Guidelines for INFECTION CONTROL POLICY - Safdarjung Hospital

ANNEXURE-I (PERFORMA)RECORD OF SHARPS/NEEDLE STICK INJURY/BLOOD, BODY FLUID EXPOSUREName of HCW: Age: Sex : M/FDepartment: Category of HCW: Regd.no. :HISTORY OF INJURY:Date of InjuryDate of reporting to casualty:How the injury was sustained (while performing which procedure)_______________________________________________________________________________Nature and source of injury : Needle prick/ Sharp cut/Laceration/Splash of FluidsHepatitis B Immunization status of HCW & source :Exposed HCWVaccinated – Yes/No:Incompletely vaccinated 1 :Unvaccinated:Previous H/O infection with HB 2SourceUnknown/unavailable for testingUnknown/but available for testingKnown HBsAg- PositiveKnown HBsAg-NegativeHIV status of ‘Source’ : Negative/Positive/UnknownAction taken in Casualty :1. Help.B vaccination initiated : Yes/No.2. HBIG : Yes/No If yes, indication:3. TT: 4. Anti Retro Treatment 5. Any otherInvestigation advised to HCW in Casualty :Haemogram, LFT, KFT, HBsAg, HIV(if consent is given).Refer to ART clinic, R.no.557 for all above investigations and further follow-up.Investigation of source patient, if available:HIVHBsAGRemarks if any.Signatue of CMO/Nodal Officer on duty (Casualty)1. Received only 1 or 2 doses of Hep.B vaccine2. Persons who have previously been infected with HB are immune to reinfection and donot require postexposure prophylaxisDept. of Medicine & Dept. of Hosp. Waste Management, SJH.38