New York Medical College

I. PURPOSE

It is the purpose of this policy to define the procedures for blood and body fluid exposures for New York Medical College (“NYMC” or the “College”) students.

II. POLICY

It is the policy of NYMC to have standardized procedures for handling blood and body fluid exposures which include needlestick injuries.

III. SCOPE

This policy applies to all NYMC students in the School of Medicine, the Graduate School of Basic Medical Sciences and all physical therapy and speech-language pathology students in the School of Health Sciences and Practice.

IV. DEFINITIONS:

Blood and body fluid exposure (“BBFE”): exposure to human blood or a body fluid/tissue, including needlestick injuries, that meets non-intact skin or mucous membranes. Such exposures pose a potential risk of transmission of blood borne pathogens.
Blood borne pathogens: These primarily are human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) but, depending upon the clinical situation, may not be limited to these infectious agents.
Risk of transmission: The likelihood of acquiring an infection. For blood borne pathogens, the risk of transmission depends upon the nature of the exposure, the infectiousness of the source, and in the case of HBV, the immune status of the exposed individual.
NYMC Health Services: Department providing health services for all NYMC students and performing the follow-up for student blood and body fluid exposures.
Exposed Student: The student who sustained a needlestick or other blood or body fluid exposure from a patient. The patient is then referred to as the source patient.
Source Patient: The patient whose blood or body fluid was potentially present during the event of the blood or body fluid exposure.
NYMC School of Medicine directors:

1. Site Director: Faculty at each clinical site responsible for the clinical training.
2. NYMC Course/ Clerkship Directors: Faculty at NYMC responsible for clinical courses across sites. There are specific directors for phase 2 clerkships, phase 2/phase 3 electives, phase 3 sub-internships, and phase 3 electives.

V. RELATED POLICIES:

Policy on Students Infected with Blood Borne Pathogens.

VI. PROCEDURES

A. Essential forms:

1. NYMC Blood and Body Fluid Exposure Form completed by the student.
2. Source Patient test results form completed by the physician responsible for the testing of the Source Patient.

B. Exposed Student Responsibilities - initial procedures when blood or body fluid exposure occurs:

1. 1. Care of the non-intact skin or mucous membrane: Immediately wash the exposed skin area thoroughly with soap and water; a germicidal soap may be used. For mucous membrane exposures, irrigate with copious amounts of water and flush thoroughly. Five minutes of irrigation is a suggested time period.
  2. Notify your supervisor that you must leave your current duties and report immediately to employee health service or the emergency room for treatment. Post-exposure prophylaxis for HIV is optimally started within 2 hours of the exposure, thus one should not delay in the procedures below.
  3. Report to employee health services or emergency room.
  4. In hospitals, or outpatient sites within a hospital complex:
    1. Blood and body fluid exposures that occur off-hours (nights/weekends) are handled in the Emergency Room.
    2. During regular working hours blood and body fluid exposures may be handled by the employee health services or the emergency room.
    3. If you are unsure where to report to, check with your supervisor or clerkship director for the appropriate site.

5. During student outpatient rotations geographically separate from a hospital, as blood tests will be required, speak with the Site Director as to how to proceed to obtain the appropriate testing and to ensure the Source Patient is tested.

C. Results for the Source Patient are provided to the treating physician or clinician caring for the Exposed Student by the physician responsible for testing the Source Patient.

D. Source patient results must also be provided to NYMC Health Services. Using the Source Patient Test Results Form (see link at beginning of procedure section of this policy) de-identified results are provided for the Source Patient. These de-identified results may be sent directly to Health_Services@nymc.edu by the treating physician, or, after the treating physician completes the form, the exposed student may send the form to Health Services.

E. For School of Medicine students only, in the event that there is difficulty in having the Source Patient tested or in receipt of the Source Patient’s results, Site Directors or NYMC Course/Clerkship Directors will assist with ensuring Source Patient testing is completed and that the Exposed Student and NYMC Health Services are informed on the de-identified results.

