Download 5-010 Occupational Exposure to Blood or Body Fluids

OCCUPATIONAL EXPOSURE TO BLOOD OR BODY FLUIDS
Healthcare professionals are at risk for occupational exposure to bloodborne pathogens, including
hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV).
Exposure occurs through needlesticks or cuts from other sharp instruments contaminated with
infected patient’s blood or through contact of the eye, nose, mouth or skin with a patient’s blood.
Most exposures do not result in infection. The risk of infection may vary with factors such as:
 The pathogen involved
 The type of exposure
 The amount of blood involved
 The amount of virus in the patient’s blood at the time of exposure.
How can occupational exposures be prevented?
It can be prevented by using safer workplace practices and routine infection control precaution
techniques, for example: disposing of used needles in appropriate sharp disposal containers, not
recapping needles by hand, using medical devices with safety features designed to prevent
injuries, using appropriate barriers such as gloves, eye and face protection or gowns when contact
with blood is expected.
What body fluids are capable of transmitting BBPs?
Blood, serum, plasma and other fluids contaminated with blood such as pleural, amniotic,
pericardial, peritoneal, synovial and cerebrospinal fluids, semen, vaginal secretions, saliva, breast
milk, contaminated lab specimen, organ and tissue transplants from an infected individual.
What should I do if I am exposed to the blood of a patient?
1. Immediately following an exposure to blood:
 Remove gloves or clothing to assess the injury.
 Allow immediate bleeding of the wound
 Wash needlesticks and cuts with soap and water
 Flush splashes to the nose, mouth or skin with water.
 Irrigate eyes with clean water, saline or sterile irrigants.
No scientific evidence shows that using antiseptics or squeezing the wound will reduce the risk of
transmission of BBP. Using caustic agents such as bleach is not recommended.
2. Report the exposure to the supervisor or to the department responsible for managing
exposures, e.g. occupational health.
Immediately report to the Outpatient/Emergency department at the nearest health care
facility to see the physician.
What is the risk of infection after an occupational exposure?
Risks of infection depend upon:
 The pathogen involved
 The type of exposure
 The amount of blood involved
 Depth of injury
 Gauge of needle (larger the gauge, larger the risk)
 The amount of virus in the patient’s blood at the time of exposure.
HBV
HCW who have received hepatitis B vaccine and have developed immunity are at virtually no
risk for infection. Employees who have been immunized and then had a blood test that
indicated immunization was effective do not need to be boostered or re- tested for Hepatitis B
immunity. If further testing indicates that antibodies have dropped, it does NOT mean you are
no longer protected because immune memory persists. Booster doses in this situation are not
indicated.
For an un-immunized person or a person for whom the vaccine did not produce immunity, the
risk from a single needlestick or cut exposure to HBV infected blood ranges from 6-30%. It also
depends on the hepatitis B e antigen (HBeAg) status of the source. Hepatitis B surface antigen
(HBsAg) - positive individuals who are HBeAg positive, have more viruses in their blood and are
more likely to transmit HBV than those who are HBeAg negative. While there is a risk for HBV
infection from exposures of mucous membranes or non-intact skin, there is no known risk for
HBV infection from exposure to intact skin. Since the availability of Hepatitis B vaccine there
has been a significant reduction in the number of occupational infections.
HCV
The average risk of Hepatitis C after needlestick or cut is approximately 3-10%. The risk
following a blood exposure to the eye, nose or mouth is unknown, but is believed to be very
small; however, HCV infection from blood splash to the eye has been reported. There also has
been a report of HCV transmission that may have resulted from exposure to non-intact skin,
but there is no known risk from exposure to intact skin.
HIV
The average risk of HIV infection after a needlestick or cut exposure to HIV infected blood is
0.3% (i.e.; three-tenth of one percent or about 1 in 300). Stated another way, 99.7% of needle
stick/cut exposures do not lead to HIV infection.
http://www.kthr.hin.sk.ca/SignedPolicies/Shared Documents/OH and S Policies/05 - Risk Management Programs/5-010 Occupational Exposure to
Blood or Body Fluids.doc
Not part of the Client’s Permanent Health Record. Last Revision Date: March 4, 2014
The risk after exposure of the eye, nose or mouth to HIV infected blood is estimated to be, on
average 0.1% (1 in 1000).
The risk after exposure of non-intact skin to HIV infected blood is estimated to be less than
0.1%. A small amount of blood on the intact skin probably poses no risk at all. There have been
no documented cases of HIV transmission due to an exposure involving a small amount of
blood on intact skin (a few drops of blood on skin for a short period of time).
Is any vaccine available to prevent BBPs?
The only vaccine available is for HBV; there is no vaccine available for HCV and HIV. All health
care personnel who have a reasonable chance of exposure to blood or body fluids should
receive hepatitis B vaccine. There are three doses of vaccine given at an interval of 0, 1 and 6
months. Workers should be tested 1-2 months after the vaccine series is completed to make
sure that vaccination has provided immunity to HBV infection.
Is treatment available to prevent infection with BBP?
