Bloodborne/Infection Control

Post-exposure management is required when Event, Exposure, Expectation, and Susceptibility are all present:

Immediately do the following:

Helpful Information

What to expect from the Occupational Health Nurse

1. After exposure, you and the source person (if known) will be tested for Hepatitis B, Hepatitis C, and HIV antibodies. The OHN will provide you with your results and will provide follow up recommendations based on the source results.

2. When the source is high-risk or unknown, you will be sent laboratory requisitions for follow up blood-work for over the next nine monthsǂ.

3. If you need to be revaccinated for Hepatitis B you will be advised by the nurse when she reports your test results.

4. Please inform the OHN if you received HBIG, Hepatitis B, Tetanus booster and/or antiretrovirals in the ED.

5. If an anti-retroviral medication starter kit is ordered by the physician in the ED and you decide to take it, you must contact your personal physician within two days to have the rest of the medication ordered and to have baseline blood tests done. Your physician will reorder the anti-retrovirals from the SPH Centre for Excellence in HIV/AIDS. You must pick up the medication from SPH.

What precautions to take until all results are negative?

1. Inform your personal physician, dentist, and other healthcare providers that you are being tested for Hepatitis and HIV. Remember, as well, to inform them when testing is finished and you have the final results.

2. Do not donate blood, body fluids, breast milk, tissue, sperm, or organs for nine months after the injury.

3. Practice safe-sex: use condoms with water-based lubricant for all acts of sexual intercourse.

4. Do not become pregnant. If you are pregnant of become pregnant, see your doctor or call the Oak Tree Clinic at BC Women’s Hospital at 604-875-2212 or toll-free at 1-888-711-3030.

5. Discontinue breast-feeding, or express and discard the milk.

6. Do not share toothbrushes, dental floss, razors, needles, or any other implements that may be contaminated with blood or body fluids.

When you call the Workplace Health Call Centre (WHCC) at 1-866-922-9464:

1. You can speak with an Occupational Health Nurse (OHN) directly when you call; who will ask you to describe the incident, provide support, and ask you to go to an ED for treatment if you have not already done so.

2. After exposure, you and the source person (if known) will be tested for Hepatitis B, Hepatitis C, and HIV antibodies. The OHN will call you with advice on any follow-up based on the results.

3. Inform the OHN if you have received medications/immunizations in the ED.

4. When the source person is considered high-risk or unknown you will be sent laboratory requisitions for follow-up blood work for the next nine months.

5. The OHN will inform you of any precautions you might need to take until you are informed that all test results are negative.

Site Specific

SPH Post-Exposure Protocol:

Advise your supervisor of the incident. Call Security at x4777 to dispatch a First Aid Attendant, who has all necessary forms to fill out.

If the source person is onsite, ensure your supervisor or source person’s physician obtains informed verbal consent for a blood sample, either from the source person (if competent – i.e., if they are able to provide consent) or the family (not competent). The physician must complete an order for the blood test.

Complete applicable sections of the “BBFE Early Notification Form” and fax it to Workplace Health Call Centre at 604-953-5138. Your supervisor will assist if necessary.

The First Aid Attendant will accompany you to the ED (Fast Track) for assessment and possible treatment. Take the BBFE form with you.

Employees are encouraged to attend an ED with a colleague who will be able to assist with navigating through the ED triage so that exposure assessments are completed within the critical two-hour window.

For safety purposes, it is highly recommended that employees working in buildings without an ED either have a colleague drive them to an ED or take a taxi (whose expense will be covered by the employee’s manager). Discuss taxi transfers and colleague accompaniments to an ED with your manager for final approval.

Call the Workplace Health Call Centre at 1-866-922-9464 to report the incident and to speak with an Occupational Health Nurse (OHN)*. Identify yourself as a resident and VCH Employee. If you get a voicemail message, leave a message with your name, ID#, where you work, your phone number, and best time to reach you. If a message is left after hours, you will get a call back during the next business day.

