Blood Borne Exposures

Immediate first aid treatment and risk assessment are necessary for any individual who has a potential exposure to blood borne pathogens (BBP) hepatitis B (HBV), hepatitis C (HCV) and/or human immunodeficiency virus (HIV). Exposures to BBPs and resultant blood borne infections can occur when a person is exposed (the exposed) to the blood or body fluids of another person (the source).

Body fluid

Body fluids potentially infectious for blood borne pathogens

Blood, serum, plasma, visibly bloody fluids, semen, vaginal secretions, rectal secretions, cerebrospinal, synovial, pleural, peritoneal, pericardial and amniotic fluid

Body fluids NOT considered potentially infectious for a blood borne pathogens

Feces, nasal secretions, saliva, sputum, sweat, tears, urine and vomitus, unless they are visibly bloody

Types of exposures

Occupational

Percutaneous – skin puncture or laceration by needle or sharp object.
Mucosal – splash to mucous membranes (e.g. eyes, nose, mouth).
Cutaneous – contact through nonintact skin (e.g. cuts, dermatitis).

Non-Occupational

Sexual activity (eg. insertive or receptive, anal or vaginal intercourse).
Needle sharing.

Managing BBP Exposure(s) Steps

Treat site and report for assessment

Remove any contaminated clothing.
Allow wound to bleed freely. Do NOT squeeze needlestick injuries.
Flush exposed area thoroughly with water or saline.
Clean exposed area with soap and water, then dry.
Report incident to supervisor or delegate.
Proceed immediately for risk assessment: Emergency Department.

Risk assessment

Assess type of exposure, type of fluid exposed to, assess length of time fluids left source’s body, assess the source’s risk factors for/history of BBPs, determine if blood borne pathogen exposure has occurred.
See St. Michael’s Pocket P.E.P. Guide for estimated risk of transmission based on pathogen and exposure type.
If assessment deems there is a risk of exposure proceed to baseline testing.

Baseline Testing

Serological testing of the source and the exposed is recommended. Serological testing of the source is the most reliable to assess risk. However, if the exposed individual is not willing to be tested, do not test the source patient unless they have a separate indication for testing.

Inform the source of the incident if not aware and ask to undergo testing. Informed consent must be obtained. If the source does not consent to testing, an application can be made to the medical officer of health requiring mandatory blood testing to protect victims of crime, emergency service workers, and other persons. The application process can be found at: http://www.health.gov.on.ca/en/common/legislation/bill105/

Serological testing

HIV antibody (HIV Ab) if suspect acute HIV, consider HIV RNA, Hepatitis B surface antigen (HBsAg); surface antibody (anti-HBs); core antibody (anti-HBc), Hepatitis C antibody (HCV Ab); if positive, test for HCV RNA
If starting on HIV Post Exposure Prophylaxis (P.E.P.): complete blood count, serum creatinine, alanine aminotransferase

Post Exposure Prophylaxis (P.E.P.)

Post-Exposure Prophylaxis is treatment used following an exposure to blood or body fluids to prevent infection. P.E.P. is available for HIV and HBV, not HCV. P.E.P. is available in emergency rooms and an attending physician should assess and determine if P.E.P. is recommended.

HBV P.E.P. Recommendations

IF the exposed is IMMUNE (has anti-HBs >10miU/mL from 3-dose vaccine series or natural immunity from previous exposure)
- No action required
IF the exposed is NOT IMMUNE (no previous vaccine serious, anti-HBs <10miU/mL after one or two series of HBV vaccine or incomplete series).
- Prophylaxis and vaccine may be required
IF the exposed individual’s antibody status is UNKNOWN
- Draw blood for anti-HBs before giving Hepatitis B immune globulin (HBIG) or vaccine. Treat as if NOT IMMUNE. P.E.P. initiation should not be delayed pending test results.
HBIG should be given as soon as possible, preferably within 24 hours after the exposure.
Hepatitis B vaccine series is indicated for those who have not been immunized, were immunized but NOT IMMUNE or partially immunized and NOT IMMUNE.

HIV P.E.P. Recommendations

P.E.P. is indicated after percutaneous (e.g. needlestick) or mucous membrane (i.e. blood splash to eye) exposure if the source is known to be HIV-positive with a detectable viral load or unknown status with significant HIV risk factors
P.E.P. is NOT indicated from exposure to stool, urine, tears, saliva, nasal secretions, vomitus, sweat, unless bloody. P.E.P. is NOT indicated oral-to-oral contact without mucosal damage, contact with intact skin, or if source was taking pre-exposure prophylaxis (PrEP).
Treatment should be initiated within hours of exposure, ideally within 72 hours.Usually consists of treatment with 2 to 3 antiretroviral drugs for four weeks
P.E.P. should be discontinued immediately if the source’s HIV test result is negative.

HCV Recommendations

There is no P.E.P. available for HCV exposures, counsel the exposed on signs and symptoms of HCV and test for HCV antibody if source known to have HCV or has unknown status.

Counselling for exposed individuals

The exposed individual should be educated on signs and symptoms of HBV, HCV and/or HIV. Also follow up serological testing should be done if source is not tested or has a confirmed BBP.
The exposed individual should be counselled on risk of transmission following exposure
To minimize secondary transmission during the first 12 weeks post-exposure, the individual should be counseled to:
- not donate blood, semen, tissues, or organs
- prevent sexual transmission (e.g. barrier protection)
- avoid needle-sharing
- not share razors or toothbrushes
- If the source is known or suspected to be positive for HIV, the exposed individual should be counseled to avoid pregnancy and breast-feeding.

Related Resources

Content on this page has been adapted from the St. Michaels Pocket P.E.P. Guide