If the source individual cannot be identified or tested, a decision regarding follow-up should be
based on the exposure risk and whether the source is likely to be infected with a BBP.
HBV: If you have not been vaccinated, hepatitis B vaccination is recommended for any
exposure regardless of the source person’s HBV status. The hepatitis immune globulin and /or
hepatitis vaccine may be recommended depending on the source person’s infection status,
your vaccination status and, if vaccinated your response to the vaccine. People who have once
proven immunity to Hepatitis B do not need to be retested or boostered.
Post exposure treatment for those who are not immune should begin ASAP after exposure,
preferably within 24 hours, and no later than 7 days.
HCV: There is no post exposure treatment that will prevent HCV infection.
HIV: A 4-week course of a combination of either two or three antiretroviral (ARV) drugs is
recommended. The recommended treatment regimen will depend upon the extent of
exposure, the volume of blood, concern about drug resistant HIV, and side effects associated
with use of drugs. Determining which drugs and how many drugs to use or when to change a
treatment regimen is largely matter of judgment. Your clinicians will make the decision with
guidance and consultation with an Infectious Diseases specialist.
Treatment should be started ASAP, preferably with in hours as opposed to days, after the
exposure. Although animal studies suggest that treatment is less effective when started more
than 24-36 hours after exposure, the time frame after which no benefit is gained in humans is
not known. Starting treatment after a longer period (e.g. 1 week) may be considered for
exposures that represent an increased risk of transmission.
http://www.kthr.hin.sk.ca/SignedPolicies/Shared Documents/OH and S Policies/05 - Risk Management Programs/5-010 Occupational Exposure to
Blood or Body Fluids.doc
Not part of the Client’s Permanent Health Record. Last Revision Date: March 4, 2014
How safe are the Hepatitis B vaccine and antiretroviral drugs? What are their side effects?
Hepatitis B vaccine and HBIG are very safe. There is no information that the vaccine causes any
chronic illnesses. However, you should report to your healthcare provider any unusual reaction
after a hepatitis B vaccination.
All of the antiretroviral drugs have been associated with some sort of side effects. The most
common side effects include upset stomach (nausea, vomiting, and diarrhea), tiredness, and
headache. The few serious side effects that have been reported after using combination of
antiretroviral drugs are kidney stones, hepatitis and suppressed blood production. The ARV
drugs may also interact with some other medicine like non-sedating antihistamines and cause
serious side effects. If you need to take ARV drugs for HIV exposure, it is important to tell the
healthcare provider managing your exposure about any medications you are currently taking.
Can pregnant HCW get Hepatitis B vaccine, HBIG or ARV drugs?
Yes, women who are pregnant or breastfeeding can receive the hepatitis B vaccine and/or
HBIG.
Pregnancy should not rule out the use of ARV drugs as post exposure treatment for HIV when
it is warranted.
What follow-up should be done after an exposure?
HBV: Post exposure treatment in preventing HBV is usually quite effective. If you receive
hepatitis B vaccine, you should be tested 1-6 months after completing the vaccine series to
determine if you have responded to the vaccine and are protected against HBV infection. If
you feel any symptoms suggesting hepatitis (e.g. yellow eyes or skin, loss of appetite, nausea,
vomiting, fever, stomach or joint pain, extreme tiredness), report to your health care provider.
HCV: You should be tested for HCV antibodies and liver enzyme levels as soon as possible after
the exposure and at 4-6 months after exposure. To check for infection earlier, you can be
tested for the virus 4-6 weeks after the exposure. Treatment of new hepatitis C infection with
long acting interferon and ribavirn can get rid of the virus in up to 60% of people with in 24-48
weeks. Report any symptoms suggesting hepatitis to your health care provider.
HIV: You should be tested for HIV antibodies as soon as possible after exposure and
periodically for at least 6 months after the exposure (e.g. at 6 weeks, 12 weeks and 6 months).
If you take ARV drugs for post-exposure treatment, you should be checked for drug toxicity by
having a complete blood count, kidney and liver function tests just before starting treatment
and 2 weeks after starting treatment. You should report any sudden or severe flu like illness
that occurs during the follow-up period, especially if it involves fever, rash, muscle aches,
tiredness, malaise or swollen glands. Any of these may suggest HIV infection, drug reaction or
other medical conditions. You should contact the healthcare provider managing your exposure
if you have any questions or problems during the follow-up period.
During the follow-up period, especially the first 6-12 weeks when most people are expected to
show signs of infection, you should follow recommendations preventing transmission of
infection.
http://www.kthr.hin.sk.ca/SignedPolicies/Shared Documents/OH and S Policies/05 - Risk Management Programs/5-010 Occupational Exposure to
Blood or Body Fluids.doc
Not part of the Client’s Permanent Health Record. Last Revision Date: March 4, 2014
What measures can an infected or potentially infected person can take to avoid spreading
infection to others?
If you know that you are or may be infected with HBV, HCV or HIV/AIDS, the following guidelines
can help protect others:

