Staying Healthy When Performing Medical Procedures

As medical students, there will be many times when you have direct contact with patients. It is critical that you know what to do if you are accidentally exposed to a patient’s body fluids through a needle or scalpel wound.

Protocol for Blood & Body Fluid Exposure

You will be taught what to do in case of a blood or body fluid exposure at least twice in medical school: early in the first year so you can participate in clinical activities, and again before you start clinical rotations. You will receive a card explaining these important procedures. Keep it in your ID holder.

What to do:

  • The most important thing to do is to REMAIN CALM.  Remember, exposures from known HIV-positive patients result in disease infections in only 0.3 percent of cases.

  • Wash area immediately with Hibiclens, Phisoderm, a bleach solution or soap and water for at least two minutes or irrigate eyes with saline or water.

  • Discuss the situation with the patient's attending physician, chief resident, or intern.  They should ask the patient’s permission to test for HIV, hepatitis B and C, and VDRL.

  • Go to:
    • If the exposure occurs between 7:30 a.m. and 4:00 p.m., go to Occupational Health for counseling and treatment (203-688-2462).
    • If the exposure occurs after 4:00 p.m. and on weekends, go to YNHH ED (203-688-2222) or ED of the hospital where you are working.
    • The treating physician may contact Dr. Nancy Angoff (Cell: 203-606-1707, Home: 203-865-3566) or Cindy Eber, RN (203-432-0312), Nurse Manager of Student Health.
       
  • Contact Cindy Eber, RN (203-432-0312) at YaleHealth ASAP after the exposure for follow-up.

  • File an incident report with the Medico-Legal Department (230 Clinic Building) or Student Medicine at YaleHealth.

Confidential HIV Testing for Health Care Workers

Health care workers or researchers who have an occupational exposure incident should be advised to call Employee Health for evaluation and counseling. Confidential testing is also offered for employees whose jobs have the risk of exposure to HIV.

  • Call the Graduate Student Health Department at 203-432-0312, Yale Health Center, 55 Lock St., and schedule an appointment with Cindy Eber, RN to have your baseline HIV and Hepatitis C drawn and to discuss treatment and follow-up.
  • In high-risk exposures, a prophylactic treatment with three antiretroviral medications should be started within one hour of the exposure.
  • Attending physicians in the emergency department are available for after-hours counseling, testing and dispensing prophylactic antiretrovirals. Any student receiving prophylactic treatment through the emergency department should contact Dr. James Perlotto at YUHSC the next business day.
  • If the patient is known to have HIV, the student must consult with an HIV/AIDS-care physician.
  • File an incident report with the Medico-Legal Department at 230 Clinic Building. Forms are available through that department or Graduate Student Health, at 203-432-0312.  

We strongly recommend that all students carry the supplemental pharmacy prescription benefit offered through the Yale Health Plan. It pays for 80 percent of prescription medicine costs after the $100 deductible is met. Students won’t be charged for post-exposure antiretroviral medications. If you are traveling abroad, contact 

Cindy Eber, RN

 for post-exposure prophylactic treatment to be used in the event of blood or body fluid exposure in another country.

Prevention

  • Insist that your instructors show you proper blood-drawing techniques, disposal of needles and instruments, etc. Never attempt a procedure you don’t feel comfortable performing.
  • Hepatitis B Vaccine: Be sure you have had a full series (three injections) and a blood test afterward to document immunity.

Instruction in Invasive Procedures

You will receive instruction in phlebotomy during the preclinical clerkship and survival fair, and you won’t be asked to perform any invasive procedure yourself or be scrubbed in to assist with a patient known to be HIV or HCV positive until you have done at least six months of clinical work and have had adequate practice.

Influenza Vaccine and PPD

  • We strongly recommend that you get an annual flu shot. They are available for free at the Yale Health Center, 55 Lock St., or at the medical school during scheduled sessions. Questions about antiviral prophylaxis and working with patients while infected with a contagious illness should be directed to Graduate Student Health at 203-432-0312.
  • The PPD must be done annually except in cases of a previously documented positive PPD. Then a negative chest X-ray must be documented. The PPD can be placed and read at no cost through the Yale Health Plan.