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
Standard precautions are recommended in the handling of:
- blood, including dried blood
- all other body substances including saliva, urine and faeces (but excluding sweat), regardless of whether they contain visible blood
- broken skin
- mucous membranes (lining of nose, mouth and genitals).
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.
Managing exposure to blood or other body substances
If any person has contact with blood or body fluids, the following procedures should be observed:
- remove contaminated clothing
- if blood or body fluids get on the skin, irrespective of whether there are cuts or abrasions, wash well with soap and water
- if the eyes are splashed, rinse the area gently but thoroughly with water while the eyes are open
- if blood or body fluid gets in the mouth, spit it out and rinse the mouth with water several times, spitting the water out each time.
Reporting mechanisms
Incidents occurring during or after work hours should be reported immediately to:
- the supervisor or work, health and safety representative for exposures in the workplace
- a doctor or emergency department for exposures outside of work
Potential blood borne virus exposure
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:
- contact their local doctor
- contact a sexual health clinic
- visit an emergency department
- for HIV exposures, call the South Australian 24 hour Post Exposure Prophylaxis (PEP) triage hotline on 1800 022 226.
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.
Post Exposure Prophylaxis
PEP may:
- prevent the development of infection
- make the infection less severe
- reduce the risk of the infection being passed on to other people.
PEP needs to begin as soon as possible after exposure to be effective.
PEP for hepatitis B consists of:
- immunoglobulin (a solution containing human antibodies that is made from blood products) and
- three hepatitis B vaccinations over 6 months
PEP for HIV consists of a 28 day course of medication (anti-retroviral).
Surface cleaning of blood and body substances
If blood or body fluids are spilled on surfaces, the following cleaning procedures should be used:
- Deal with the spill as soon as possible.
- Protect yourself by wearing disposable rubber gloves. Eye protection and a plastic apron should be worn where there is a risk of splashing.
- Remove as much of the spill as possible with a paper towel.
- Clean area with warm water and detergent, using a disposable cleaning cloth or sponge.
- The area should be left clean and dry.
- Disinfect the area with a solution of household bleach, diluted according to the manufacturer’s instructions.
- Remove and dispose of gloves, paper towel and cleaning cloth in a sealed plastic bag after use. The plastic bag may then be thrown away with household waste.
- Wash hands thoroughly with soap and warm water.
Useful links
- Hepatitis B
- Hepatitis C
- HIV infection
- Hand hygiene
Source: Google Images.
An occupational exposure is defined as a percutaneous (through the skin) injury such as a needle stick or cut with a sharp object or contact of mucous membrane or non-intact skin with blood, tissue, or OPIM. Non-intact skin may be chapped, abraded, or afflicted with dermatitis. Intact skin is a good barrier against these viruses. For exposure to occur there must be some sort of break in the skin, a “portal of entry,” such as a needle stick, cut, dermatitis, or exposure of a mucous membrane. The skin is the primary “suit of armour” against pathogens and to avoid a “pathogen party” the host must protect skin by using a barrier, such as gloves when coming in contact with potential pathogens, and then wash off after exposure.
Factors influencing the risk of infection include:
- Whether the exposure was from a hollow-bore needle or other sharp instrument
- Whether the exposure was to non-intact skin or mucous membranes such as the eyes, nose, or mouth
- The amount of blood that was involved
- The amount of virus present in the source's blood
- Which virus is involved—hepatitis B can be much more infectious than hepatitis C or HIV.
The OSHA Bloodborne Pathogens Standard requires medical follow-up for workers who have an exposure incident. Exposures should be reported within 1 hour if possible to allow for prompt intervention to reduce the risk of infection. Follow the protocol of your employer. Wash the exposed area with soap and water, or use an eye-wash station in the event of an eye-splash. Then report the exposure to the department or individual at your workplace who is responsible for managing exposure, which is often the occupational health nurse or infection control department/worker. Your employer should let you know how to do this as part of your orientation. If you do not know or are not sure, ask.
