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    This document is a needle stick injury assessment and post exposure prophylaxis format used at MES Medical College Hospital in Perinthalmanna. It collects information about the healthcare worker who experienced the injury such as their name, age, sex, department, and hepatitis B vaccination status. It also documents details about the injury like the date it occurred, how it happened, and follow up advice given. The source patient's infectious disease status is noted if known.

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    health workers to be filled after needle still injury

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    This document is a needle stick injury assessment and post exposure prophylaxis format used at MES Medical College Hospital in Perinthalmanna. It collects information about the healthcare worker who experienced the injury such as their name, age, sex, department, and hepatitis B vaccination status. It also documents details about the injury like the date it occurred, how it happened, and follow up advice given. The source patient's infectious disease status is noted if known.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Download as docx, pdf, or txt
    333 views1 page

    Needle Stick Injury Format

    Uploaded by

    quality quality
    This document is a needle stick injury assessment and post exposure prophylaxis format used at MES Medical College Hospital in Perinthalmanna. It collects information about the healthcare worker who experienced the injury such as their name, age, sex, department, and hepatitis B vaccination status. It also documents details about the injury like the date it occurred, how it happened, and follow up advice given. The source patient's infectious disease status is noted if known.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    MES MEDICAL COLLEGE HOSPITAL, PERINTHALMANNA

    Needle Stick Injury Assessment & Post Exposure Prophylaxis Format

    Name of H.C.W : Age/Sex:

    Department :

    Vaccination status of staff : Inj TT / Hep-B (Complete / Incomplete)

    How many doses (Hep-B) taken : One/Two/Three

    Date of Injury Occurred :

    Date & Time of Reporting :

    Site & Depth of Injury :

    Type of Injury : Needle Prick / Sharp Cut / Lacerations / Splash of Fluids

    Cause of injury : IVcannulation / injections / GRBS / Blood collection / Recapping / Waste

    Disposal / Waste Bin / OT Instrument / Surgical Blade / Others (eg: Splash

    & Skin exposure)

    Status of Source
    Unknown : Yes / No
    If No,
    a. Name of the Patient :
    b. IP No. :
    c. OP No. :
    HBs Ag : Positive / Negative / Known case

    HIV : Positive / Negative / Known case

    HCV : Positive / Negative / Known case

    Follow- up Advice :

    Signature :

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