What are the steps to take if you are exposed to blood or other infections materials?
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To minimise the risk of spread of infection, all blood and body substances should be treated as potentially infectious. The techniques used in handling these substances are known as standard precautions. Standard precautions are recommended in the handling of: Standard precautions are good hygiene practices relating to hand hygiene, the use of gloves and other protective clothing (as appropriate), and the safe disposal of waste. If any person has contact with blood or body fluids, the following procedures should be observed: Incidents occurring during or
after work hours should be reported immediately to: If a person thinks he or she has been exposed to human immunodeficiency virus (HIV) or hepatitis B, for further information he or she can: If a potential HIV or hepatitis B exposure occurs in the workplace, the PEP assessment should be provided through the work, health and safety procedures for the workplace. PEP may: PEP needs to begin as soon as possible after exposure to be effective. PEP for hepatitis B consists of: PEP for HIV consists of a 28 day
course of medication (anti-retroviral). If blood or body fluids are spilled on surfaces, the following cleaning procedures should be used: Exposures include sharps injuries (including needlestick) and splashes into or onto mucous membranes or non-intact skin. Occupational hazards for healthcare workers from sharps injuries (including needlestick injury), and other blood or body fluid incidents include human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Exposure is an injury or incident that involves direct skin contact with a body fluid or substance (listed below), where there is compromised skin integrity (such as an open wound, abrasion or dermatitis) or direct mucous membrane contact. For exposure to skin, the larger the area of skin exposed and the longer the time of contact, the more important it is to verify that all the relevant skin area is intact. The following body fluids pose a risk for bloodborne virus transmission:
Exposures and infection control protocolsAll health services must develop their own infection control protocols for communicable diseases. This includes clear written instructions on the appropriate action to take in the event of an exposure to blood or body fluids/substances, such as needlestick injuries and other blood or body fluid incidents involving either patients or healthcare workers. The protocol should include:
Treatment protocols should include removal of contaminated clothing and thorough washing of the injured area with soap and water. Affected mucous membranes should be flushed with large amounts of water. Eyes should be flushed gently. The exposed person must report any occupational exposures immediately. The exposed person should have a medical evaluation, including information about medications they are taking and underlying medical conditions or circumstances. Postexposure prophylaxis (PEP), non-occupational post-exposure prophylaxis (N-PEP) and counselling should be available and offered as appropriate. Treatment should be available during all working hours and on call after hours (for example, through an on-call infectious diseases physician). Patients or others exposed to blood or other body fluids/substances must be informed of the exposure by a designated professional, while maintaining confidentiality about the source of the blood. Baseline serum should be collected from the patient and expert counselling provided on the implications of what has happened. PEP, N-PEP and appropriate long-term follow-up should be offered, where applicable. Patient or source refusal for testing and serum storage should be documented. Document the incident and include:
Exposure incidents that do not occur in a health service should be reported to a general medical practitioner or the emergency department at the nearest hospital. Post-exposure management of the source individualThe person whose blood or body fluids are the source of an occupational/non-occupational exposure or other injury should be evaluated for infection with HIV, HBV and HCV. Information available in the medical record or from the source person may suggest or rule out infection with each virus. If the source is known to have HIV infection, then information on stage of infection, and current and previous antiretroviral therapy should be gathered and used in deciding the most appropriate regimen of PEP. If the HIV, HBV or HCV status of the source person is unknown, then the source person should be informed of the incident, and their consent sought to test for these viruses, with appropriate pre- and post-test counselling. Their consent to having the information in their patient record used should be also sought. If consent cannot be obtained – for example, if the patient is unconscious or unwilling to consent – then procedures should be followed that comply with legislation in Victoria. The source individual should be tested for, as follows, at the time of injury:
