Does the patient have capacity? Is the lack of capacity likely to be temporary?** Has the patient recently been tested for blood-borne viruses? A thorough search of both primary and secondary care records is necessary before proceeding further. If prolonged lack of capacity, does the patient have an attorney or a deputy with the legal authority to make decisions for him or her?** If there is no legal deputy then speak to friends and family to establish whether the patient would have ordinarily objected to being tested for this purpose? If there is no recent test result available and there is no evidence that the patient would have ordinarily objected then testing can proceed To minimise harm, testing should be performed on a recently stored sample or if a new sample is needed it should be taken at the same time as blood is taken for other clinical purposes. Once the patient regains capacity they should be advised of the needle-stick injury and any testing that was undertaken and appropriate information should be provided so that the patient can make an informed decision about whether to receive the result. It should be accepted that some patients may not want to know the results but it must be remembered that consent is an ongoing process and a patient who declines to receive the result at a certain point may decide otherwise in the future and adequate support should be put into place so that a change in consent can be accommodated.
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