Desiree has just moved to a small, isolated community that doesn’t have a provincial home care program. She is a registered nurse (RN) at a not-for-profit agency which delivers home care services to members of the community. Her role includes providing nursing interventions and education about health and infection prevention strategies.
On a hot summer day she is seeing many members of the community in their homes. One of the agency’s services is to provide containers for used medical sharps to community members who may need them. If the individual does not have a means of transportation, the agency will pick up full sharps containers and take them to the medical clinic for safe disposal. The RN is responsible for exchanging the sharps disposal containers during a visit.
Desiree has completed her home visits for today and while carrying the two sharps containers by their handles into the staff entrance of the medical clinic, the bottom of one container falls to the floor scattering the contents everywhere. Desiree feels a jabbing sensation and looks down to see one needle with the syringe attached lodged in her leg and also notices two additional puncture wounds.
Desiree puts her nursing bag and the remaining sharps container down. She puts on a pair of gloves and removes the needle from her leg. She realizes that the sharps container has not broken but separated, so she places the lid back on the base and presses it firmly into place. Once she’s confident it’s secure, she picks the sharps off the floor and places them into the container. She places both sharps containers in the designated area for disposal.
Desiree knows she needs to clean her wounds and report this incident. She is also worried about the risks to her health. The small agency she works for doesn’t have an occupational health nurse (OHN) or an infection prevention and control (IP&C) nurse. She is new to this workplace and unaware if there is a policy about possible exposure to blood and body fluids. The manager has already left for the day and she doesn’t want to bother her at home.
Desiree returns to her office to access the computer seeking information on what next steps to take after an exposure to blood and body fluids. She follows employer policy on reporting incidents and reviews the employer’s policy on blood and body fluid exposure which lists Blood and Body Fluid Exposure Resources for Health-care Professionals website (bbfeab.ca) as a resource for the post exposure pathway to follow. Desiree finds out that it is the responsibility of her supervisor or a health-care professional with expertise in blood and body fluid exposure to contact the clients about obtaining consent for source testing. She decides that she should contact her manager as soon as possible in order to adhere to the recommended two-hour post exposure window to ensure potential post-exposure prophylaxis for HIV or hepatitis B is started as soon as possible.
Desiree’s manager advises her to follow the post exposure pathway indicated on the bbfeab.ca website and seek care from a physician or nurse practitioner as soon as possible for the assessment of her wound and to discuss the potential risk for a blood borne pathogen infection from this exposure. Desiree decides to call Health Link to find out where the best place for her to seek care for this exposure is as she knows that Health Link is a province wide service and will be able to direct her appropriately.
Desiree follows the direction in the post exposure pathway as well as the direction of Health Link and the expert health-care professionals she speaks with to have the best possible outcome from this situation. The next day she meets with her manager and coworkers to discuss and put into place processes and interventions to prevent a similar situation from occurring in the future.
Our case studies are fictional educational resources. While we strive to make the scenarios as realistic as possible, any resemblance to actual people or events is coincidental.