Bloodborne Pathogens Exposure Information Sheet

Employee Health Service (EHS) performs the evaluation and treatment of body substance exposures for employees of the Medical Center. You can access this service at any time by paging the Employee Health Service beeper #5356. During EHS hours the Employee Health nurse will return your page. After EHS hours, the pager will be forwarded to the appropriate staff in the Emergency Department (ED). The nurse in the ED will order blood on the source patient and complete an initial assessment for HIV to determine whether post exposure prophylaxis for HIV is warranted. Further evaluation and treatment will be given in EHS. Employees must follow up with EHS in person or by telephone on the next business day. A nurse from EHS is notified about any exposures that were evaluated during off-hours and (s)he contacts employees for follow-up.

What are bloodborne pathogens?
Bloodborne pathogens are viruses that can be transmitted through contact with blood and other body fluids. The most important viruses affecting health care workers exposed to blood and body substances are Hepatitis B, HIV, and Hepatitis C. Health care workers are exposed to these pathogens through blood, mucous membrane, or skin exposures such as needle stick injuries, splashes, etc.

Hepatitis B virus causes a hepatitis, or inflammation of the liver. It can be acquired by sharing blood or by sexual contact with infected people. The usual symptoms are jaundice (yellowing of the skin or eyes), fatigue, nausea, and stomach pain. Often the disease will be so mild that people will not even know they have had the illness. Rarely the disease is severe enough to cause liver failure and death. About 10% of people who get the disease will become chronic carriers of the virus, which means they can develop chronic liver disease such as cirrhosis and they can infect other people by sharing blood through sexual contact. There is a vaccine that can protect people from getting this disease; this vaccine is safe and very effective. Information about Hepatitis B is available in the EHS information sheet "Hepatitis Protection for Health Care Workers". Please ask Employee Health for a copy.

HIV is the virus that causes AIDS. It is spread in the same way as Hepatitis B; blood and sexual contact. The initial symptoms of infection with HIV may be minimal, but might include fever, enlarged lymph nodes, sore throat, or a rash. The virus remains in the body and multiplies, causing damage to the immune system, the body's defense system against infection. Over the course of the years the virus will destroy the immune system enough so that the person becomes sick with the type of bacterial, viral, and other infections that occur in people with AIDS. At this time there is no vaccine to protect against HIV infection.

Hepatitis C is an inflammation of the liver caused by the Hepatitis C virus. It is spread mainly through blood contact, although there is a small chance of infection with sexual contact. Like other forms of hepatitis, the symptoms range from none at all to jaundice (yellow skin), fatigue, loss of appetite, and stomach pain. The initial infection with Hepatitis C may cause very mild symptoms, the risk of the disease becoming chronic is much greater than with Hepatitis B. Up to 50% of people with Hepatitis C will have chronic disease that may lead to cirrhosis. There is currently no vaccine against Hepatitis C.

How can I avoid being exposed to bloodborne pathogens?
Health care workers may come into contact with infected fluids through routine patient care activities such as drawing blood, changing dressings, irrigating catheters, or disposing of used needles. In the surgical areas, health care workers can be exposed by cuts from scalpels or other sharp instruments while in use or by passing them in the operative field. Every health care worker should be familiar with and comply with the Hospital's Body Substance Precautions Policy. Body substance precautions is a method of using personal protective equipment such as gloves, gowns, masks, eye and face shields, etc., to prevent contact with body fluids. This equipment is available in every patient care area. Body substance precautions includes using and disposing of sharps safely. Used needles should not be recapped and should be placed in the designated sharps disposal containers. Appropriate safety sharps devices must be used. Soiled linen and other objects should also be disposed of properly. The Body Substance Exposure Policy includes useful information on recommended barriers to be used when performing specific patient care activities. Follow this link for information about safety devices used here at the hospital to help prevent body substance exposures.

If I have an exposure, what is my chance of becoming infected with one of the viruses?
The risk of getting infections with bloodborne pathogens depends on three things:

For example, a transfusion with a pint of blood would carry much more risk than a stick from a needle used to draw blood. A splash to mucous membranes, such as eyes or lips is generally less of a risk than a needle stick. The source may be more infectious if (s)he has a lot of the virus in the blood. For example, people who are very sick with AIDS will be more infectious than someone who is infected with the virus but not yet sick. Certain viruses are better able than others to be transmitted. For example, Hepatitis B is much more infectious than either Hepatitis C or HIV. A health care worker cannot be infected with any bloodborne pathogen if the source of the exposure does not carry the virus. Most of the exposures that occur in our Hospitals and Health Centers do not carry the risk of any of the viruses mentioned. We try to test all source patients to see whether they are infected with any of the above viruses. Rarely, the patient is not available for testing, but in most cases EHS can give you information regarding the risk of the source of your exposure. Data on health care workers' exposures throughout the world have been collected to try and determine what is the risk of infection from an infected source. Below is a table that summarizes the risk of infection depending on the type of exposure and the particular virus.

