'Stat' workflow modifications to expedite care after needlestick injuries.
BACKGROUND
Post-exposure prophylaxis (PEP) for human immunodeficiency virus (HIV) is recommended to start within hours of needlestick injuries (NSIs) among healthcare workers (HCWs). Delays associated with awaiting the results of testing from the source patient (whose blood was involved in the NSI) can lead to psychological consequences for the exposed HCW as well as symptomatic toxicities from empiric PEP.


AIMS
After developing a 'stat' (immediate) workflow that prioritized phlebotomy and resulting of source patient bloodwork for immediate handling and processing, we retrospectively investigated whether our new workflow had (i) decreased HIV order-result interval times for source patient HIV bloodwork and (ii) decreased the frequency of HIV PEP prescriptions being dispensed to exposed HCWs.


METHODS
We retrospectively analysed NSI records to identify source patient HIV order-result intervals and PEP dispensing frequencies across a 6-year period (encompassing a 54-month pre-intervention period and 16-month post-intervention period).


RESULTS
We identified 251 NSIs, which occurred at similar frequencies before versus after our intervention (means 3.54 NSIs and 3.75 NSIs per month, respectively). Median HIV order-result intervals decreased significantly (P < 0.05) from 195 to 156 min after our intervention, while the proportion of HCWs who received one or more doses of PEP decreased significantly (P < 0.001) from 50% (96/191) to 23% (14/60).


CONCLUSION
Using a 'stat' workflow to prioritize source patient testing after NSIs, we achieved a modest decrease in order-result intervals and a dramatic decrease in HIV PEP dispensing rates. This simple intervention may improve HCWs' physical and psychological health during a traumatic time.
['Smith|J L|JL|', 'Banerjee|R|R|', 'Linkin|D R|DR|', 'Schwab|E P|EP|', 'Saberi|P|P|', 'Lanzi|M|M|']
D015658:HIV Infections D006282:Health Personnel D006801:Humans D016602:Needlestick Injuries D016273:Occupational Exposure D056990:Post-Exposure Prophylaxis D012189:Retrospective Studies D057188:Workflow
post-exposure prophylaxis (PEP) HIV needlestick injury (NSI) occupational health order set