Blood and Body Fluid Exposure Management

Added to Handbook: Prior to June 2004
Revised January 2014

PURPOSE:

To minimize the risk of transmission of blood borne pathogens in persons exposed to blood or bodily fluids; and

To provide guidance for the appropriate treatment, documentation and follow-up for individuals who have been involved in the exposure to blood borne pathogens.

BACKGROUND:

These guidelines are based on the BC Centre for Disease Control publication Communicable Disease Control Blood and Body Fluid Exposure Management (March 2010). It is not the intent of these guidelines to discuss the assessment of risk and management of exposures to pathogens other than HIV, HBV, and HCV.

All persons exposed to blood or body fluids should be assessed for potential risk of infection from HIV, HBV, and HCV, and be provided with appropriate counseling and treatment. The source of a blood borne virus (BBV) may be from a registrant or client (known or unknown). Bi-directional transmission is possible if percutaneous, permucosal, or non-intact skin exposure to blood or bodily fluid has occurred. Although the risk may be lower, bites and splashes to the eye should also be assessed for potential risk of infection.

Post Exposure Management Procedure:

1. Cleanse:

  • Rinse the mucous membranes or eye with water.
  • Wash skin with soap and water for 10 minutes.
  • DO NOT promote bleeding by cutting, scratching or puncturing the skin. This may damage the tissues and increase uptake of any pathogen(s).
  • Allow injury/wound site to bleed freely, and then cover lightly.
  • Do not apply bleach to the injury/wound or soak it in bleach.

2. Triage:
If percutaneous, permucosal, or non-intact skin exposure has occurred, the exposed person should immediately have a risk assessment performed by a qualified health professional, preferably within 2 hours of exposure.

  • In the event of an exposure through the course of clinical practice, a dental hygienist should go to the local hospital Emergency Department as soon as possible (or an alternative site that has antiretroviral starter kits supplied by the BC Centre for Excellence in HIV/AIDS) and identify him/herself as a healthcare practitioner initiating protocol for a percutaneous exposure or needlestick injury. Detailed risk assessment and management of potential exposure to ALL pathogens (HIV, HBV, and HCV) can take place in the Emergency Department or other health facility.
  • If antiretroviral therapy is indicated for possible HIV exposure, it must be administered as soon as possible after exposure, preferably within 2 hours.
  • Hepatitis B vaccine and hepatitis B immune globulin (HBIG) should be given preferably within 48 hours after exposure to the hepatitis B virus, but may be given for up to 7 days.

3. Assess the risk:

  • Complete a risk assessment of the exposure using the Management of Percutaneous or Permucosal Exposure to Blood and Body Fluid/Laboratory Requisition form available on-line or in the Emergency Department or health facilities supplied with antiretroviral starter kits,
  • Determine if the source of the blood or body fluid is known. If the source person discloses they are HIV+, contact the BC Centre for Excellence in HIV/AIDS to obtain advice regarding appropriate anti-retroviral therapy for the exposed person.
  • Obtain the source person's consent for testing for anti-HIV, anti-HCV, HBsAg, anti-HBs, and anti-HBc. The appropriate pre- and post-test counseling should be done for each test.
  • Obtaining informed consent from the source is an integral part of all post-exposure testing procedures, as is maintaining confidentiality of all information.
  • If the attending physician of the source person is known, that physician may, without breaching confidentiality, or with the client's permission, provide some insight into whether or not the exposure should be regarded as higher risk.
  • If the source has recently tested negative for HIV, HBV or HCV, but is in a high risk group (a chart is provided in the complete document), subtract 6 months from the date of the most recent blood test result. From that date, if the source has continued to participate in high risk behaviour for HIV, HBV or HCV infection, he/she should be considered potentially infectious despite their negative test result and the exposed person managed accordingly. Do not wait for the source's test results before initiating post-exposure treatment.

Discuss the following with the source person:

  • Why/how their test results are needed for the post-exposure management of the exposed person, as well as for possible follow-up of their own test results should any be positive
  • That their consent is also needed for:
    • disclosure of their test results to their own follow-up physician (so that they can be contacted if any of their test results are positive)
    • disclosure of their test results to the exposed person's follow-up physician
    • disclosure of their test results to the exposed person's worksite occupational health liaison (if applicable) and WorkSafe BC (in the instance of occupational exposure).
  • That the exposed person will not be informed of their (the source) test results; the exposed person will only be told whether or not to continue HIV and/or HB prophylaxis.
  • How they can be contacted if any of their test results are positive. The name of their follow-up physician is required if they have chosen anti-HIV testing non-nominally.HBV and HCV tests can only be done nominally.

A process must be established by which identification of the source is kept confidential.

4. Determine the HIV, HBV and HCV status of the exposed person and previous immunization against HBV:

  • If the exposed person has not recently been tested, obtain informed consent and obtain blood tests, but do not await results before commencing post-exposure treatment.

5. Determine the requirement for post-exposure management:

  • Percutaneous, permucosal or non-intact skin exposure has occurred
  • The exposure is to blood, potentially infectious body fluid or tissue
  • The source is considered potentially infectious (positive test, in a higher risk group, unreliable, or unknown), And
  • The exposed person is considered susceptible (no history of positive test to HIV, HBV or HCV).

6. Counselling and follow up:

  • Arrange for post-exposure counselling in the health facility;
  • Contact the family physician within three days of the exposure to plan 12 months of follow up; and
  • Clinical and laboratory follow-up should be arranged with the exposed person's family physician or other designated physician, following guidelines established by the Ministry of Health.

7. Document:

  • In all cases an accident / incident report should be completed. Each organization should ensure that it has appropriate arrangements in place for the reporting and recording of untoward incidents. WorkSafeBC has mandatory reporting requirements for employees and employers of BC Businesses.

POLICY:

Post-exposure management is required when all of the following indications are present:

  • percutaneous, permucosal, or non-intact skin exposure (injury < 3 days old, or with skin having compromised integrity such as dermatitis, abrasions, scratches, burns);
  • the exposure is to blood, potentially infectious body fluid or tissue; the source is considered potentially infectious (positive test, or in a higher risk group, or exposure occurred in a higher risk setting); AND
  • the exposed person is considered susceptible to at least one of the following viruses: HIV, HBV, or HCV.

Post-exposure prophylaxis may be considered for bites if there is broken skin and bleeding and either:

  • The person bitten is sero+ for a bloodborne pathogen and the biter has non-intact oral mucosa; OR
  • The biter is sero+ for a bloodborne pathogen.

REFERENCES:

  • BC Centre for Disease Control: Communicable disease control blood and body fluid exposure management. March 2010. Available from:
    BCCDC EPI_Guideline_(pdf)
  • BC Ministry of Health: Management of percutaneous or permucosal exposure to blood and body fluid/laboratory requisition form HLTH 2339. 2011. Available from: 
    HLTH 2339.2011 (pdf)
  • Centers for Disease Control and Prevention: Infection control frequently asked questions - bloodborne Pathogens - occupational exposure. 2013. Available from:
    CDC Oral Health Infection Control FAQ