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University of KwaZulu-Natal Policy & Procedure for Employees & Students = Accidental Exposure to HIV Infection
(e.g. needlestick injury, contaminated blood and body fluids etc.)
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The documents hereunder were amended and approved by the Council of the University at its meeting held on 3 December 1999
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1. Employees and students are required to take all precautions necessary to prevent needlestick injuries or exposure to contaminated blood and body fluids.
2. All incidents/accidents must be reported immediately to the Head of the School/Division/ Unit/Department or person acting in that capacity, who will immediately initiate and monitor the action relevant to the procedures contained in the document entitled Procedure to be Followed in the Event of Accidental Exposure to HIV Infection of Employees/Students (e.g. Needlestick Injury, Contaminated Blood and Body Fluids etc), and also be responsible for the relevant follow-up action.
3. Assistance can be obtained by using the HIV 24 hour Hotline: 082-822-2290 or 082-822-2291
4. CONSENT AND CONFIDENTIALITY:
4.1 The prerequisites for HIV testing in terms of this policy are:
4.1.1 Informed consent of the person to be tested
4.1.2 Confidential treatment of results. In order to maintain absolute confidentiality, any person reporting an accidental exposure is to be given a code number and thereafter no reference by name is to be made in any further documentation.
5. COUNSELLING:
5.1 All concerned must be sensitive to the trauma suffered by persons accidentally exposed to the possibility of HIV infection. Such persons should be informed of the confidential counselling services provided by the Student Counselling Centres at the Durban and the Pietermaritzburg centres and should be encouraged and assisted to attend one of these centres to receive counselling.
5.2 IMPORTANT TELEPHONE NUMBERS FOR CONFIDENTIAL COUNSELLING:
 Student Counselling Centre: Durban - 031-260 2668
Student Counselling Centre: Pietermaritzburg - 033 260 5213
UND Crisis Hotline : 031-260 3113
Lifeline : 0800 012320 (Toll Free)
University of KwaZulu-Natal: PROCEDURE TO BE FOLLOWED IN THE EVENT OF ACCIDENTAL EXPOSURE TO HIV INFECTION : EMPLOYEES/STUDENTS (E.G. NEEDLESTICK INJURY, CONTAMINATED BLOOD AND BODY FLUIDS ETC)
1. Report details of incident immediately to the Head of the School/Division/Unit/Department or person acting in that capacity. It is essential that post exposure prophylaxis be initiated within one (1) hour of the accident). The University of KwaZulu-Natal's 24 hour HIV hotline is 082-822-2290 or 082-822-2291.
1.1 If the source patient or blood or body fluid sample is known to be HIV-positive:
1.1.1 The risk-exposed employee or student shall be sent by the Head of School/Division/Unit/Department without delay to the Campus Health Clinic or in the case of the Medical School, to the Virology Department, where a blood sample shall be taken immediately and post-exposure prophylaxis started immediately - preferably within one (1) hour of exposure.
1.1.2 After three (3) weeks and again after six (6) weeks and three (3) months and six (6) months and twelve (12) months from the date of the accident, the risk-exposed employee or student shall be sent by the Head, to the Campus Health Clinic or in the case of the Medical School to the Virology Department, for repeat blood samples to be taken.
1.1.3 All blood samples from risk-exposed employees or students shall be sent immediately to the Virology Laboratory, at the Medical School (see Section 2 below) by the Campus Health Clinic. Heads must check that this has been done. These blood samples must be marked for URGENT attention (see 2.2 below).
1.2 If the HIV status of the source patient or blood sample or body fluid is not known:
1.2.1 In the case of suspected contamination from a source patient, the Head of School/Division/Unit/Department shall, with the source patient's consent, arrange to have a blood sample taken immediately from the source patient by a qualified medical practitioner or nurse. If the source patient is unable to consent, e.g. is unconscious, the Head responsible shall treat the matter as an emergency and arrange for a doctor or nurse immediately to take a blood sample from the source patient without the latter's consent and for that blood sample to be tested while ensuring that the source patient remains anonymous. Blood samples must immediately be sent for urgent testing to the Virology Laboratory at the Medical School, to assess the source patient's HIV status. Blood samples from the Pietermaritzburg Centre may be transported by the Registry courier, but must be marked as a priority and will be delivered directly to the Virology Laboratory by the courier. If, for any reason, it is not possible or convenient to use this courier, the HIV hotline 082-8222290/1 should be used and other arrangements made to transport the blood sample to the Virology Laboratory. Post-exposure prophylaxis must be started immediately (preferably within one (1) hour of exposure).
1.2.2 If the source patient refuses to be tested, then the source must be assumed to be HIV-positive and post-exposure prophylaxis must be started immediately (preferably within one (1) hour after exposure).
1.2.3 In the case of suspected contamination from a blood sample or body fluid, the Head responsible must arrange for such sample or fluid immediately to be sent to the Virology laboratory at the Medical School (see Section 2 below).
1.2.4 The risk-exposed employee or student must be sent without delay by the responsible Head to the Campus Health Clinic or in the case of the Medical School, to the Virology Department, where a blood sample shall be taken immediately.
