What the HLTH 2340 is for
HLTH 2340 is a letter from the emergency department to the exposed person’s family physician or other follow-up provider. It covers percutaneous and permucosal exposures to blood and body fluids, such as needlestick injuries and splashes. It tells you what prophylaxis was given, which baseline tests were drawn, where to get the results, and what you still need to do. The clinical detail behind it is Chapter 1, Blood and Body Fluid Exposure Management, of the BCCDC Communicable Disease Control Manual.
Who completes it
The emergency department physician completes and signs the letter, stamps it with the health facility, and gives the white copy to the patient to bring to you. The yellow copy goes to the exposed person’s worksite occupational health and the pink copy stays on their chart. As the follow-up physician, your part is acting on the boxes the emergency physician ticked.
How to read and act on the letter
Post-exposure prophylaxis received
The letter records wound cleaning, tetanus prophylaxis, hepatitis B immune globulin, one dose of hepatitis B vaccine, a five-day antiretroviral starter kit, and preliminary counselling. If the starter kit was given, the five-day window is short, so the next step can’t wait for a routine appointment.
Baseline tests and where to get results
Baseline tests may include HIV Ag/Ab, HBsAg, anti-HBs, anti-HBc total, anti-HCV and a pregnancy test. The letter gives a phone number and the department to ask, such as medical records, the emergency department or the lab. The baseline results decide what further testing is needed.
What’s required of you
If antiretrovirals were started, consult the BC Centre for Excellence in HIV/AIDS at 1-888-511-6222 as soon as possible to decide on the rest of a one-month supply and arrange delivery. If a hepatitis B vaccine dose was given, offer or refer for the remaining doses of the schedule.
Follow-up blood tests
Arrange the tests the emergency physician ticked: HIV Ag/Ab at 3 weeks, 6 weeks and 3 months; HCV RNA at 3 weeks when the source is HCV positive or high risk, repeated at 6 months if positive; and anti-HCV, HBsAg, anti-HBs and anti-HBc total at 3 months. A change from non-reactive to reactive on any marker means seroconversion. The patient may also need counselling on infection risk and avoiding transmission.
Common reasons follow-up goes wrong
- The patient arrives after the five-day starter kit has run out.
- Baseline results aren’t retrieved, so the need for further testing is unclear.
- Hepatitis B vaccine doses after the first one are never scheduled.
- Only the 3-month serology is drawn when earlier HIV or HCV RNA testing was ticked.
- No one tells the patient about transmission precautions while results are pending.
Submitting and who pays
The letter isn’t submitted anywhere. The patient brings it to you, and you file it on the chart and order the tests on a lab requisition. If the exposure happened at work, the worksite copy supports the occupational health follow-up, and the visit may belong to a WorkSafeBC claim.