We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.
You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.
To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:
On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.
On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.
Please get in touch with ann.wales3@nhs.scot with any questions.
Determine risk using the Needlestick injury immediate care and BBV risk assessment flowchart and, if required, the Blood borne viruses – Background information for risk assessment document. This will inform your course of action.
High-risk sources are defined as individuals with a baseline risk of greater than:
Review the injured person’s HBV vaccination status.
For children, also check tetanus status.
In every case of Significant Exposure, take a baseline blood sample (4.5ml or 2x2.7ml anti- coagulated EDTA, red cap / clotted sample in children) from the injured party and send to RIE Virology for storage. These samples are kept for 2 years, and in the event of a subsequent positive result for BBV the stored sample helps determine BBV serostatus at time of injury.
Occupational Health offer injured healthcare workers follow-up appointments for storage bloods to at 6, 12 and 24 weeks as required.
Follow up testing should be offered in all cases but recommended in high-risk scenarios.
The information leaflet Testing for blood borne viruses can be given to patients prior to testing; this contains basic information on BBVs and issues to consider prior to being tested.
Healthcare Workers will be tested (if required or requested) by Occupational Health, unless a course of PEP has been started – in which case follow up testing will be done in RIDU.
There is a professional obligation on certain HCWs to submit to testing when they have been at significant risk.
The schedule for follow-up testing is as per Table 1 below:
| BBV | Test | Timing (weeks) | ||
| 6 | 12 | 24 | ||
| HIV | HIV Ag/Ab test | Yes | Yes | No |
| HBV | HBsAg | Yes | Yes | Yes |
| HBcAb | No | No | Yes | |
| HCV | HCV Antibody | No | Yes | Yes |
| HCV RNA (PCR) | Yes | Yes | No | |
Table 1. Recommended testing schedule for BBVs after significant exposure event.
Note: If giving HIV PEP, testing occurs 6 and 12 weeks from the end of treatment.
Follow up for non-HCWs is undertaken as follows:
1. Adults commenced on HIV Post Exposure Prophylaxis (PEP): Regional Infectious Disease Unit
2. Adults who have not been commenced on HIV PEP: advised to discuss ongoing concerns/arrange follow up testing with their GP
3. Children: contact the on-call paediatric consultant at RHCYP. If unavailable - see section Where to get expert advice.
Injured party concern: There will be situations where no significant injury has occurred or transmission risk is low, but patient anxiety may determine the need for referral to RIDU for counselling +/- follow up testing. This is appropriate.
The injured worker’s line manager should make every effort is made to establish source serostatus. Urgent testing is available, but rarely required (see section Urgent BBV testing in NHS Lothian, below).
A senior member of the source patient’s clinical team should approach them and ask them to consent to testing.
The injured HCW should not approach the source themselves.
If the HCW sustaining the injury is single-handed, there may be no option but for them to approach the source patient themselves.
In this case, if the source agrees to BBV testing, they should be referred to their GP or A&E. The single-handed practitioner should contact the GP/A&E to discuss the situation.
Brief pre-test discussion and informed consent is required and can be provided by any competent HCW.
Consent to HIV testing is rarely withheld in these circumstances when the approach is made in a sensitive manner.
If consent for testing is withheld or cannot be obtained from the source patient then testing cannot occur.
If the source patient is unconscious they cannot consent; do NOT carry out testing.
This is almost never required. In most cases where the risk is considered to be high the injured party can be started on HIV PEP and source status confirmed by non-urgent testing the following day.
For HBV, the only indication for urgent testing is an unvaccinated injured party, where identifying the source as HBV+ would prompt the administration of HBIG.
In extenuating circumstances, urgent source testing can be performed by RIE Virology (results available within 2 hours of arriving at the lab).
Urgent testing procedure
Infectious diseases