1.2.5 After three (3) weeks and again after six (6) weeks and three (3) months and six (6) months and twelve (12) months from the date of the accident, the risk-exposed employee or student must be sent by the Head to the Student Health Clinic, or in the case of the Medical School to the Virology Department, for repeat blood samples to be taken.
1.3 Schools/Departments/ Units whose students are placed in clinical settings far from campus e.g. nursing students posted to outlying hospitals/clinics, or students completing clinical Masters degrees, or "rural attachment programme" medical students, or dietetic students enrolled in the postgraduate diploma, must:
1.3.1 provide all such students with the 24 hour HIV hotline telephone number;
1.3.2 make prior written arrangements with the management in these institutions for students who sustain needlestick injuries to immediately be given the first post-exposure prophylaxis treatment, at that place of work, and for blood samples to be taken from the student and the source patient. These blood samples must be sent for urgent testing either at the place of work or, if convenient and feasible, to the Virology Department at Medical School.
The dosages for the first post-prophylactic treatment are indicated in 1.4 below. The injury must be reported to the Head of the relevant University School/Department/Unit or person acting in that capacity, who will make contact with the student to ensure that the action required in 1.3.2 above has been carried out and who will thereafter ensure that the student is put in contact with the Virology Department at the Medical School, that the results of the tests of the blood samples referred to in 1.3.2 are conveyed to the Virology Department and that the appropriate post-exposure prophylaxis and the taking of repeat blood samples is carried out.
1.3.3 In settlings/placements where the risk-exposed students are likely to be unable to obtain prophylactic treatment within one hour of a needlestick injury occurring, Heads of Schools/Departments/Unit must arrange for those students to be issued with a five (5) day "starter kit" of drugs. Firm inventory control must also be initiated to monitor the use of these drugs as well as the recovery of unused drugs.
1.4 Zidovudine (AZT) is available and is of proven value in reducing the small chance of infection after accidental exposure. 3TC will further reduce the chance of infection. If, after due consideration, it is decided to use post-exposure prophylaxis, Zidovudine and 3TC shall be taken as soon as possible (within one (1) hour) after the accident. When the source patient/blood sample is known or found to be HIV-positive, Zidovudine and 3TC therapy shall be continued for four (4) weeks.
2 BLOOD AND BODY FLUID SPECIMENS:
2.1. The Campus Health Clinic or doctor or nurse concerned shall immediately send all blood or body fluid specimens for urgent testing to the Virology Laboratory from:
2.1.1 exposed persons;
2.1.2 patients' or blood or body fluid samples whose HIV status is not known.
2.2 The Campus Health Clinic or doctor or nurse concerned shall mark the request URGENT : NEEDLESTICK INJURY.
3. The exposed employee or student shall be advised to use condoms for a period of twelve (12) weeks after the accident.
4. I.O.D. FORMS (staff only) and ANNEXURE 2 ACCIDENT REPORT FORMS (staff and students):
4.1 In all cases the relevant I.O.D. information and the Annexure 2 Accident Report shall be processed by the Department of Virology and retained by that Department.
5. REPEAT BLOOD SAMPLES:
5.1 When contacted by the Department of Virology, Heads of School/Division/Unit/Department must ensure that a repeat blood sample is taken from the exposed employee or student after three (3) weeks and again after six (6) weeks and three (3) months and six (6) months and twelve (12) months from the date of the accident.
6. POST-EXPOSURE PROPHYLAXIS:
6.1 Employees and students taking post-exposure prophylaxis must report to the Department of Virology where they will be monitored for side effects of the drugs.
7. HEPATITIS B AND HEPATITIS C:
7.1 All blood and body fluid samples sent to the Department of Virology will automatically be tested for Hepatitis B and Hepatitis C.
8. COST OF POST-EXPOSURE PROPHYLAXIS:
8.1 It must not be assumed that as a result of following these procedures, the University will automatically become responsible for the cost of prophylactic treatment. It is the risk-exposed person who will primarily be responsible for these costs.
9. PRECAUTIONS:
9.1 Employees and students are required to take all precautions necessary to prevent such accidents but should such an accident occur, they should not panic, but follow the above procedure IMMEDIATELY.
10. ASSISTANCE:
10.1 ASSISTANCE CAN ALWAYS BE OBTAINED BY USING THE University of KwaZulu-Natal 24 HOUR HIV HOTLINE 082-822-2290 or 082-822-2291.
11. CONSENT AND CONFIDENTIALITY:
11.1 The prerequisites for HIV testing in terms of these procedures are :
11.1.1 Informed consent of the person to be tested
11.1.2 Confidential treatment of results. In order to maintain absolute confidentiality, any person reporting an accidental exposure will be given a code number and thereafter no reference by name will be made in any further documentation.
12. COUNSELLING:
12.1 All concerned must be sensitive to the trauma suffered by persons accidentally exposed to the possibility of HIV infection. Such persons should be informed of the confidential Counselling servicesprovided by the Student Counselling Centres at the Durban and the Pietermaritzburg centres and should be encouraged and assisted to attend one of these centres to receive counselling.
10.12.1999
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