Table 3.

Review of Post-exposure Evaluation and Follow-up

OSHA Standard	Rating*	Hospital Algorithm
Following a report of an exposure incident, the employer shall make immediately available to the exposed employee a confidential medical evaluation and follow- up.	A	If the injury occurs during a weekday from 9am to 5pm, the employee is instructed to report to the voluntary counseling and testing center for a risk assessment with a counselor or a post- exposure prophylaxis team member; if the injury occurs during the weekend, the employee reports to the dispensary, where risk assessment with a pharmacist or by phone with a post- exposure prophylaxis team member takes place.
(f)(3)(i) Documentation of the route(s) of exposure, and the circumstances under which the exposure incident occurred;	C	No direction provided by algorithm/protocol.
f)(3)(ii) Identification and documentation of the source individual, unless the employer can establish that identification is infeasible or prohibited by state or local law;	A	Details surrounding the exposure (such as patient name, time, and location) should be documented.
(f)(3)(ii)(A) The source individual's blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity. If consent is not obtained, the employer shall establish that legally required consent cannot be obtained. When the source individual's consent is not required by law, the source individual's blood, if available, shall be tested and the results documented.	B	A source blood draw for HIV testing is performed following all needlestick exposures. Regardless of when the needlestick injury happens, the counselor, post-exposure prophylaxis team member, or pharmacist rates the risk of infection (i.e., negligible/very low risk; significant risk). If the incident is rated as a significant risk, HIV post-exposure prophylaxis is started immediately (with employee consent) by the public health MD/physician or pharmacist.
(f)(3)(ii)(B) When the source individual is already known to be infected with HBV or HIV, testing for the source individual's known HBV or HIV status need not be repeated.	C	No direction provided by algorithm/protocol.
(f)(3)(ii)(C) Results of the source individual's testing shall be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.	C	No direction provided by algorithm/protocol.
(f)(3)(iii) Collection and testing of blood for HBV and HIV serological status; (f)(3)(iii)(A) The exposed employee's blood shall be collected as soon as feasible and tested after consent is obtained.	A	A blood draw HIV testing is performed following all needlestick exposures.
(f)(3)(iii)(B) If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample shall be preserved for at least 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible.	C	No direction provided by algorithm/protocol.
(f)(3)(iv) Post-exposure prophylaxis, when medically indicated, as recommended by the U.S. Public Health Service;	A	If the incident is rated as a significant risk, HIV post-exposure prophylaxis is started immediately (with employee consent) by the public health MD/physician or pharmacist.
(f)(3)(v) Counseling	A	All needlestick injuries reported to the voluntary counseling and testing center/dispensary are then documented on a post-exposure prophylaxis record sheet completed and signed by the employee, employee’s supervisor, and counselor/post exposure prophylaxis team member/pharmacist.
(f)(3)(vi) Evaluation of reported illnesses.	A	The voluntary counseling and testing center maintains copies of these documents for five years, and the public health unit enters this information into the public health unit computer system. Additionally, the counselor, public health MD/physician, or pharmacist instructs the employee in HIV post exposure prophylaxis medication administration, and to return to the center in 3 and/or 6 months, as necessary.

^*A= standard fully met; B= standard partially met; C= standard not met