______________________________ Infection Control for New York Health Care Professionals ‒ 2024 Update
Preventing Transmission of Bloodborne Pathogens HIV, HBV, and HCV are three of the most common bloodborne pathogens that put healthcare workers at risk. Today, simultaneous infection from multiple diseases; multidrug-resistant organisms, including HIV, hepatitis B or C, and methicillin-resistant Staphylococcus aureus (MRSA); and comorbidities associated with diabetes increase healthcare workers’ risk of occupational exposure [30]. Healthcare workers are potentially exposed to these diseases in one of two ways [30]: • A percutaneous injury in which they are injured by a sharps object • A mucocutaneous exposure incident with contact of a mucous membrane or nonintact skin with blood, tissue, or other potentially infectious bodily fluids When PPE is not readily available or accessible, employees are less likely to wear it. This puts them at risk of exposure to blood and body fluids, thus making them more vulnerable to bloodborne pathogens. Following a specific exposure, the risk of infection varies depending on factors such as the following. • The pathogen involved • The type and severity of exposure • The amount of blood involved in the exposure • The amount of pathogen in the patient’s blood at the time of exposure Although most exposures do not result in infection, the exposed person should be evaluated immediately by a qualified healthcare professional in case treatment is needed. Postexposure Management and Prophylaxis Healthcare workers may face the risk of exposure to infection from pathogens despite the use of precautions, engineering controls, and safe work practices. Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus are the three most common pathogens of concern, according to the CDC, due to exposure to blood and other bodily fluids. According to the Bloodborne Pathogens standard at 29 CFR § 1910.1030, it is the employer’s responsibility to meet the requirement at paragraph (f)(3)(iii)(A), to collect and test the exposed employee’s blood for HBV and HIV after consent is obtained, regardless of the status of the source patient [17]. The National Occupational Research Agenda (NORA) works within the CDC on innovative research projects for workplace safety based on CDC content. The References Campaign, a NORA program, works to bring awareness to healthcare work- ers concerning the risks of exposure to bloodborne pathogens due to needle sticks or injury from sharp objects. The campaign includes guidelines and resources that address postexposure practices, including the following steps [30].
Step one: Immediate care to the exposure site 1. Wash puncture and small wounds with soap and water for 15 minutes. 2. Be aware of wash station locations in your facility. 3. Apply direct pressure to lacerations to control bleeding and seek medical attention. 4. Flush mucous membranes with water. a. Mouth: Rinse several times with water. b. Eyes: 1) Remove contact lenses. 2) If eye wash station is available, flush eyes for 15 minutes. 3) If eye wash station is not available, have a peer flush exposed eye with 500 mL lactated Ring- ers or normal saline. 5. If unable to do the above, then flush under the sink with water (preferably tepid) for 15 minutes or as toler- ated. Keep the eyes open and rotate the eyeballs in all directions to remove contamination from around the eyes. Help may be needed to hold the eyelids open. Step two: Evaluate exposure and report 1. Seek medical care to determine risk associated with exposure. 2. Report blood and body fluid exposure immediately, as it poses a risk of infection transmission. 3. Reporting as soon as possible will assist in obtaining a test from the source. 4. Remember to complete an incident report so that a cause investigation may occur that can result in preventing similar type incidents with others. Step three: Give postexposure prophylaxis (PEP) for exposures posing risk of infection transmission. 1. HBV. a. Give PEP as soon as possible, preferably within 24 hours. b. PEP can be given to pregnant women. 2. HCV: PEP not recommended. 3. HIV. a. Initiate PEP as soon as possible, within hours of exposure. b. Offer pregnancy testing to all women of childbear- ing age even if they are not known to be pregnant.
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