What is the protocol for a healthy adult female dental hygienist with a small cut on her index finger from a scaler used on another patient, piercing her glove?

Occupational Exposure Protocol for Dental Hygienist with Scaler Injury

The dental hygienist should immediately wash the wound thoroughly with soap and water, report the exposure to the appropriate supervisor or infection control officer, and undergo evaluation for bloodborne pathogen exposure (HIV, Hepatitis B, and Hepatitis C) with baseline testing and potential post-exposure prophylaxis based on the source patient's risk factors. 1

Immediate Actions at Time of Injury

Wound Care

• Immediately wash the puncture site thoroughly with soap and water as soon as patient safety permits the interruption of the procedure 1
• Allow the wound to bleed freely for a brief moment to help flush out potential contaminants 1
• Do not squeeze or manipulate the wound excessively 1

Glove Removal and Hand Hygiene

• Remove the torn or punctured glove as soon as patient safety permits 1
• Perform thorough handwashing with soap and water after glove removal 1
• If the procedure must be completed, reglove with a new pair of gloves after proper handwashing 1

Post-Exposure Management Protocol

Reporting Requirements

• Report the occupational exposure immediately to the designated supervisor, infection control officer, or occupational health department 1
• Document the incident with details including: time of exposure, type of instrument involved, depth of injury, and any information about the source patient 1

Source Patient Evaluation

• Attempt to determine the source patient's bloodborne pathogen status (HIV, Hepatitis B, Hepatitis C) through medical history or testing with appropriate consent 1
• Assess source patient risk factors including: history of injection drug use, high-risk sexual behaviors, previous blood transfusions, known liver disease, or incarceration history 1

Exposed Healthcare Worker Testing

• Obtain baseline serologic testing for the exposed healthcare worker as soon as possible (ideally within hours) including: 1
  • HIV antibody testing
  • Hepatitis B surface antibody (anti-HBs) if vaccination status is unknown or incomplete
  • Hepatitis C antibody (anti-HCV)
  • Liver function tests (baseline)

Post-Exposure Prophylaxis Considerations

HIV Post-Exposure Prophylaxis (PEP)

• HIV PEP should be initiated within 2 hours (ideally) and no later than 72 hours if the source patient is HIV-positive or has unknown HIV status with high-risk factors 1
• The decision to start PEP depends on source patient status and exposure severity 1
• Consultation with infectious disease specialist or occupational health is recommended for PEP decisions 1

Hepatitis B Post-Exposure Management

• If the exposed healthcare worker is unvaccinated or incompletely vaccinated for Hepatitis B, administer Hepatitis B vaccine and/or Hepatitis B immune globulin (HBIG) based on source patient status 1
• If fully vaccinated with documented adequate antibody response, no additional treatment is typically needed 1

Hepatitis C Post-Exposure Management

• No post-exposure prophylaxis is available for Hepatitis C 1
• Follow-up testing at 4-6 months is recommended to detect seroconversion 1
• Early detection allows for prompt treatment if infection occurs 1

Follow-Up Testing Schedule

• HIV testing should be repeated at 6 weeks, 12 weeks, and 6 months post-exposure 1
• Hepatitis C testing should be repeated at 4-6 months post-exposure 1
• Additional testing may be warranted based on initial results and clinical symptoms 1

Prevention of Future Exposures

Proper Instrument Handling

• Sharp instruments contaminated with patient blood and saliva should always be considered potentially infective and handled with extreme care 1, 2
• Used sharp instruments should be placed in appropriate puncture-resistant containers located as close as practical to the area of use 1, 2
• Never bend, break, or manipulate sharp instruments unnecessarily before disposal 1, 2

Glove Selection and Use

• Ensure appropriate gloves in the correct size are readily accessible to prevent tears from poor fit 1
• Wear puncture-resistant utility gloves when cleaning contaminated instruments 1, 2
• Keep fingernails short with smooth, filed edges to prevent glove tears 1
• Do not wear hand or nail jewelry that compromises glove fit and integrity 1

Common Pitfalls to Avoid

• Do not delay wound washing - immediate irrigation is critical for reducing pathogen load 1
• Do not fail to report the exposure - delayed reporting can result in missed opportunities for timely PEP initiation 1
• Do not assume the source patient is low-risk - many individuals with bloodborne pathogens are unaware of their status 1
• Do not delay HIV PEP decision-making - efficacy decreases significantly after 72 hours, with optimal benefit within 2 hours 1
• Do not continue working with exudative lesions or weeping dermatitis on hands - this increases infection risk and should prompt temporary reassignment from direct patient care 1