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Question

Difficulty: HardAccident, Error, and Injury Prevention

A registered nurse sustains a percutaneous injury from a contaminated hollow-bore needle immediately after administering an intramuscular medication to a client. Arrange the following actions the nurse must take in the correct priority sequence to minimize injury risk and adhere to evidence-based post-exposure protocols.

  1. 1Cleanse the punctured area immediately with copious amounts of soap and running water.
  2. 2Notify the charge nurse to report the exposure and secure coverage for the client assignment.
  3. 3Report to the occupational health department or emergency department for a risk assessment and post-exposure prophylaxis (PEP) evaluation.
  4. 4Ensure facility protocols are initiated to obtain informed consent and test the source client for bloodborne pathogens.
  5. 5Complete a formal facility incident report detailing the exact circumstances of the exposure event.

Answer

The correct chronological sequence is to first cleanse the puncture site, then notify the charge nurse for unit coverage, report to occupational health for immediate medical evaluation, ensure the source client is tested, and finally complete the administrative incident report.
Following a percutaneous exposure, immediate physiological safety (cleansing the site) is the highest priority. This is followed by ensuring unit safety (notifying the charge nurse for coverage), obtaining personal medical intervention (occupational health/PEP evaluation), gathering critical risk data (source client testing), and finally completing administrative duties (incident report).

Step-by-Step Solution

1
Cleanse the punctured area immediately with copious amounts of soap and running water.
Decontamination of the immediate puncture wound.
This is the primary physiological intervention to reduce the presence of the pathogen and minimize systemic absorption. The site should not be squeezed or scrubbed vigorously.
2
Notify the charge nurse to report the exposure and secure coverage for the client assignment.
Unit leadership is informed and patient care is safely handed off.
The nurse cannot safely continue providing care or abruptly abandon their patients. Coverage must be secured before the nurse leaves the unit to seek treatment.
3
Report to the occupational health department or emergency department for a risk assessment and post-exposure prophylaxis (PEP) evaluation.
The nurse receives an immediate medical evaluation and baseline serology.
Time is critical. If indicated, HIV post-exposure prophylaxis (PEP) should be administered as soon as possible, ideally within 1 to 2 hours of the exposure.
4
Ensure facility protocols are initiated to obtain informed consent and test the source client for bloodborne pathogens.
The source client's blood is drawn for HIV, Hepatitis B, and Hepatitis C testing.
Identifying the source client's infection status determines the necessity, duration, and type of post-exposure treatment the nurse will require.
5
Complete a formal facility incident report detailing the exact circumstances of the exposure event.
An official administrative record of the workplace injury is created.
Incident reports are required for root cause analysis, facility safety metrics, and workers' compensation, but administrative paperwork must never delay urgent medical care.

Key Concept

Prioritization of occupational exposure management: immediate decontamination, unit safety, urgent medical prophylaxis, risk stratification, and administrative reporting.
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Topics

Accident, Error, and Injury Prevention

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