Health Services

Occupational Health

Needlesticks/Exposures

Bloodborne Pathogens, Exposures, Risks, and Prophylaxis

The following information is provided as a brief guide to define an exposure and to list body fluids regarded as potentially infectious. Risks of transmission and prophylaxis for hepatitis B and C are included.

An 8 page booklet "Exposure to Blood: What Healthcare Personnel Need to Know" (updated July 2003) is available at the CDC site.

The following information has been condensed from the:
MMWR June 2001 Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposure for HBV, HCV and HIV and Recommendations for Postexposure Prophylaxis and the September MMWR September 2005 Updated U.S. Public Health Service Guidelines for Management of Occupational Exposure to HIV and Recommendations for Post Exposure Prophylaxis.

Bloodborne Pathogen: an organism that causes HIV, Hepatitis B and/or C.

An exposure occurs when a health-care personnel (including student) has a percutaneus injury (needlestick or cut with a sharp object) or contact of mucous membrane or nonintact (chapped or open wound) skin with another person’s blood, tissue or other body fluids that are potentially infectious.

Potentially infectious blood and body fluids include fluids containing visible blood, semen, vaginal secretions and blood as well as cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid and amniotic fluid. If an exposure to saliva occurs during a dental procedure, it is considered an exposure.

Unless visible blood is present, the following body fluids are NOT considered to be potentially infectious for bloodborne pathogens:feces, nasal secretions, saliva, sputum, sweat, tears, urine and vomitus. The risk for transmitting hepatitis B/C or HIV from these fluids and materials is extremely low. EXCEPTION: exposue to saliva during dental procedures is considered to be potentially infectious.

Transmission Risks

Hepatitis B
The occupational transmission risk of Hepatitis B has become extremely low since most healthcare workers have received the 3-series Hepatitis B vaccinations. While the vaccine series is not REQUIRED, its high rate of use is responsible for decreasing occupationally acquired cases of Hepatitis B by 95%. The risk of developing clinical hepatitis from a needle contaminated with Hepatitis B surface antigen + blood in a non-vaccinated individual is approximately 1-6%. The HBV can live in dried blood at room temperature on environmental surfaces for up to one week. Proper disinfection of surfaces is very important!

Hepatitis C
Hepatitis C has become more a risk than Hepatitis B or HIV. The average incidence of HCV conversion after a percutanuous exposure is 1.8%. Transmission rarely occurs from mucous membrane exposures and no transmission from skin (intact or non-intact skin) exposure is known. Between 15-25% of patients with acute HCV infection resolve the infection without treatment. Coinfection of the source patient with HIV may increase the risk of transmitting HCV.

HIV
A percutaneous exposure from an HIV infected person carries a risk of .3% (3 in 1000). The risk of transmitting HIV from a mucocutaneous exposure is even less (.09%). The degree of risk depends upon type of needle/instrument (hollow bore vs solid); depth of injury; needle placement within vein or artery; amount of blood or body fluid; and terminal illness of the source patient. Terminally ill HIV+ patients have higher transmission rates, but viral load needs to be considered. Low viral load does not eliminate the risk but may reduce it.

Prophylaxis

Hepatitis B
If a person has not received the hepatitis B series, a dose of hepatitis B immune globulin (HBIG) is recommended after an exposure. HBIG can reduce the risk of Hepatitis B by 70-75%. The hepatitis series should be started as soon as possible post exposure. The vaccine is responsible for decreasing rates of occupationally acquired HBV by 95%. Keep yourself safe and help reduce the incidence of Hepatitis B by being vaccinated.

A titre should be drawn 1-2 months after completion of the vaccine series to determine if immunity has been achieved.

Hepatitis C
There is no prophylaxis or vaccine for Hepatitis C. Antiviral medications do not affect transmission of HCV. Ribaviron/interferon is useful in eradicating chronic HCV infections, but is not indicated for prophylaxis.

HIV
Antivirals to decrease the risk of transmission are useful, depending upon the degree of risk. One must weigh the risk of transmission against the risks of side effects. Protease inhibitors cause more side effects than other antivirals. Nearly 50% of individuals taking antivirals will have at least one side effect. Approximately 1/3 of individuals stop antiviral treatment due to side effects. It is best to begin antiviral therapy within 2 hours of the exposure, but is still effective if started within 24 hours.

A basic regimen of 2 antiviral medications (i.e. Combivir, Kaletra or Truvada) may be initiated for low risk exposures; an expanded regimen may be prescribed if the source patient is known to be HIV +. The type of injury must also be considered when making a decision to prescribe antivirals. Zovudine has shown an 81% decrease in transmission rates of HIV.

If antivirals are prescribed, additional lab tests (urine pregnancy test, CBC and CMP) will be ordered to monitor for side effects ( elevated liver function tests, anemia, neutropenia, hyperglycemia, pancreatitis etc.). Labs will be drawn at baseline and periodically throughout treatment.

While a needlestick or other exposure can be frightening, low transmission rates, Hepatitis B vaccination, and use of antivirals in appropriate situations can greatly decrease the risk. Very few documented seroconversions among healthcare workers have occurred.