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Epinet 

Uniform Blood and Body Fluid Exposure Report
77 Hospitals, 1993-1995

Total Cases: 2

JOB CATEGORY
M.D. (attending/staff) 0 0%
M.D. (intern/resident/fellow) 0 0%
Medical student 0 0%
Nurse RN/LPN 1 50%
Nursing student 0 0%
Respiratory therapist 0 0%
Surgery attendant 1 50%
Other attendant 0 0%
Phlebotomist/venipuncture/I.V. team 0 0%
Clinical laboratory worker 0 0%
Technologist (non-lab) 0 0%
Dentist 0 0%
Dental hygienist 0 0%
Housekeeper/laundry worker 0 0%
Other 0 0%
( 0 missing)


PLACE OF OCCURRENCE
Where did the injury occur in the institution?
Patient room 0 0%
Outside patient room 0 0%
Emergency department 0 0%
Intensive/critical care unit 0 0%
Operating room 0 0%
Outpatient clinic/office 0 0%
Blood bank 0 0%
Venipuncture 2 100%
Dialysis facility 0 0%
Procedure room 0 0%
Clinical laboratories 0 0%
Autopsy/pathology 0 0%
Service/utility area 0 0%
Other 0 0%
( 0 missing)


SOURCE PATIENT
Was the source patient known?
Yes 2 100%
No 0 0%
Unknown 0 0%
N/A 0 0%
( 0 missing)


BODY FLUIDS
Which body fluids were involved in the exposure?
Blood or blood product 1 50%
Vomit 0 0%
CSF 0 0%
Peritoneal fluid 0 0%
Pleural fluid 0 0%
Amniotic fluid 0 0%
Urine 0 0%
Other 1 50%


EXPOSED PART
Was the exposed part:
Intact skin 1 50%
Non-intact skin 2 100%
Eye(s) 0 0%
Nose 0 0%
Mouth 0 0%
Other 0 0%


TYPE OF EXPOSURE
Did the blood or body fluid:
Touch unprotected skin 2 100%
Touch skin through gap between protective garments 0 0%
Soak through protective garment 0 0%
Soak through clothing 0 0%


PROTECTIVE ITEMS WORN
Which protective items were worn at the time of the exposure?
Single pair latex/vinyl gloves 1 50%
Double pair latex/vinyl gloves 0 0%
Goggles 0 0%
Eyeglasses 0 0%
Faceshield 0 0%
Surgical mask 0 0%
Surgical gown 0 0%
Plastic apron 0 0%
Lab coat, cloth 0 0%
Lab coat, other 0 0%
Other item 0 0%


RESULT
Was the exposure the result of:
Direct patient exposure 2 100%
Specimen container leaked/spilled 0 0%
Specimen container broke 0 0%
IV tubing/bag/pump leaked 0 0%
Other body fluid container spilled/leaked 0 0%
Touched contaminated equipment 0 0%
Touched contaimnated drapes/sheets, etc. 0 0%
Unknown 0 0%
Other 0 0%
( 0 missing)


TIME IN CONTACT
For how long was the blood or body fluid in contact with your skin or mucous membranes?
Less than 5 minutes 2 100%
5-14 minutes 0 0%
15 minutes - 1 hour 0 0%
More than 1 hour 0 0%
( 0 missing)


QUANTITY
Estimate the quantity of blood/body fluid that came in contact with your skin or mucous membranes:
Small amount (up to 5 cc) 2 100%
Moderate amount (5-50 cc) 0 0%
Large amount (more than 50 cc) 0 0%


BODY PART
Right hand, back 1
Right hand, front 1
Left hand, front 0
Left hand, back 0
Right arm 0
Left arm 0
Head 2
Chest 0
Back 0
Mid-body 0
Right leg 0
Left leg 0
Right foot 0
Left foot 0


OSHA
Is this incident OSHA reportable?
Yes 0 0%
No 2 100%
( 0 missing)


For those cases that are OSHA reportable:
Cumulative number of days away from work: 0
Cumulative number of days of restricted work activity: 0