By: Leslie Canham, CDA, RDA, CSP

Imagine you are working on a patient and as you reach for an instrument, you suddenly feel something sharp. You are bleeding and you realize that you just had an exposure incident! Do you know exactly what to do? When accidents happen you must respond immediately to prevent infection transmission and to comply with the OSHA Bloodborne Pathogen Standard.

Dentists are responsible for keeping their team safe by following all OSHA regulations. This includes training the clinical team annually on Bloodborne Pathogens. If a team member has an exposure to blood or body fluid, they need to know exactly how to respond step-by-step, by step. Just like CPR training can help save a life, a good, well-rehearsed protocol for exposure incidents can reduce the risk of infection transmission.

An effective emergency action plan includes selecting a health care provider in advance of an accident. An outpatient occupational center for work-related injuries is a safe choice. Check with your local hospital or do an Internet search to find one near you.

Next, train the team on the plan and explain the importance of reporting the incident to you promptly. This way you can initiate the exposure incident protocol. Use the sample exposure incident protocol below to conduct training.

Sample Exposure Incident Protocol
When an exposure incident occurs, immediate action must be taken to assure compliance with the OSHA bloodborne pathogen standard and to expedite medical treatment for the exposed employee. Below is a sample written exposure incident plan.

1) First Aid -Provide immediate care to the exposure site.
– Wash wounds and skin with soap and water.
– For mucous membranes exposures, flush with water.
– DO NOT RE-USE the instrument involved in the accident on a patient!
– Employee must report the incident immediately to supervisor/employer

2) Determine if the instrument was contaminated. If yes, determine the risk associated with exposure by
– Type of fluid (e.g., blood, visibly bloody fluid, or other potentially infectious fluid or tissue).
– Type of exposure (e.g., percutaneous injury, mucous membranes or nonintact skin exposure, or bites resulting in blood exposure).

3) Evaluate exposure source
– Assess the risk of infection using available information.
– The source individual (patient) must be asked if they know their HBV, HCV, HIV status and if not known, will they consent to testing.

4) Refer the exposed employee as soon as possible* to a health care provider who will follow the current recommendations of the U.S. Public Health Service Centers for Disease Control and Prevention for testing, medical examination, prophylaxis and counseling procedures.
– Note “ASAP*” because certain interventions that may be indicated must be initiated promptly to be effective.
– The exposed employee may refuse any medical evaluation, testing, or follow-up recommendation. This refusal must be documented.

5) Send all of the following with the exposed employee to the health care provider:
– A copy of the Bloodborne Pathogen Standard.
– A description of the exposed employee’s duties as they relate to the exposure incident. (Accidental Bodily Fluid Exposure Form*)
– Documentation of the route(s) of exposure and circumstances under which exposure occurred. (Accidental Bodily Fluid Exposure Form).
– All medical records relevant to the appropriate treatment of the employee including HBV vaccination status records and source
individual’s HBV/HCV/HIV status, if known.

6) The Health Care Provider (HCP) will:
– Evaluate the exposure incident.
– Arrange for testing of employee and source individual (if status not already known).
– Notify the employee of results of all testing.
– Provide counseling and post-exposure prophylaxis.
– Evaluate reported illnesses.
– Send written opinion to employer limited to the following
    – Documentation that employee was informed of evaluation results and the need for further follow-up.
    – Whether Hepatitis B vaccine is indicated and if vaccine was received.

Having a well-rehearsed protocol for exposure incidents will help expedite medical treatment for the exposed person. Prepare all of your exposure incident documentation in a file for each employee. Time is of the essence because certain post-exposure medications are more effective if administered within hours of the incident rather than days. Be sure to locate a health care provider near your office before you or anyone in your practice has an exposure incident.

If would like a complimentary copy of the sample exposure incident protocol in word document so you can personalize it, send an email to
Office@LeslieCanham.com.

Ms. Leslie Canham is a speaker and consultant specializing in infection control, OSHA compliance, HIPAA regulations and accommodating and treating special needs patients and patients living with HIV/AIDS. Leslie is a Certified Speaking Professional and lectures nationally and internationally. She is authorized by the Department of Labor as an OSHA Outreach Trainer.