APPENDIX A. Practice Recommendations for Health-Care Facilities Implementing the U.S. Public Health Service Guidelines for Management of Occupational Exposures to Bloodborne Pathogens

Practice recommendation	Implementation checklist
Establish a bloodborne pathogen policy.	All institutions where health-care personnel (HCP) might experience exposures should have a written policy for management of exposures.
	The policy should be based on the U.S. Public Health Service (PHS) guidelines.
	The policy should be reviewed periodically to ensure that it is consistent with PHS recommendations.
Implement management policies.	Health-care facilities (HCF) should provide appropriate training to all personnel on the prevention of and response to occupational exposures.
	HCF should establish hepatitis B vaccination programs.
	HCF should establish exposure-reporting systems.
	HCF should have personnel who can manage an exposure readily available at all hours of the day.
	HCF should have ready access to postexposure prophylaxis (PEP) for use by exposed personnel as necessary.
Establish laboratory capacity for bloodborne pathogen testing.	HCF should provide prompt processing of exposed person and source person specimens to guide management of occupational exposures.
	Testing should be performed with appropriate counseling and consent.

Practice recommendation	Implementation checklist
Select and use appropriate PEP regimens.	HCF should develop a policy for the selection and use of PEP antiretroviral regimens for HIV exposures within their institution.
	Hepatitis B vaccine and HBIG should be available for timely administration.
	HCF should have access to resources with expertise in the selection and use of PEP.
Provide access to counseling for exposed HCP.	HCF should provide counseling for HCP who might need help dealing with the emotional effect of an exposure.
	HCF should provide medication adherence counsel ing to assist HCP in completing HIV PEP as necessary.
Monitor for adverse effects of PEP.	HCP taking antiretroviral PEP should be monitored periodically for adverse effects of PEP through baseline and testing (every 2 weeks) and clinical evaluation.
Monitor for seroconversion.	HCF should develop a system to encourage exposed HCP to return for follow-up testing.
	Exposed HCP should be tested for HCV and HIV.
Monitor exposure management programs.	HCF should develop a system to monitor reporting and management of occupational exposures to ensure timely and appropriate response.
	Evaluate exposure reports for completeness and accuracy, access to care (i.e., the time of exposure to the time of evaluation), and laboratory result reporting time.
	Review exposures to ensure that HCP exposed to sources not infected with bloodborne pathogens do not receive PEP or that PEP is stopped.
	Monitor completion rates of HBV vaccination and HIV PEP and completion of exposure follow-up.

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