are not familiar with the device used at this facility, ask for instructions before you use it. 5) Discard sharps at point of use into puncture-resistant sharps containers. 6) DO NOT RECAP, BEND, OR BREAK NEEDLES. All students are required to get annual PPD skin tests at the Student Health Service to see if they have been exposed to tuberculosis (TB). Failure to do so will result in a hold being placed on their registration.