Blood or body fluid exposures

Commonly known as needlestick or sharps injury

The greatest risk of blood-borne infections (infections that are spread through contamination by blood and other body fluids) being passed from one person to another in the workplace is through needlestick or sharps injuries. Spread of infection can also happen when splashes of infected blood or other body fluids make contact with broken skin or with the mucous membranes of the nose, mouth and eyes.

Although many infections may be transmitted by this kind of contact, the most concerning are hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). 

While only a very small percentage of people in the general population carry a blood-borne infectious disease, even small amounts of infectious fluid can spread certain diseases.

Occupational exposure to blood-borne diseases

You can be exposed to blood-borne infections in a wide range of jobs and situations. Exposure can be through needlestick and sharps injuries or through mucous membranes and broken skin. These are discussed below.

You should seek immediate medical advice if you have a needlestick injury or are exposed to blood-borne infections in any other way.

Needlestick and sharps injuries

  • Once someone has used a needle, viruses in their blood may infect it. Blood can also contaminate other sharps such as disposable syringes, lancets and scalpels.
  • Healthcare professionals who work with this kind of equipment are most at risk of accidental injury, but people doing other jobs are also at risk, such as rubbish collectors, cleaners and tattoo artists.
  • When not disposed of properly, needles and sharps can become concealed in linen or garbage and injure others who encounter them unexpectedly.

Mucous membranes

  • The moist lining of the nose, eyes, mouth and genitals tends to prolong the life of relatively fragile viruses, such as HIV and HCV, which cannot normally survive so long in drier environments.
  • These membranes are more porous than skin on the rest of the body, making it easier for viruses to pass through them into the bloodstream.
  • In the workplace, accidental exposure usually happens when blood or other body fluid splashes into the eyes, mouth or nose.
  • Spread of infection in this way is rare.

Skin breakages

  • Healthy, intact skin is an effective physical barrier which can prevent the entry of infectious germs into the body.
  • However, when the skin is damaged, such as through cuts, eczema or dermatitis, it is possible for germs to enter the bloodstream.

What should I do if I have an accidental exposure to body fluids?

If you injure yourself with a used needle or sharp, or were exposed in some other way to someone else's blood or body fluid, immediately follow these steps: (1)

  • If needlestick or other sharps injury:
    • encourage wound to bleed by holding it under running water
    • wash the wound with soap and water
    • do not scrub the wound while you are washing it
    • do not suck the wound
    • dry the wound and cover it with a waterproof plaster.
  • If splashes to the nose, mouth, or skin:
    • flush these areas with running water.
  • If eyes:
    • wash the eye with clean water or saline.
  • Report the incident to your supervisor.
  • Immediately seek medical treatment.

What can my doctor do?

Your doctor will discuss the time, type and severity of the incident and use this information to assess your risk of infection. Let your doctor know if you are pregnant, breastfeeding or have a medical condition such as kidney or liver disease.

You will be given a blood test to check for viruses (HIV, hepatitis B, hepatitis C). In some cases, the person whose body fluids made contact with you may also be required to do a blood test.

  • If HIV exposure is suspected, you may be given preventative treatment with a post-exposure prophylaxis (PEP).
  • If hepatitis B is thought to be a risk, a hepatitis B vaccination may be given (if you are not already vaccinated).
  • There is no preventative treatment available for exposure to hepatitis C, but transmission of this virus is poor.

If you develop a skin infection at the site of injury, this can be treated with antibiotics.

Post-Exposure Prophylaxis (PEP)

If the person who's blood or body fluid you were exposed to is known or high risk for HIV, you may be given a short course of anti-HIV medication that may be able to prevent you from getting infected – this is known as post-exposure prophylaxis or PEP.

  • PEP needs to be given as soon as possible after the injury – within the first 2-4 hours (but up to 72 hours) after exposure.
  • While there are some side effects associated with PEP, it may reduce the risk of developing HIV by half.

Hepatitis B vaccination

If you are not vaccinated or uncertain about this then your doctor may advise beginning a hepatitis B vaccination course within a few days and/or offer immunoglobulin prophylaxis depending on the circumstances. This will almost completely stop any chance of you catching hepatitis B.

Other measures

After a blood or body fluid exposure incident, you should: 

  • use a condom when having sex for up to three months afterwards
  • not donate blood until all necessary screening tests are clear
  • see your doctor if you develop a fever.

What else do I need to know?

It can take up to six months to know for certain whether an infection has occurred or not. Depending on the circumstances, your doctor may advise you to have one or more blood tests up to six months from the exposure incident. 

This can be a potentially stressful time, during which you may wish to consider counselling. It may be reassuring to know that only a small percentage of the population has HIV, or hepatitis B or C infection, and your risk of infection is very low.

I've been exposed to infected fluids – how likely am I to become infected? 

HIV
  • The risk for developing HIV after a needlestick injury involving an HIV-infected person is around 0.3%.
  • This means you have a 3 in 1000 chance of developing HIV after a needlestick or sharps injury involving a person who was HIV positive.
  • This risk may be halved if preventative treatment (PEP) is given promptly.
Hepatitis C
  • Following a needlestick injury involving a hepatitis C infected person, the risk of contracting hepatitis C averages about 1.8% (on average less than 2 chances in 100). 
Hepatitis B
  • After a needlestick injury involving a hepatitis B infected person:
    • if you have not been vaccinated for hepatitis B your risk of getting hepatitis B ranges from 6 to 30% 
    • if have been fully vaccinated for hepatitis B, and don't have kidney disease or a weakened immune system, your risk of getting hepatitis B is close to 0%. 

What increases my risk of infection?

The greatest risk is when a hypodermic syringe used recently on someone with a blood-borne infection accidently pierces the skin of someone else. The risk increases when:

  • there was visible blood on the syringe prior to the injury
  • the needle pierces deeply
  • the needle is large (allows for a greater volume of fluid to be shared).

Unless blood is present, saliva, sputum, sweat, tears, faeces, nasal secretions, urine, and vomit carry a much lower risk of transmission of HBV, HCV, and HIV but are nevertheless potentially infectious.

General measures for the prevention of exposures

  • Wash hands before and after contact with each patient and before putting on and after removing gloves.
  • Change gloves between patients.
  • Cover any existing wounds, skin lesions and all breaks in exposed skin with waterproof dressings.
  • Wear gloves if you think you may be coming in contact with blood.
  • Avoid sharps usage where possible and, where sharps usage is essential, handle and dispose of these carefully.
  • Avoid wearing open footwear in situations where blood may be spilt, or where sharp instruments or needles are handled.
  • Clear up spillage of blood promptly and disinfect surfaces.
  • Wear gloves when cleaning equipment prior to sterilisation or disinfection.
  • Follow safe procedures when disposing of contaminated waste.

Learn more

What should I do if I injure myself with a used needle? NHS Choices, UK
Post Exposure Prophylaxis (PEP) NZ Aids Foundation

References

  1. Bloodborne infectious diseases: HIV, Hepatitis B, Hepatitis C Centre for Disease Control and Prevention