If the HCV antibody test is positive, then HCV polymerase chain reaction (PCR) should be performed to test for HCV RNA. Transmission is much less likely to occur from a source who is PCR negative. The status of the source individual may be known at the time of the incident. In this case the affected person should be managed as described below under ‘Immediate management’. If the source is unknown, the case should be managed as described in ‘Management of the exposed person’. Source individual unknownReasonable efforts should be made to identify the source. If the source remains unknown, appropriate follow-up should be determined on an individual basis depending on:
Management of the exposed personImmediate care of the exposure siteContaminated clothing should be removed, and the injured area should be washed well with soap and water (an antiseptic could also be applied). Any affected mucous membranes should be flushed with large amounts of water. If the eyes are contaminated, they should be rinsed gently but thoroughly with water or normal saline, while kept open. Evaluation of the exposureThe exposed person should be examined to confirm the nature of exposure and counselled about the possibility of transmission of bloodborne disease. Evaluation and testing of the exposed personThe exposed person should have a medical evaluation, including information about medications they are taking, and underlying medical conditions or circumstances. All exposed people should be assessed to determine the risk of tetanus. Depending on the circumstances of the exposure, the following may need to be considered:
The current edition of The Australian immunisation handbook should be consulted for further details. The exposed person would normally be tested for HIV antibody, HCV antibody and antibody to HBsAg at the time of the injury, to establish their serostatus at the time of the exposure. Expert counselling on the implications of the event, PEP and appropriate long-term follow-up should be offered. An option that may be offered to healthcare workers who do not wish to undergo testing at the time of the exposure is to have blood collected and stored but not tested. Blood that is collected and stored for this purpose must be retained for a minimum of 12 months. If the source person is found to be HIV, HBV and HCV negative, no further follow-up of the exposed person is generally necessary, unless there is reason to suspect the source person is seroconverting to one of these viruses, or was a high risk of bloodborne viral infection at the time of the exposure. If the source is positive for one of these viruses, pregnancy testing should be offered to women of child-bearing age who have been exposed and whose pregnancy status is unknown. Postexposure counsellingA specialist with knowledge of bloodborne infections should do the follow-up. If it is demonstrated that a person has been exposed to a bloodborne pathogen, they should not donate blood, semen, organs or tissue for 6 months, and should not share implements that may be contaminated with even a small amount of blood (for example, razors or toothbrushes). For HIV and HBV, the exposed person should be informed of the risk of transmission to sexual and injecting partners for a 6-month period, and be counselled about issues of safe sex and safe injecting. If PEP is indicated, or if there is a risk of acute infection with HIV, HCV or HBV, advice should be offered on pregnancy and breastfeeding based on an individual risk assessment. In the case of HIV, patients should be advised of the remote risk of seroconversion up to 12 months post-exposure, particularly if specific PEP was undertaken. Follow-up for the exposed personIf the source person is seronegative for HIV, HBsAg and HCV, baseline testing or further follow-up of the healthcare worker is normally not necessary. If the source person has recently engaged in behaviours that are associated with a risk for transmission of these viruses, baseline and follow-up HIV-antibody testing of the healthcare worker should be considered. Summary: management of exposure to blood and body fluids or substancesTable 1 summarises the management of exposures to blood, body fluids or body substances. Table 1: Management of exposures to blood, body fluids or body substances.
What are the steps to take if you are exposed to blood or other infectious materials?If you are stuck by a needle or other sharp or get blood or other potentially infectious materials in your eyes, nose, mouth, or on broken skin, immediately flood the exposed area with water and clean any wound with soap and water or a skin disinfectant if available.
What are the steps you should take if you are exposed to blood or body fluids?Wash/flush the exposed area.
For needlesticks/cuts: clean wound with soap and water immediately for 2 minutes. For splashes: flush mucous membranes with clean water. For eye exposure: remove contacts if present, and flush eye(s) using an eye wash station.
What steps should you take if you have an exposure incident?Wash wounds and skin with soap and water.. Flush mucous membranes with water.. DO NOT USE instrument involved on patient!. Employee must report incident immediately to supervisor/employer.. What can you do to protect yourself from exposure to blood?The Bloodborne Pathogens standard (29 CFR 1910.1030) and CDC's recommended standard precautions both include personal protective equipment, such as gloves, gowns, masks, eye protection (e.g., goggles), and face shields, to protect workers from exposure to infectious diseases.
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