Re: Patient consent post anaesthetic for Body Fluid Exposure Bloods

[Michael Wishart]

Hi Sara

Not sure if this helps or not. The QLD Health Guidelines on Occupational Exposures 2017 (https://www.health.qld.gov.au/__data/assets/pdf_file/0016/151162/qh-gdl-321-8.pdf) says this:

The designated person should assess the HIV, HBV and HCV status of the source, to adequately determine risk to the exposed person.1 This is important in all cases exposure (see table 1). If the status of the source individual is unknown at the time of the exposure, the designated person should undertake baseline testing to determine the source’s infectious status. 1 Baseline testing should be undertaken by testing for HIV antibody (HIV Ab), HBV surface antigen (HBsAg) and HCV antibody (HCV Ab). If these baseline tests are positive, more specific testing of viral load may be indicated. The designated person should discuss tests, obtain informed consent and provide post-test counselling to the source, for HIV and HCV tests (refer to attachment 3). Confidentiality should be maintained, not only of the source individual, but also regarding the current exposure.

The Attachment 3 referred to says:
Informed Consent for Testing Informed consent for testing means that the person being tested agrees to be tested on the basis of understanding the testing procedures, the reasons for testing and is able to assess the personal implications of the potential test results. Obtaining informed consent may take more than one consultation. Informed consent is required for HIV, HBV and HCV testing, except for rare occasions when a legal order is made for compulsory testing or in emergency settings. On these rare occasions where informed consent cannot be attained, pre-test provision of all appropriate information to the person should still take place. The person performing the test should use their clinical judgment in securing informed consent. This should be based on their understanding of the context in which the test is being performed, taking into account: * the features which precipitate testing such as clinical presentation, risk exposure, epidemiology and prevalence and patient initiation; and * an assessment of the person being tested with respect to their understanding of the HIV and HCV testing process and consequences of the result. Relationships between health care providers and patients can be complex. General principles of professional conduct apply in the case of HIV, HBV and HCV testing. People involved in HIV, HBV and HCV testing must use whatever additional support is necessary to assist the person considering testing to become adequately informed. The discussion should be appropriate to the gender, culture, behaviour and literacy level of the person being tested and to their intellectual capacity. Professional interpreters (accredited in the person’s language, or in Auslan for people with a hearing impairment or deafness) should be used where requested or where, in the health professional’s judgement, an interpreter is required. This process can also involve a referral to support groups. The person being tested needs to be made aware of confidentiality considerations and protections.

I had been under the impression that the consent form for the procedure does NOT cover consent for serology in the event of a needlestick UNLESS explicit discussion is given about this.

In practice, we wait until the patient is awake and alert post-anaesthetic before getting verbal consent and drawing blood post needlestick during a procedure. We certainly do not routinely wait 24 hours post anaesthetic. If the patient is stull unconscious (or expected to remain unconscious) for a long time post-procedure (eg ventilated and sedated) we sometimes get either next of kin consent OR treating intensivist consent.

Not sure if any of that helps, though!

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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Afternoon Brains Trust,

I am trying to update our Body Fluid Exposure consent process for patients.

If the patient has not consented to the collection of Hep B, C & HIV prior to surgery, I was lead to believe that we had to wait 24 hrs post an anaesthetic for the consent to be valid, however I do not have any written evidence to back this up. I have also been told today that this is no longer correct.

Are you able to direct me or provide any assistance with the correct information in relation to this.

Many thanks for any assistance you can provide

Regards

Sara

Sara Godden CICP
Infection Control Coordinator
Acting Stomal Therapy Nurse

Brisbane Private Hospital
259 Wickham Terrace, Brisbane QLD 4000
T (07) 3834 6771 | M 0404 821 418 | F (07) 3834 6234
E sara.godden@healthscope.com.au
Website http://www.brisbaneprivatehospital.com.au

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