Post-Exposure Management of Occupational Exposure to Blood/Body Fluids

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Risk of Occupational Exposure

This information sheet provides guidance for CARNA members on key measures to prevent the acquisition of blood-borne virus infection (BBVI) following occupational exposure. Protocols for the management of exposure to the hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in the health-care environment most often involve health-care worker exposure to the blood or specific blood fluids of others (e.g. patients). Less frequently, exposures involve the potential transmission from health-care workers to patients or from one patient to another; most of these exposures do not result in infection. The risk by virus type is highest for HBV, followed by HCV and is lowest for HIV. While exposure prevention is the primary strategy for reducing the risk of occupational BBVI, post-exposure followup reduces the potential of acquiring BBVI following occupational exposure to blood and infectious body fluids.

Health-Care Organization Policy

All health-care organizations should have protocols for the management of occupational exposure to HBV, HCV and/or HIV. Employees of health-care organizations should be instructed about the written protocols for reporting, counselling, treatment, followup and evaluation of occupational exposures to blood and infectious body fluids. Policies and other information about post-exposure follow up are often included in job orientation or training.

Definition of Occupational Exposure

An occupational exposure to HBV, HCV and/or HIV follows contact with blood or potentially infectious body fluids of another person (e.g. patient) in the workplace by:
• the percutaneous route (e.g. skin puncture, needlestick, bite or laceration)
• human bites may represent a risk to the person bitten, and the person who
inflicted the bite, although the transmission of HIV and hepatitis B has been
rarely reported
• mucous membrane contact (e.g. splash or spray in the eye, mouth and/or nose)
• contact with non-intact skin (e.g. chapped skin, dermatitis, or eczema)

There is no evidence that BBVs can be transmitted through intact skin.

Reporting Occupational Exposures

All health-care workers and other employees should be aware of employer procedures for post-exposure follow up in the event of an exposure to blood or potentially infectious body fluids in the work setting. Protocols should be in place from the perspective of the health-care worker and the patient. When the exposure involves a health-care worker infected with BBVI (either as the source or recipient of exposure), the Alberta Expert Review Panel recommends that exposures be reported to the employer’s department of occupational health and safety or the infection prevention and control department. If staff of the occupational health and safety department or the infection prevention and control department are not available, the local medical officer of health should be contacted for advice. The identity of the health-care worker with BBVI need not be revealed to the patient during followup when the patient is the recipient of the exposure. All occupational exposures require immediate followup.

Immediate Post Exposure Actions

Immediate actions after exposure to blood or potentially infectious body fluids include:
• removing any contaminated clothing
• allowing the exposure site to bleed freely
• cleansing the site (e.g. needle stick or cut) by washing with soap and water.
A skin antiseptic can be applied, when available, as a first aid measure
• flushing splashes or sprays to skin, nose, or mouth with water or saline
• irrigating splashes to the eyes with clean water, saline or sterile irrigants

Cleansing with skin antiseptics or bleach is not advised and “squeezing” the wound will not reduce the potential for acquiring BBVI.

Treatment After Exposure

Treatment after exposure depends on the susceptibility of the recipient (person exposed) and the infectivity of the blood/body fluid from the source of the exposure (positive for BBV or not). Possible treatment following exposure to a positive source varies by the type of BBV involved in the exposure and should be discussed with an infectious disease specialist.

HIV
• There is no vaccine for HIV, but antiretroviral drugs may reduce the transmission of HIV. People receiving HIV post-exposure prophylaxis (PEP) should be given HIV PEP within hours (preferably one to two hours) of exposure. Drug regimens of several drugs are considered. It is recommended that a medical expert in antiviral therapy select the HIV PEP drug regimen for potential HIV exposures. The prescribing physician will discuss drug risks and side effects.

HBV
• Hepatitis B vaccine: Both the hepatitis B immunization status and the vaccine
antibody response (anti-HBs) are considered in the decision to provide
prophylaxis.
• Hepatitis B Immune Globulin (HBIG): HBIG is available for exposure recipients
who do not have protective anti-HBs. When indicated after occupational exposure,
HBIG should be administered as soon as possible.
•Vaccination may still be required after infection; contact an infectious disease specialist


HCV
• No vaccine for hepatitis C is available. A medical specialist knowledgeable in treating
early HCV infection should be consulted.

Decreasing Occupational Exposure Risk

• Follow recommended infection prevention control practices, including safe
handling of sharps, e.g. avoid needle recapping or overfilling of sharps containers.
• Use recommended protective barriers, e.g. gloves and eye protection.
• Follow occupational health and safety policies and guidelines for the prevention
of BBVI, e.g. hepatitis B immunization.
• Assume responsibility for awareness of, and compliance with, occupational
post-exposure follow up.
• Use safety-engineered sharps whenever possible.
• Support organizational strategies, e.g. employee educational sessions, about
the surveillance, evaluation and prevention of occupational exposures to blood-
borne viruses in the workplace.
• When given the opportunity, participate in the evaluation of equipment with
improved design for the prevention of exposures.


Additional information on post-exposure follow up can be obtained from:

Department of Health and Human Services, Centers for Disease Control and Prevention.
Exposure to blood: What health-care personnel need to know

References


1. Canadian Centre for Occupational Health and Safety. (Updated 2005). Needle stick injuries. Accessed on Feb 20, 2009.

2. Department of Health and Human Services, Centers for Disease Control and Prevention. (2001). Updated U.S. Public Health Service guidelines for the management of occupational exposure to HBV, HCV, and HIV and recommendations for post exposure prophylaxis. MMWR, 50 (RR11), 1- 42.

3. Department of Health and Human Services, Centers for Disease Control and Prevention. (2005). Updated U.S. Public Health Service guidelines for the management of occupational exposure to HIV and recommendations for post exposure prophylaxis. MMWR, 54 (RR09), 1-17.

4.  Health Canada. (2002). Infection control guidelines: Prevention and control of occupational infections in health care. Canada Communicable Disease Report, 28S1.

5. Public Health Agency of Canada, Canadian Immunization Guide (7th ed.). (2006). Hepatitis B Vaccine. Accessed on Feb. 13, 2008.

 

6. UK Departments of Health (1998. Guidance for clinical health care workers: protection against infection with blood-borne viruses. Accessed. Feb. 13, 2009.

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