F. Billing:

1. 1. Students must present health insurance information for billing purposes at the time of medical evaluation. Provide your information even if no one asks for it.
  2. Students are not covered under Workers’ Compensation as they are not employees.

G. After the initial medical evaluation, notify NYMC Health Services:

1. 1. It is essential that the Exposed Student report the injury to NYMC Health Services; if the injury occurred after hours, this can be reported on the next working day.
  2. This is required to provide needed follow-up for blood tests, answer questions, seek consultation if needed, and in the case of HIV prophylaxis, to prescribe the medications needed to complete the course of treatment.
  3. Obtain a copy of your off-campus medical evaluation and any tests performed for you. The exposed student sends his/her test results to NYMC Health Services.
  4. Test results of the Source Patient are sent to NYMC Health Services using the Source Patient test results form. These are sent by the clinician for the Source Patient or the clinician may complete the de-identified form and give it to the Exposed Student to submit to Health Services.

H. Medical evaluation of the Exposed Student at the time of exposure- what to expect:

1. 1. 1. 1. Blood and body fluid exposures require a medical evaluation.
      2. You will be asked to recall the specific events of the exposure and to provide a clear description of how the exposure occurred, what type of needle or device was involved, the body fluids involved, and whether or not the exposure involved visible blood from the Source Patient or the Exposed Student. For needlesticks, please note if the needle was a hollow bore needle and if the needle was directly placed in a vein or artery.
      3. Completion of an incident report: Exposed Students may be asked to complete an incident report for the hospital / clinical site in accordance with site procedures.
      4. Blood test results for the Source Patient: A rapid HIV test result is communicated to the clinician evaluating the student. Written documentation of the results for Source Patient HIV, Hepatitis B Virus and Hepatitis C virus is provided by the clinician evaluating the Source Patient. De-identified results are provided to NYMC Health Services using the Source Patient test results form.
        
        Blood tests for the Exposed Student - baseline blood tests:
        
        Tests for HIV antibody, HCV antibody are required.
        
        An HBV surface antibody and HBV surface antigen is performed only if the Exposed Student does not know his/her Hepatitis B surface Ab status.
        
        If the Exposed Student knows they are immune to HBV, repeat testing is unnecessary and should not be done.
        
        A complete blood count and differential, complete metabolic profile, and a pregnancy test are obtained if HIV post-exposure prophylaxis is to be started.
        
        Tetanus booster: If the Exposed Student has not received a tetanus booster within the past 10 years, a booster may be administered at the time of evaluation.
        
        Evaluation of Source Patient:
        
        The clinician responsible for the Source Patient is to assist with determining the Source Patient’s status for HIV, HBV and HCV.
        
        Site Directors and/or NYMC Course/ Clerkship Directors may be needed to assist with ensuring the source patient testing is performed and is available for the Exposed Student and de-identified and available for NYMC Health Services. In particular, if a Source Patient is discharged or leaves a clinical setting, the assistance of a Course/Clerkship Director will likely be needed.
        
        Below are procedures depending upon the status of the Source Patient:
        
        HIV status unknown or negative: An HIV test of the Source Patient is to be performed in accordance with Department of Health procedures for informing the patient of the need for the test/ consent. A rapid HIV test for the Source Patient is preferred to allow this information to be available to assist with the decision of post-exposure prophylaxis.
        
        HIV positive Source patient: Information regarding the potential infectivity of the Source Patient, including CD4 cell count, viral load and current antiretroviral medications is to be provided if possible.
        
        HBV status and HCV status of Source Patient are determined through the tests, HBV core antibody, HBV surface antibody and HBV surface antigen and HCV antibody obtained for the Source Patient.
        
        Other transmissible agents: The primary care provider for the Source Patient may indicate that the Source Patient was infected with another agent that is potentially transmissible by blood or body fluid exposure. This information is communicated to the clinician evaluating the Exposed Student.
        
        Medical determination of need for post-exposure prophylaxis
        
        Based upon the information known regarding the Source Patient, the clinician evaluating the Exposed Student will discuss the risks of exposure and make a recommendation for post-exposure prophylaxis.
        