VGH Post-Exposure Protocol:

Advise your supervisor / manager / charge nurse of this incident and refer to the form HLTH 2339, “Management of Percutaneous or Permucosal Exposure to Blood and Body Fluid/laboratory Requisition” (available here)

If the source contact is on-site, ensure that your supervisor or source person’s physician obtains informed consent for a blood sample either from the source person (if competent) or the family (not competent). Make sure the physician completes the requisition for the sample.

Complete applicable sections of HLTH 2339 and give a copy to your supervisor/manager/charge nurse (not the top white copy). The copy can be used by the source person’s physician to complete and send with the source person’s blood for testing to BCCDC.

Immediately take the original of the HLTH 2339 form to the nearest ED (not SPH or MSJ as PHC has a different procedure) within two hours of the incident. If you are a VCH employee at a non- VCH site, ask that the HLTH 2339 form be faxed to the Workplace Health Call Centre (WHCC) at 604-953-5138 before your bloodwork is sent for testing.

Employees are encouraged to attend an ED with a colleague who will be able to assist with navigating through the ED triage so that exposure assessments are completed within the two- hour window.

For safety purposes, it is highly recommended that employees working in buildings without an ED either have a colleague drive them to and ED or take a taxi.

Please discuss taxi transfers and colleague accompaniments to an ED with your manager for final approval.

Call the Workplace Health Call Centre at 1-866-922-9464 to report the incident* and to speak with an Occupational Health Nurse (OHN). If you get a voicemail leave your name, ID#, where you work, your phone number, and the best time to reach you for a callback. If a message is left after hours, you will get a call back the next business day.

Several resources are available online!

BC Centre for Disease Control – Communicable Disease Control Blood and Body Fluid Exposure Management

BC Centre for Disease Control – Surveillance Forms

CPSBC – Infection Prevention and Control – Sharps Safety

LearningHub – Infection Prevention and Control Practices for Direct/Professional Clinical Care Providers

VCH – Routine Infection Control Practices in the Community

WorkSafeBC – Controlling Exposure to Infectious Disease

WorkSafeBC – Controlling Exposure to Plume in Healthcare

Codes

Dosimeters

If you do not have a dosimeter and need one contact your supervisor to get connected with the correct admin. If they are unable to provide one, please contact peoplesafety@vch.ca

Exposure, Injury Or Illness

What to do if you have been exposed through a needlestick injury, puncture wound, cut, or splash:

1. Seek immediate clinical assessment and/or first aid following your worksite BBF (blood and bodily fluids) exposure protocols. Antiretroviral prophylaxis, if required, is most effective when started within two hours of the exposure. If you need to leave your work area, tell your supervisor. This might be your preceptor, attending, program director, or senior resident.

2. If you haven’t already, notify the person supervising you so that they know what happened. Make sure you say that the incident happened at work.

3. As a health authority employee, it is critical that you report the incident by phoning the Workplace Health Call Centre on 1-866-922-9464. When they call you back, you are entitled and supported by both the employer and UBC to take clinical time to respond to the workplace call centre, any investigation that results and WorkSafeBC if necessary.

4. Start a confidential WorkSafeBC claim for medical treatment and/or missed time from work. Complete a WorkSafeBC form online (www.worksafebc.com), or by Teleclaim (1-888-967-5377). The workplace health call centre can also connect you with WorkSafeBC during your call.

5. Create a confidential permanent record of your exposure. Complete a WorkSafeBC Exposure Registry Form. Available online (worksafebc.com). This step is important so that you are not billed for any necessary tests. Results will be delivered directly to you and will not be shared with WorkSafeBC.

6. Participate in the incident investigation with the JOSH committee. Ask your Health and Safety Advisor for support if need be. If you are not sure who this is, contact RDBC.

7. For additional support and guidance, or if you experience any challenges with the reporting process, let a Resident Doctors of BC representative know about the report by emailing or calling RDBC at info@residentdoctorsbc.ca or (604) 876-7636. All information shared with RDBC will be treated confidentially unless we are instructed otherwise by you.

Injury or Illness

What to do if you are physically injured at work or become ill because of your work:

1. Seek first aid or medical attention as soon as possible. If you need to leave your work area, tell your supervisor. This might be your preceptor/attending/program director, or senior resident. Make sure you say that the incident happened at work.

