22 THE ADA PRACTICAL GUIDE TO EFFECTIVE INFECTION CONTROL It is very important that dentists identify and keep on hand the name of a qualified physician who will evaluate any occupational exposure incident. This will facilitate the prompt referral and evaluation of any exposed dental team member. Post-exposure Evaluation and Follow-up Immediately following an occupational blood or OPIM exposure, first aid should be administered as necessary. Puncture wounds and other injuries to the skin should be washed with soap and water mucous membranes should be flushed with water. No evidence exists that using antiseptics for wound care or expressing fluid by squeezing the wound further reduces the risk of bloodborne pathogen transmission however, the use of antiseptics is not contra-indicated. The application of caustic agents (e.g., bleach) or the injection of antiseptics or disinfectants into the wound is not recommended. The exposure incident should then be quickly reported to the infection control coordinator, who should initiate referral to the qualified health care professional and complete necessary reports. Because many factors contribute to the risk of infection after an exposure incident, the following information must be included in the exposure report, recorded in the exposed person’s confidential medical record and provided to the qualified health care professional: • Date and time of exposure • Details of the procedure being performed, including where and how the exposure occurred and whether the exposure involved a sharp device the type and brand of the device and how and when during its handling the exposure occurred • Details of the exposure, including its severity and the type and amount of fluid or material involved. For a percutaneous injury, severity might be measured by the depth of the wound, gauge of the needle, and whether fluid was injected for a skin or mucous membrane exposure, by the estimated volume of material, duration of contact, and the condition of the skin (chapped, abraded, intact) • Details about the exposure source: whether the source material was known to contain HIV and/or other bloodborne pathogens, and, if the source was infected with HIV, the stage of disease, history of antiretroviral therapy, and viral load, if known • Details about the exposed person (e.g., HBV vaccination and vaccine-response status) • Details about counseling, post-exposure management, and follow-up It is very important that dentists identify and keep on hand the name of a qualified physician who will evaluate any occupational exposure incident. This will facilitate the prompt referral and evaluation of any exposed dental team member. The post-exposure management program must be consistent with the practices and procedures for worker protection required by OSHA and with current USPHS recommendations for managing occupational exposures to blood.