PROTOCOL

MANAGING EXPOSURE TO BLOOD AND/OR BODY FLUIDS

Policy Bulletin 172

OBJECTIVE

1. To protect the health and safety of people through prompt and consistent response to staff, inmates, and offenders residing in a CCC, who have had exposure to the blood or body fluids of another person.

AUTHORITY

2. Commissioner's Directive 821 Management of Inmates with Human Immunodeficiency Virus (HIV) Infections.

DEFINITIONS

3. Significant exposure: where an individual has:

1. come in contact with body fluids capable of transmitting HIV, Hepatitis B or Hepatitis C, including:
   1. blood, serum, plasma, and all body fluids visibly contaminated with blood;
   2. uterine/vaginal secretions or semen; or
   3. saliva;

AND

2. one of the fluids listed in a. comes into contact with the following:
   1. tissue under the skin (needle stick type injuries, bites breaking the skin, stab wounds);
   2. non-intact skin (cut, chapped, or scraped skin); or
   3. mucous membranes (eyes, nose, mouth);
3. fluids coming into contact with intact skin do not represent a significant exposure.

4. Officer-in-Charge

1. A staff member designated by an institutional head to exercise the powers, perform the duties or carry out the functions in the absence of the institutional head.
2. The local manager or senior staff member present at a parole office or CCC.

RESPONSIBILITIES

National Headquarters

5. The Human Resource Management Sector at National Headquarters is responsible for reimbursing the cost of post-exposure prophylactic medication for CSC staff members.

Operational Unit Head

6. The Operational Unit Head is responsible for:

1. the effective implementation of the Protocol;
2. ensuring that arrangements have been made with a nearby hospital/clinic:
   • to deal with Post-exposure Protocol; and
   • to have the appropriate post-exposure medication available for the treatment of staff and offenders
3. ensuring that one pharmacy in the area has a supply of post-exposure medications for staff and that staff are aware of these arrangements;
4. ensuring that the institutional health services pharmacy has a stock of post exposure medications for inmates;
5. ensuring that a staff member who has had an exposure is offered the services of the Employee Assistance Program (EAP) and that support mechanisms are in place to assist throughout the follow-up period; and
6. ensuring that an inmate who has had an exposure receives medical follow-up by an institutional physician and is offered counselling by the psychology staff.

Individual Exposed to Blood or Body Fluids

7. The individual who has had an exposure shall immediately:

1. remove all contaminated clothing;
2. allow immediate bleeding of the wound;
3. wash the injured area well with soap and water;
4. if the eyes, nose or mouth are involved, flush them with large amounts of water.

8. A staff member, inmate or offender in a CCC should immediately report the exposure to a nurse (if on site), or to the Officer-in-Charge (if no nurse on-site).

9. Staff members and offenders in a CCC will obtain medical follow-up with their personal physician or through a hospital/clinic.

Nurse or Officer-in-Charge

10. The nurse or the Officer-in-Charge shall immediately take all the following actions:

1. without delay, arrange for the person who has been exposed (staff, inmate or offender at a CCC) to be taken to the nearest hospital/clinic, where arrangements to deal with Post-exposure Protocol have been made; or
   if it is an inmate who has had the exposure, and a nurse is on-site, the nurse may make an assessment of the degree of exposure, and, if the exposure is deemed significant, the institutional physician may direct the immediate initiation of treatment at the institution.
2. where the exposure involves a staff member:
   1. complete Form 1249 "Certification of Payment for Post-Exposure Prophylactic Treatment for Employees of the Correctional Service of Canada";
   2. provide copies to the staff member for presentation at hospital/clinic, practitioner and pharmacy to ensure that all expenses related to the post-exposure treatment will be covered by CSC National Headquarters; and
   3. offer to have another staff member accompany the individual to the hospital/clinic.
3. notify the receiving hospital/clinic of the pending arrival of the individual.

11. If a nurse is on-site and if there is documented serological status of the source person, the nurse will notify the attending physician of the serological status of the source person.

12. If the serological status of the source person is unknown, every effort should be made to encourage the source person to be tested for HIV, Hepatitis B and Hepatitis C. Testing of the source person cannot be done without their informed consent.

13. Where a staff member is involved in an exposure incident, after the exposure has been medically managed, the officer-in-charge will:

1. submit a copy of the completed Form 1249 "Certification of Payment for Post-Exposure Prophylactic Treatment for Employees of the Correctional Service of Canada" to the Workplace Occupational Health and Safety Committee;
2. complete and submit the provincial worker's compensation report of injury/illness and the Hazardous Occurrence Investigation Report.

Original signed by :

Director General, Health Services
Françoise Bouchard, M.D., MPH, FRCP(c)

Assistant Commissioner, Human Resource Management
Simon Coakeley

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