If you know the name of the individual who was the source of the exposure, take it and any information of the device involved when you report the exposure. For example, the brand of the safety sharp in use should be brought to the attention of the person receiving the report as a supply success or failure can be evaluated and lead to improvements in supplies carried by the facility. You will be asked about the situation that led to the exposure. These facts are needed for follow-up and prevention of similar exposures to others.
Reporting is important because part of the follow-up includes testing the blood of the individual source to determine HBV and HIV infectivity, if this is unknown and if permission for testing can be obtained. There are now at least four FDA-approved tests available for rapid HIV antibody testing that can confirm negative HIV status within an hour after blood is drawn from a source individual.
An employer’s failure to use rapid HIV antibody testing of the individual source could be considered a violation of paragraph 1910.1030(f)(3)(ii)(A) in the OSHA standard (OSHA, 2019a). The exposed employee must be informed of the results of these tests. Employers must tell the employee what to do if an exposure incident occurs.
Medical Evaluation and Follow-up
The Bloodborne Pathogens Standard requires employers whose employees may have exposure to body fluids on the job have a system in place for managing occupational exposures. This system must be available without delay, 24 hours per day, 7 days per week. This requirement may be challenging for employers who are not health-care providers, such as correctional facilities, firefighters, and first-aid providers. It is often managed by contractual arrangement.
Knowledge of the way to access this system is required as part of your orientation to the job and as part of your annual update education. If you do not know how to do it on your job, ask. Employers must provide free medical evaluation and treatment to employees who experience an exposure incident. A licensed healthcare provider will evaluate the exposure and advise on how to prevent further spread of any potential infection. If known, the source patient’s blood will be tested for HBV, HCV and HIV, with appropriate consent.
The blood of the exposed employee will be tested with their consent, or the employee may choose to have blood drawn but may not delay testing later than 24 hours or be tested until later. The employer must hold this specimen for at least 90 days. This baseline specimen is needed to determine if any later disease is related to the exposure or may have been present before the exposure.
The healthcare provider will share information from testing with the employee and will prescribe appropriate treatment in line with current U.S. Public Health Service recommendations. If the source individual was HBV- or HIV-positive or in a high-risk category, the exposed employee may be offered post exposure prophylaxis (PEP), medication that can be taken following exposure to reduce risk of infection. There is no available PEP against hepatitis C. Hepatitis B vaccine should always be offered following any exposure incident unless the employee is already immune as confirmed with a blood titer.
Because of the complexity of selecting an HIV/PEP regimen, consultation with people having expertise in antiretroviral therapy and HIV transmission is strongly recommended. The National PEP Hotline is available 24/7 at no cost to treating professionals at 888-448- 4911 (Clinical Consultation Center, 2019).
Written Opinion
In addition to counseling the employee, the healthcare provider will provide a written report to the employer. This report simply identifies whether hepatitis B vaccination was recommended for the exposed employee and whether the employee received vaccination. The employer must provide a copy of the report to the employee within 15 days of the completion of the evaluation. The healthcare provider also must note that the employee has been informed of the results of the evaluation and told of any medical conditions resulting from exposure to blood which require further evaluation or treatment. Any added findings must be kept confidential.
Confidentiality
Medical records must remain confidential. Employee health and medical records are not available to the employer, without the written consent of the employee. The employee must give specific written consent for anyone to see the records. Records must be maintained for the duration of employment plus 30 years in accordance with OSHA's standard on access to employee exposure and medical records.
Recordkeeping
The OSHA Bloodborne Pathogens Standard specifies recordkeeping requirements for employers that include confidential medical records for employees with occupational exposures, records of training provided, and a sharps injury log that documents every sharps injury in detail.
Online Resource
What is Post Exposure Prophylaxis? [1:32]
//www.youtube.com/watch?v=Yu82TFo6j94
Apply Your Knowledge
If you were to be stuck with a needle at your facility, do you know who to go to for reporting, testing, and treatment? How can you find out who that is?