Blood and Body Fluid Exposure

Blood and Body Fluid Exposure

Bloodborne pathogens are infectious viruses present in blood or other body fluids that can cause disease in humans.

These pathogens include:

  • Hepatitis B virus (HBC)
  • Hepatitis C virus (HCV)
  • Human Immunodeficiency Virus (HIV)

A blood or bodily fluid exposure is an event where a person is exposed to potentially infectious blood or bodily fluid through one of the following exposures:

  • Percutaneous: Puncture of the by needlestick or another sharp object.
  • Mucosal: Contact with mucous membrane.
  • Non-intact skin: Eczema, scratches, and damaged skin.

Blood and Body Fluids capable of transmitting bloodborne pathogens

Fluid

HIV

HBV

HCV

Blood and body fluids visibly contaminated with blood

Yes

Yes

Yes

Semen

Yes

Yes

Yes, if blood is present

Vaginal/rectal secretions

Yes

Yes

Yes, if blood is present

Pleural, amniotic, pericardial, peritoneal, synovial, and cerebrospinal fluids, and inflammatory exudates (e.g., wounds)

Yes

Yes

Yes

Salvia

No, unless contaminated with blood

Extremely low risk unless blood present *

No, unless contaminated with blood

Transplanted tissue or organs

Yes

Yes

Yes

Faeces, nasal secretions, sputum, sweat, tears, urine, vomitus

No, unless they contain visible blood

* HBV transmission via casual mucosal contact to saliva that is not visibly contaminated with blood is uncommon. Although HBV has been detected in the saliva, reports involving HBV transmission when a person with HBV bites (i.e., percutaneous) someone who was unvaccinated for hepatitis B, have involved bloody salvia. Blood was more likely the means of transmission not saliva.

Reference: BC Centre for Disease Control (April 2021). Communicable Disease Control Blood and Body Fluid Exposure Management

Risk of Exposure

The risk will vary depending on the site, the type, and the source of exposure. Transmission risk is increased with:

  • Deep puncture.
  • Large, hollow bore needles containing blood.
  • Amount of blood involved in the exposure.
  • High amount of virus in the source persons blood at time of exposure.

Source has detectable virus

Theoretical risk for transmission from a needlestick injury

HBV

 

HBsAg positive/

HBeAg positive

 

 

  • Virtually zero if exposed person previously vaccinated
  • 30% if the exposed person has not been previously vaccinated

 

HBsAg positive/

HBeAg negative

 

 

  • Virtually zero if the exposed person previously vaccinated
  • 5-10% if the exposed person has not been previously vaccinated

HCV
  • 2% (20 in 1000)

 

HIV
  • 0.2% (per 1000 exposures)

 

Other risk:

The risk after exposure of the eye, nose, or mouth to HIV-infected blood is estimated to be, on average, 0.1% (1 in 1,000)

Reference:

BC Centre for Disease Control.  (April 2021). Communicable Disease Control Blood and Body Fluid Exposure Management.

Centre for Disease Control (July 2008). Exposure of Blood - What Healthcare Personnel Need to Know.

 

Post Exposure Follow-up Actions

If you think you have had an exposure to blood or bodily fluids, it is important to seek medical attention right away for assessment and treatment. Post-exposure prophylaxis treatment to prevent infection needs to be started right away.

Initial First Aid

Needlestick/wound:

  • Allow the wound to bleed freely.
  • Do not promote bleeding by squeezing the wound, this may damage the tissues and increase uptake of any virus(s).
  • Wash well with soap and water.

Mucous membrane or eye:

  • Irrigate with water or normal saline.

Skin:

  • Wash well with soap and water, do not apply bleach to wound.

Report and Seek Medical Assessment

Occupational exposures should be reported right away to your employer. If you are an emergency service worker, report to your Designated Officer or Supervisor who will help assess the exposure and support the follow-up process.

It is important to seek medical attention right away for assessment (ER visit). This assessment should not be delayed. If post-exposure prophylaxis is recommended, it needs to be started within certain timelines to be effective. It is also important to have baseline bloodwork drawn as soon as possible after the potential exposure.  

Post-exposure Prophylaxis (PEP)

Virus

Post-exposure Prophylaxis

HBV
  • Hepatitis B vaccine and HBIg can provide susceptible individuals with protection from HBV infection after exposure when given within certain timeframe. Immunization history and serologic testing will help guide decision if PEP is indicated or not.

HCV
  • There is currently no PEP available.

HIV
  • HIV antiretrovirals can prevent HIV infection. Ideally, PEP should be started 1-2 hours after exposure, but needs to be started with 72 hours from exposure to be effective. HIV PEP can be discontinued once more information becomes available however, delaying the start of PEP is not recommended.

Counselling and Follow-up Testing

Individuals should receive counselling regarding the risk of transmission following a significant exposure. To minimize secondary transmission during the first 12 weeks post-exposure, the individual should be counselled to:

  • Not to donate blood, semen, tissues, or organs
  • Prevent sexual transmission (e.g. barrier protection)
  • Defer pregnancy or consult with your primary care provider.
  • Not to share personal items that may contain blood (e.g., toothbrush, razors, nail clippers)

Follow-up blood testing is generally required at 3 weeks, 6 weeks, and 3 months. It is important to repeat these blood tests as certain infections may take longer to show up as a positive result. Follow-up testing may vary depending on individual situation, please follow your health care providers testing recommendations.

 

Mandatory Blood Testing Act

The Mandatory Blood Testing Act, 2006 (MBTA), allows an individual to apply to have the blood of another person tested for specific infectious diseases if you have come into contact with their bodily fluids.

The Act covers the following infectious diseases only:

  • Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS)
  • Hepatitis B
  • Hepatitis C

Forms must be completed and submitted to the Medical Officer of Health (MOH) in the respondent’s (source person) local public health unit no more than 30 calendar days after the exposure. 

For more information on the MBTA and to access Forms please visit:

Mandatory Blood Testing Act | Ontario.
 

Please contact Grey Bruce Public Health @ 519-376-9420 ext. 6 (Mon-Fri 8:30am-4:30pm) for information regarding blood and bodily fluid exposures or the MBTA.

Call after hours # for urgent reporting.

 

 

References:

BC Centre for Disease Control (April 2021). Communicable Disease Control Blood and Body Fluid Exposure Management.

Centre for Disease Control (July 2008). Exposure of Blood - What Healthcare Personnel Need to Know.

Ministry of Health (2023). Mandatory Blood Testing  

St. Michaels Hospital (March 2019). Pocket P.E.P. Clinical Management of non-occupational and occupational exposures to blood borne pathogens.

 

Updated April 2024

 

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