Management of blood-borne virus exposure in healthcare settings
Any significant exposure to blood and some other body fluids or tissue has the potential to transmit blood borne viruses, the most important of which are Hepatitis B (HBV), Hepatitis C (HCV), and HIV.
The risk of becoming infected with a blood borne virus (BBV) following percutaneous or mucocutaneous exposure varies with the circumstances and the particular virus involved. Four factors are proven to increase the risk of occupationally acquired blood borne virus infection:
| Virus | Transmission Risk | Key Interventions |
|---|---|---|
| Hepatitis B (HBV) | 30% (3 in 10) | Vaccine ± Immunoglobulin |
| Hepatitis C (HCV) | 3% (3 in 100) | No PEP available |
| HIV | 0.3% (3 in 1000) | 3-drug PEP within 72h |
The risk of HBV and HIV infection is significantly reduced by immunisation against Hepatitis B and the use of post-exposure prophylaxis (PEP).
First aid should be carried out immediately following any exposure to blood or a body fluid. Wash the area liberally with soap and water but without scrubbing. Scrubs and antiseptics should not be used. In the case of a puncture wound or needlestick injury, encourage the wound to bleed freely but do not suck the wound. Dry the area and cover any percutaneous injury with a waterproof dressing. Exposed mucous membranes, including conjunctivae, should be irrigated copiously with water, before and after removing any contact lenses.
Where appropriate, the individual who is the source of the blood/body fluid should be approached, given an explanation of the incident and asked for informed consent to disclose their infection status or to be tested for HIV, HBV and HCV, where the status is not already known. This universal approach to source testing for BBV normalises the procedure and avoids perceived discrimination.
For each of the three main blood-borne viruses, there are possible post-exposure interventions and management strategies designed to minimise the chances of the exposed worker acquiring a blood borne virus as a result of the exposure.
All interventions must be instituted after careful risk assessment by appropriately trained clinical personnel. Exposed individuals should seek immediate specialist post-exposure care at a recognised specialist centre. Occupational exposures to HIV must be reported to the Health and Safety Executive (HSE).