2. If you haven’t already, notify the person supervising you so that they know what happened. Make sure you say that the incident happened at work.

3. As a health authority employee, it is critical that you report the incident by phoning the Workplace Health Call Centre on 1-866-922-9464. If you call after hours, leave a message. When they call you back, you are entitled and supported by both the employer and UBC to take clinical time to respond to the workplace call centre, any investigation that results and WorkSafeBC if necessary

4. Start a confidential WorkSafeBC claim for medical treatment and/or missed time from work. Complete a WorkSafeBC form online (www.worksafebc.com), or by Teleclaim (1-888-967-5377). The workplace health call centre can also connect you with WorkSafeBC during your call.

5. Participate in the incident investigation with the JOSH committee. Ask your Health and Safety advisor for support if need be. If you are not sure who this is, contact RDBC.

6. For additional support and guidance, or if you experience any challenges with the reporting process let a Resident Doctors of BC representative know about the report by emailing or calling RDBC at info@residentdoctorsbc.ca or (604) 876-7636. All information shared with RDBC will be treated confidentially unless instructed otherwise by you.

Fatigue Risk Management

Fatigue management:

• Self-awareness is the first step for preparing, surviving, and recovering from shiftwork.

Preparing for the nightshift:

• Try to establish a sleep routine prior to the night shift

• When possible, get extra sleep before your shift

• Nap as needed leading up to your shift

During the nightshift:

• Undertake light to moderate physical activity to stay alert

• Increase water intake

• Eat light

• Nap when possible

Recovering from the nightshift:

• Only drive home if safe to do so

• Eat a light breakfast after your shift

• Sleep as soon as possible after work

• Try to re-establish sleep routines

Other resources:

The Epworth Sleepiness Scale

Drowsy Driving – National Sleep Foundation

Psychological Safety

The employer is required by BC law to establish and maintain a safe and healthy workplace and specifically to “ensure the health and safety of all workers working for that employer, and any other workers present at a workplace at which that employer’s work is being carried out” (WorkSafe BC, Workers Compensation Act).

Much work has also gone into reducing the stigma around psychological health and safety at work. Strides are currently being made to ensure there is a safe way for residents to report a mental health injury at work, and for this to be included within the Occupational Health and Safety framework.

If you are experiencing harassment, bullying, or intimidation in your workplace or have experienced a mental health injury as the result of your work, please refer to the following resources for different Health Authorities regarding advice, guidance, or the process of filing a formal complaint:

• VCH’s Respectful Workplace Reporting provides various support options for employees who experience or witness any type of disrespectful behaviour or conflict within the workplace. Contact them at 1 (866) 858-6014 or report complaints online. The service is designed to be accessible and inclusive and is supported by responsive staff who receive ongoing equity, diversity and inclusion (EDI), anti-racism and cultural sensitivity training.

• Providence has a policy on respect in the workplace that outlines the resolution process for resolving disrespectful conduct, discriminatory harassment (including sexism), and personal harassment. You can report to phcnobully@providencehealth.bc.ca

• Fraser: contact respect@fraserhealth.ca. View their policy here.

• Interior’s process and procedure are available here.

• PHSA has a policy on how they foster a culture on respect. Their email contact for reporting: respect@phsa.ca

• Island: contact respectfulworkplace@islandhealth.ca. View their policy here.

• Northern: contact respectfulworkplace@northerhealth.ca

Additionally, UBC Faculty of Medicine has Policies & Guidelines you can access. As a resident, you also have the option of reporting to the PGME Mistreatment Office at https://mistreatmenthelp.med.ubc.ca/.

Other resources:

• CMPA provides learning materials on managing conflict and aggression in medical practice.

• WorkSafeBC provides information on bullying and harassment.

Resident Doctors of BC is available to assist you with whichever reporting method you choose. Please contact info@residentdoctorsbc.ca, or call (604) 876-7636. Visit our Wellness page for all the support services offered to residents.