        Infectious diseases telephone consultation is advised in the case of a blood or body fluid exposure involving an HIV infected Source Patient or a case in which the Exposed Student is receiving anti-retroviral treatment.
        
        Procedures for infectious diseases consultation are followed as per the procedures at the clinical site in which the exposure occurred.
        
        Procedures for HIV Post-exposure prophylaxis: If HIV post-exposure prophylaxis is advised, a 48-72-hour supply of medications is provided through the emergency room or employee health services evaluating the individual. Exposed Students sustaining a blood or body fluid exposure at a private office must bring a prescription to a local pharmacy.
        
        Post-exposure prophylaxis should not be interrupted. All doses are to be taken until further assessment. The follow-up assessment may change the duration of prophylaxis depending on further information regarding the Source Patient or tolerability of prophylaxis.
        
        The possible side effects of medications and the need for birth control during chemoprophylaxis are discussed with the Exposed Student.
        
        In the event HIV post-exposure prophylaxis is recommended and the Exposed Student declines post-exposure prophylaxis, the Exposed Student is to sign a declination of treatment.
        
        Exposures involving a Source Patient that is infectious for HBV: The need for prophylaxis depends upon the immune status of the Exposed Student. An Exposed Student who is seronegative for HBV or who has declined HBV vaccination may require receipt of HBV immune globulin in the case of a high risk injury.
        
        Exposures involving a Source Patient that is infectious for HCV: The Exposed Student will require periodic blood tests to assess transmission. No post exposure treatment currently recommended.

I. Site Directors and NYMC Course/Clerkship Director Responsibilities

1. 1. 1. 1. At orientation, inform students of where to go in the event of a blood or body fluid exposure and remind the students that evaluations for blood and body fluid exposures must be done through the billing of their medical insurance.
      2. Assist with testing and communication of Source Patient results if needed. See section on Source Patient testing above. Source Patient testing results are communicated de-identified using the Source Patient test results form linked at the beginning of Procedures section.
      3. If a Site Director or a Course/Clerkship Director is aware of a BBFE and is unsure if the Exposed Student has reported it to Health Services, the Course/Clerkship Director would inform Health Services and Health Services staff will reach out to the student. occur. Health Services may be notified by telephone 914-594-4234 or sending a secure email to Health_Services@nymc.edu.

J. Procedures by Health Services:

1. 1. 1. Health Services meets with the Exposed Student by telephone or in person (depending upon the nature of the injury) and reviews the data from the medical evaluation performed at the site of the exposure. This occurs on the day of the exposure of the next working day depending upon the time of the exposure.
    2. The NYMC Health Services Blood and Body Fluid Exposure Form can be found in Section VI.A.1 of this policy
    3. Follow-up testing for any blood borne pathogen may be required. NYMC Health Services sends the Exposed Student an Exposure Lab Follow up Form after the Source Patient’s labs are received. This form is sent even when no further follow up is needed to confirm closure of the case.
    4. Co-pays for medical evaluation or post exposure prophylaxis medications are reimbursed through NYMC Health Services for NYMC School of Medicine, Doctorate of Physical Therapy and Speech and Language Pathology students. Students must present the applicable explanation of benefits information to NYMC Health Services for re-imbursement.

VII. References

Updated US public health service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis, May 23, 2018 update. https://stacks.cdc.gov/view/cdc/20711 downloaded June 20, 2023.

Centers for Disease Control and Prevention. Testing and clinical management of health care personnel potentially exposure to hepatitis C virus. – CDC guidance, United States 2020.

2025 US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Post-exposure Prophylaxis in Healthcare Settings Infection Control & Hospital Epidemiology (2025), 46, 863–873. doi:10.1017/ice.2025.10254

VIII. EFFECTIVE DATE

This policy is effective immediately.

IX. POLICY MANAGEMENT

Executive Stakeholder: Director, Health Services
Oversight Office: NYMC Health Services

Policy on Blood and Body Fluid Exposure (Needle stick)