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Discussion

Blood is the most important source of HBV and HCV transmission in healthcare workers.13 The physician in this case should report exposure immediately because the patient would be at high risk of hepatitis with a history of heroin drug use.

Exposure occurred through contact with mucous membranes (the eye). The source patient should be assessed after obtaining informed consent, even if there had been a prior negative test; however the patient in this case was unknown to carry the hepatitis virus. The immunization status of the physician should be followed up.

A report of the exposure should immediately have been done by the physician, such as the date and time of the exposure, the nature ofthe exposure (i.e., non-intact skin, mucosal, percutaneous or human bite), type of fluid, which was blood in this case, the body location (the physician’s eye) and time of exposure. Further, all of the information in an occupational report of exposure should be added to the physician’s employee healthfile.13

The alarming reality is that often health clinicians will not report an injury and in the case of this physician, not only did he hurriedly bypass the OSHA guided employee safety policy of the hospital but he moved quickly on to another emergency case where the risk for exposure with bodily injured patients would be just as high or more.

What could the health team have done when the physician appeared without PPE to perform a blood draw procedure on an uncooperative patient? This is a self-reflective question each healthcare worker should ponder.

In some hospital settings, healthcare workers are required to perform team safety steps, such as procedural time outs or checklists, which must be followed in a standardized format no matter the urgency at hand before a procedure begins.22 Any member of the health team could educate and ask another team member to properly use PPE before starting a high risk procedure of exposure. This type of team approach and care to see safety standards followed might have saved this physician working late in a 24-hour rotation from hurriedly arriving to a patient’s bedside and bypassing known hospital protocol to prevent an occurrence of employee exposure.