Bloodborne Pathogens

What Hospital Health and Safety Personnel Should Know

What are the common bloodborne pathogens?

Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) Human Immunodeficiency virus (HIV)

How do exposures occur?

Bloody or blood-contaminated fluids, via: Needlesticks or sharps Contact of eyes, nose, mouth (mucous membranes) Contact with skin

What factors affect risk?

The pathogen involved The type of exposure
Needlestick versus mucous membrane, etc.

The amount of blood involved in the exposure The amount of virus involved in the patients blood at the time of the exposure

How can occupational exposures be prevented?

Hepatitis B vaccination Safe techniques in sharps handling
Dont re-cap needles Dispose of needles in sharps container

Use of medical devices with safety features Use of appropriate barriers when contact with blood is expected

What should be done if blood exposure occurs?

Immediately Wash needlesticks with soap and water Flush splashes to the nose, mouth, or skin with water Irrigate eyes with water or eye wash Later (within 30 minutes) Report exposure to designated authority Discuss degree of risk and management

What is the risk of HBV infection?

If vaccinated, there is no risk Non-vaccinated: 6-30%
Highest risk in patients with high viral titers (HBsAg and HBeAg positive)

What is the risk of HCV infection?

1.8% from needlestick or cut Very small risk from blood splash

What is the risk of HIV infection?

Needlestick: 1/300 (0.3%) Mucous membrane: 1/1000 (0.1%) Skin: <0.1%
No cases described if skin intact

How many HCWs have been infected?

HBV: 800/year in U.S. (90% decrease from 1985-96vaccine) HCV: unknown, but 1%of HCWs in U.S. is infected compared to 1.8% of general population HIV: 54 documented cases in U.S., 134 possible cases; 1985-98

Is treatment available for HBV?

Vaccination is the first line for all HCWs Hepatitis B Immunoglobulin is effective in preventing infection after exposures
Is the source patient positive for HBsAg? Has the HCW been vaccinated? Is the HCW immune? Test the HCW and source patient to make a decision

Is treatment available for HCV exposure?

No vaccine available No treatment available Follow HCWs immune status to treat active HCV infection

Is there treatment for HIV exposure?

No vaccine available May use medications to prevent infection after exposure: post-exposure prophylaxis (PEP)

What if the source patient is not known?

Estimate risk based on:
Where the exposure occurred The rate of disease in the population What type of device caused the exposure Body fluid: blood and cerebrospinal fluid are very infective; saliva, urine, feces are not

What follow-up should be done after exposure?

HBV: none if patient is immune or received HBIG; watch for signs of hepatitis HCV: check antibody and liver function tests immediately and at 4-6 months; watch for signs of hepatitis HIV: check antibody immediately (baseline), at 6 weeks, 12 weeks, 6 months

What precautions should be taken in follow-up period?

HBV: none, if person is immune or received HBIG HCV: risk low, no precautions recommended HIV: first 6-12 weeks
Dont donate blood, organs, semen No sexual intercourse No breastfeeding