Bloodborn Pathogens Risk Table

Risk of Transmission Infectious Material
  Percutaneous injury (needle stick) Mucosal contact or contact with broken skin Bite wound Documented Possible Unlikely
Hepatitis B 2-40 percent Not quantified (transmission by this route has not been documented; the magnitude of risk is probably high relative to that for HCV and HIV) Not quantified (transmission by this route has not been documented) Blood, blood products Semen, vaginal fluid, bloody fluids, saliva Urine, feces
Hepatitis C 3-10 percent Not quantified (transmission by this route has been documented but risk is less than percutanous injury) Not possible (transmission by this route has not been documented) Blood Blood products, bloody fluids, semen, vaginal fluid Saliva, urine, feces
HIV 0.2-0.5 percent Not quantified (transmission by this route has been documented; pooled risk estimate: 0.1 percent) Not quantified (possible route of transmission in two cases of non-occupational exposure) Blood, blood products, bloody fluids Semen, vaginal fluid, cerebrospinal fluid, breast milk, exudates, serosal fluids, amniotic fluid, saliva (during dental procedures) Saliva, urine, feces

ref. Gerberding, NEJM, V332 No. 7, pg. 445, Feb. 16, 1995

This is statistical information gathered from many sources. Your own experience may be similar or different from the cases used for this table. The most important thing to remember is that the risk of getting HIV or Hepatitis C from a needle stick or other exposure is quite small. As an example, since June 1981, there were 57 health care workers with documented occupationally acquired HIV infection in the United States. In addition, 139 other cases of HIV infection or AIDS have occurred among healthcare workers who have not reported other risk factors for HIV infection and who report a history of occupational exposure to blood, body fluids, or HIV infected laboratory material, but for whom seroconversion after exposure was not documented. No new documented cases of occupationally acquired HIV/AIDS have been reported since December 2001. The risk of Hepatitis B can be eliminated through vaccination.

Post exposure line (PEPline) offers health care providers around-the-clock advice on managing occupational exposures to HIV and Hepatitis B and C. Exposed health care workers may call the PEPline but are encouraged to first seek prompt local medical attention. National Clinician's Post-Exposure Prophylaxis Hotline: 1-888-448-4911

What does EHS do for me in the event of an exposure?
If you are exposed to body substances, page the Employee Health Service beeper #5356. You will speak to a nurse and (s)he will obtain information regarding the exposure. We will evaluate the exposure for risks of bloodborne pathogens and order blood drawn on the source patient. We will offer you post-exposure treatment for Hepatitis B, if appropriate. This may be the Hepatitis B immune globulin. If the exposure was high risk for HIV, the nurse will counsel you regarding the option of taking medications that may be helpful in preventing the transmission of infection. If the exposure was high risk for Hepatitis C, the nurse will counsel you regarding early testing for Hepatitis C infection, and possible treatment.

Follow up blood work and monitoring of any symptoms you might develop is very important in determining whether you have been infected as a result of your exposure. For all exposures we offer follow-up testing for HIV, Hepatitis B and Hepatitis C. CDC recommendations of June 29, 2001, indicate that if the source patient is not infected with a bloodborne pathogen, baseline testing or further follow up of the exposed person is not necessary. For sources whose infection status remains unknown, consider medical diagnoses, clinical symptoms, and history of risk behaviors. If your exposure was very low risk, based on the source's blood work and the type of exposure, you may choose not to complete follow up blood work. For employees exposed to Hepatitis C, we offer testing for Hepatitis C virus and liver function periodically until six months. The nature of HIV, Hepatitis B and C is such that if a person is infected from an exposure, the blood tests will generally become positive within six months.

It is also important that you monitor yourself and report any symptoms that might be caused by infection with bloodborne viruses. Any acute illness with fever, sore throat, rash, enlarged lymph nodes, or jaundice that occurs within six months after an exposure should be reported to EHS. Although the risk of infection is small, and it is very unlikely that the illness would be due to one of these viruses, it is important to follow up with us and let us evaluate the illness.

How will I know when to return to EHS for follow up blood work?
1-2 weeks after your exposure EHS will send you a notice with the results of the blood work done on the source patient, and follow up recommendations. You will be notified by e-mail, or the regular mail system with information regarding your follow up visits. At the follow up visit you can refiew your questions, and follow up lab testing will be completed.

What about sexual activity during the follow up period?
Because HIV, Hepatitis B and, to a much lesser degree, Hepatitis C can be spread through sexual contact, we recommend that after a high risk exposure (exposure to blood that is infected with the virus) you follow these "safer sex" guidelines:

We hope this may answer some of your questions or concerns regarding body substance exposures. If you need further information please call us 734-764-8021 and ask to speak with a nurse. We are also on Tele-care which can be reached at 734-764-4100. The Telecare program for bloodborne pathogens is #1057. We also offer Tele-care on tuberculosis testing, work injuries, and an introduction to our services.