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JukkapekkaJousimaa

Occupational Exposure to Blood and Body Secretions

Essentials

  • Occupational exposure to blood and other body fluids is prevented by adequate training and protection of the personnel in risk situations.
  • Every employee should be properly instructed in the appropriate handling of used injection needles. They should be stored in a purpose-specific container. A used needle must never be recapped.
  • The risk of infection is assessed immediately after the accident, and necessary precautions to prevent infection are taken.
  • If the possible infection source is known to be infective or this can justifiably be suspected, it is possible to start protective measures against hepatitis B (immunoglobulin) or HIV infection (prophylactic medication) immediately after the accident.
  • All emergency rooms and on-call units must have clear instructions on how to act in case of exposure.
  • The same protective measures help prevent all microbial infections transmitted by blood or body secretions. Usually, however, the source of possible infection and the exposed person are only tested for HIV and hepatitis if there are no grounds to suspect an infection caused by some other pathogen.

Accidents involving risk of infection

  • A needle or other instrument contaminated by blood, bloody secretions or tissue fluids causes a penetrating skin wound.
  • Blood spurts into the eyes or mouth, or on erythematous or broken skin.
  • Bite wounds

First aid

  • Do not squeeze the wound but rinse it with ample water.
  • In punctures, allow the wound to bleed.
  • Remove possible foreign bodies.
  • Wash the injured area with water and soap.
  • If blood contaminates broken skin, a wound or a puncture, place an alcohol-containing compress on the site of the injury for 2 minutes or rinse the wound with alcohol.
  • Rinse mucous membranes with ample water.

Laboratory samples

  • To ensure that the right samples are taken it may be advisable to agree upon a local laboratory practice where the necessary tests are combined to a single laboratory order item. The samples taken from the infection source, from the exposed person and during the follow-up of the exposed person may somewhat differ. The local guidelines vary.
  • The following blood samples are taken from the source of possible infection with the person's consent: HIV antibodies (HIV-Ab), hepatitis B surface antigen (HBs-Ag), hepatitis B core antibody (HBc-Ab), hepatitis C antibody (HCV-Ab). If, due to the illness, the patient is unable to give his/her consent for testing, the samples can be taken after the doctor's own deliberation.
  • The samples taken from the exposed person (zero sample) include HIV-Ab, HBs-Ag, hepatitis B surface antibody (HBs-Ab) and HCV-Ab. These zero samples are sent to the laboratory immediately if the suspected source of infection does not comply with testing. If the tests from the source are obtained, the zero samples can be frozen while waiting for the results for the source of infection. If the test results are negative, the zero samples of the exposed person need not be examined and further samples are not necessary. If the source is found to have HIV, hepatitis B or C, the zero samples are sent for examination.
  • Interpretation of hepatitis B serology: see Viral Hepatitis for more details
  • The samples from the exposed worker are as a rule collected by the occupational health service on the next working day. The samples may also be collected on an emergency basis if there are particular reasons to warrant it, e.g. before the administration of hepatitis B immunoglobulin.
  • If the source of infection is not known, does not cooperate or is found to be HIV, HBV or HCV positive, further samples including HBs-Ag, HBc-Ab, HCV-Ab and HIV-Ab are taken from the exposed person at 1, 3 and 6 months.

Course of action when the source is a verified or strongly suspected hepatitis B carrier

  • Procedures according to table T2

Procedures in exposure to hepatitis B

The exposed person's protection against hepatitis BSource of transmission HBsAg+Source of transmission HBsAg-Source of transmission HBsAg?
Not vaccinatedAnti-HBV-immunoglobulin within 24 hours. Start B-hepatitis vaccination seriesStart B-hepatitis vaccination seriesStart B-hepatitis vaccination series
Vaccinated, level of protection knownNo treatmentNo treatmentNo treatment
Vaccinated, protection not developedAnti-HBV-immunoglobulin within 24 hours and a boosterNo treatmentIf there is a strong suspicion of carrier status, treat like HBsAg+
Vaccinated, level of protection not verifiedCheck exposed person's protection level (HBs-Ab). If sufficient, no treatment. If insufficient, anti-HBV-immunoglobulin within 24 hours and a boosterNo treatmentCheck exposed person's protection level (anti-HBs). If sufficient, no treatment. If insufficient, booster and checking of protection after 1-2 months.

Exposure to hepatitis C

  • When the risk is obvious, an HCV RNA test can be performed on the source of infection to evaluate infectivity.
  • Hepatitis C antibodies are investigated from the exposed at 1, 3 and 6 months from exposure.
  • If hepatitis C antibodies are detected during follow-up, interferon treatment can be started.
  • There is no vaccination.

Occupational exposure to HIV

  • Investigate HIV serology immediately after exposure and repeat the test at 2 month intervals for 6 months.
  • Condom use is recommended during the follow-up period.
  • Inform the insurance company about accidental exposure.
  • If the risk of infection is evident, prophylactic medication should be considered Antiretroviral Post-Exposure Prophylaxis (Pep) for Occupational HIV Exposure HIV Infection. Treatment should be started preferably within 2 hours but not later than 72 hours of exposure. Find out from the nearest hospital treating HIV patients what drugs should be used and have this information readily available in your practice.

Risk of infection following exposure

  • See table T1

Occupational exposure to viral agents

VirusPenetrating woundBiteInfective material
CertainProbableUnprobable
HBV5% if HBsAg +; 25% if HBeAg +ProvenBlood, blood productsSemen, body fluids, vaginal secretion, sputumUrine, faeces
HCV1-5%Not provenBloodBlood products, bloody body fluids, semen, vaginal secretionSputum, urine
HIV0.3-0.4%
Proven
Blood, blood productsSemen, vaginal fluid, liquor, breast milk, exudates, serous fluids, amniotic fluid, sputum, dental proceduresSputum, urine, faeces

Protection for personnel treating HIV-positive and hepatitis patients

  • Use gloves and a face mask when treating patients with injuries. Avoid stitch wounds.
  • Wearing more than one glove on top of each other provides a better protection than single gloves in situations where the transmission risk is particularly high Extra Gloves for Preventing Percutaneous Exposure Injuries in Healthcare Personnel.
  • Use gloves during blood sampling. A face mask is not necessary (if vacuum bottles are used).
  • Ensure that sharp objects are handled carefully and disposed off safely.

    References

    • Verbeek JH, Rajamaki B, Ijaz S, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2020;4(4):CD011621 [PubMed]
    • Mischke C, Verbeek JH, Saarto A, et al. Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel. Cochrane Database Syst Rev 2014;2014(3):CD009573 [PubMed]
    • Parantainen A, Verbeek JH, Lavoie MC, et al. Blunt versus sharp suture needles for preventing percutaneous exposure incidents in surgical staff. Cochrane Database Syst Rev 2011;2011(11):CD009170 [PubMed]