Reporting Hazards

You don’t have to wait for something to injure or expose you to report.

Hazards, which could potentially lead to an incident if left unaddressed, can be reported by contacting your Health and Safety Advisor who can advise on the correct reporting process for your Health Authority. If you’re unsure who to contact, please contact Resident Doctors of BC at info@residentdoctorsbc.ca or (604) 876-7636 for further guidance.

A near miss, where an incident occurs that could have caused an injury, can be reported using the Workplace Health Call Centre at 1-866-922-9464 and selecting option 2.

If it is after hours, please leave a message, they will call you back.

Any incident involving injury, exposure or risk to the patient should be reported to PSLS. If the incident involves an injury or exposure to both yourself and the patient you will need to report to PSLS as well at the Provincial Workplace Health Call Centre.

Violence Prevention

Health care employers have made a provincial commitment to ensure the health and safety of all workers against violence in the workplace. As part of this commitment, there is a Provincial Violence Prevention Curriculum. It has four main principles:

• Prevention is everyone’s responsibility

• Communicate respectfully

• Be proactive, not reactive

• Take personal responsibility for the safety of yourself and others

The curriculum is based on the overarching principles and a Provincial Violence Prevention Curriculum framework that identifies four (4) main responsibilities in preventing and protecting against violence in the workplace:

1. Recognize Risks and Behaviours – This includes being aware and familiar with the general risks and behaviours that are associated with violence so you know what to look for.

2. Assess and Plan – This includes informal and formal assessment of a particular person or situation you are faced with.

3. Respond to the Risk – This includes strategies to prevent escalation, de-escalation techniques, knowing when and how to get help, and applying personal safety techniques.

4. Report and Communicate Post-Incident – This includes proper reporting processes, knowing when/how to communicate risks, and where/how to access supporting resources. For information on patient confidentiality visit WorkSafeBC

The full Violence Prevention course can be found on the LearningHub. There is also a 30 minute refresher available if it has been more than a year from your last session.

Have you experienced a violent incident at work? Here’s what to do:

1. Notify your supervisor or manager about all incidents, even if there is no injury.

2. Seek first aid or medical attention as soon as possible. If you need to leave your work area, tell your supervisor. Make sure you say that the incident happened at work.

3. Report the incident by phoning the Workplace Health Call Centre 1-866-922-9464.

4. Start a WorkSafeBC claim for medical treatment and/or missed time from work. Complete a WorkSafeBC form online (www.worksafebc.com), or by Teleclaim (1-877-967-5377).

5. After a traumatic incident you may benefit from critical incident stress debriefing (CISD).

Resources:

Physician Health Program

PHP offers 24-hour access where you can be connected to an intake counsellor who will quickly determine with you what your needs are and will provide you with access to a variety of services which include a network of clinical counsellors. Phone: 1-800-663-6729

Employee & Family Assistance Program (EFAP)

All residents are eligible for services through the Vancouver Coastal Health LifeWorks Employee and Family Assistance Program. Residents are able to log in directly to the VCH portal to access services information. They can also log in to the LifeWorks digital platform to access support.

Resident Counselling and Peer Support (RCAPS) Office

Appointments with a Resident Wellness Counsellor can be booked online here.
Email: resident.wellness@ubc.ca

N95 Fit Testing

Fit Testing occurs annually if you need one at a greater frequency, use the contacts below.

VGH: https://v2.waitwhile.com/welcome/ft-vgh or contact peoplesafety@vch.ca

Providence: Ongoing fit testing sessions, contact OHS@ProvidenceHealth.bc.ca

Interior: Ongoing regular sessions, workplaceinjury.prevention@interiorhealth.ca

Island Health: fit testing can be arranged through OHSPrevention@viha.ca, who will then coordinate with the site they are at or select a site and date through the intranet system.

Northern: workplacehealthandsafety@northernhealth.ca it is also done by an internal system for OHS issues.

Fraser: Fit testing can be arranged through MyHealth@fraserhealth.ca.

If you aren’t sure who to contact, or which Health Authority is the right area for testing, please contact Resident Doctors of BC and we are happy to assist.