Follow safer sex practices. The only 100% safe way to protect your sexual partner or
partners from infection is abstinence. If you choose not to abstain, practice safer activities
to avoid practices that expose them to blood, saliva, semen and vaginal secretions. Barring
that, carefully follow guidelines by practicing safer sex, including using a new latex condom
each and every time you have vaginal or anal sex and using a dental dam, condom or piece
of non-porous plastic wrap for oral sex. If you are allergic to latex, use a plastic
(polyurethane) condom. Avoid lambskin condoms because they will not protect from
sexually transmitted viruses. Use only water based lubricants, not petroleum jelly, cold
cream or oils. Oil based lubricants can weaken condoms and cause them to break.
Remember that although condoms can reduce risk, they don’t eliminate the risk entirely.
Condoms can break or develop small tears and people don’t always use them properly. Do
not use condoms that are beyond the expiry date as they weaken with age. Don’t store
condoms where they can be damaged by heat, cold or sharp objects. Condoms should not
be carried in back pockets. If you use sexual devices, don't share them.

Tell your sexual partner(s). If you have a BBP, you should inform your sexual partners.
Public Health can assist with notifying partners. You may also choose to use condoms for
each and every sexual encounter (oral, vaginal, anal).

If you have recently become aware of your infection with any BBP, Let anyone with
whom you've had sex know that you are infected. Your partners need to be tested, and
should receive medical care if they have any of these viruses. They also need to know their
status so that they don't infect others. Your doctor and Public Health can help you inform
them.

Don't share needles or other drug use equipment. If you use IV drugs, never share your
needles, or other equipment and syringes with anyone. Always use a sharps container for
all used needles.

Don't donate blood, semen or organs. Donating infected blood, semen or organs spreads
the virus.

Don't share razor blades or toothbrushes. These items may carry traces of infected blood.
Some experts also suggest not sharing your comb, hairbrush and nail clippers.

If you're pregnant and have a BBP, be sure to tell your doctor. That way, your baby can be
treated as soon as he or she is born. There are medications and/or immunizations, which
may help to prevent transmission to the baby either before, during or after delivery.
Women who are infected or potentially infected should consider not breastfeeding infants
during the follow up period after an exposure to a blood borne pathogen.
http://www.kthr.hin.sk.ca/SignedPolicies/Shared Documents/OH and S Policies/05 - Risk Management Programs/5-010 Occupational Exposure to
Blood or Body Fluids.doc
Not part of the Client’s Permanent Health Record. Last Revision Date: March 4, 2014