Bloodborne pathogens (BBPs) are infectious microorganisms found in human blood that can cause various diseases. Healthcare workers face a consistent risk of exposure to these pathogens. Understanding transmission modes and implementing protective measures are key to mitigating this occupational hazard.
Understanding Bloodborne Pathogens
Bloodborne pathogens are disease-causing microorganisms present in human blood and certain other body fluids. The most commonly recognized BBPs include Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV). These pathogens can lead to serious health complications, ranging from acute infections to chronic liver disease or immune system failure.
Transmission occurs when contaminated blood or body fluids from an infected person enter another individual’s body. This can happen through direct contact with infected blood, or indirectly via contaminated objects. While blood is the primary concern, other potentially infectious materials include semen, vaginal secretions, cerebrospinal fluid, and any body fluid visibly contaminated with blood.
The Leading Risk: Needlestick and Sharps Injuries
The most common risk of exposure to bloodborne pathogens for healthcare workers arises from needlestick and other sharps injuries. These incidents occur when a contaminated needle, scalpel, broken glass, or other sharp object accidentally punctures the skin. Such injuries are a leading cause of occupational exposure in clinical environments.
Sharps injuries commonly happen during procedures like drawing blood, administering injections, or handling surgical instruments. Factors contributing to their prevalence include the fast-paced nature of healthcare settings and practices such as recapping used needles, which is discouraged. Improper disposal of sharps also increases the risk, making appropriate containment important.
Other Exposure Pathways
While sharps injuries pose the most frequent risk, other pathways can lead to bloodborne pathogen exposure. These include contact with mucous membranes, such as the eyes, nose, or mouth. Splashes of contaminated blood or body fluids into these areas can facilitate pathogen entry.
Exposure can also occur through contact with non-intact skin, such as skin with cuts, abrasions, or dermatitis. Even a small break in the skin can allow pathogens to enter.
Protecting Healthcare Workers: Prevention Strategies
Protecting healthcare workers from bloodborne pathogens involves a multi-faceted approach.
Standard Precautions and Personal Protective Equipment
This approach starts with Standard Precautions, a principle dictating that all human blood and certain body fluids should be treated as infectious. Standard Precautions encompass hand hygiene, which involves washing hands thoroughly with soap and water after glove removal or any contact with potentially infectious materials. Personal protective equipment (PPE) forms a physical barrier against exposure and includes gloves, gowns, masks, and eye protection. Employers are required to provide appropriate PPE, which must be worn whenever there is potential for contact with blood or body fluids.
Engineering Controls
Engineering controls are devices that isolate or remove the bloodborne pathogen hazard from the workplace. Examples include puncture-resistant sharps disposal containers at the point of use and safer medical devices with built-in safety features, such as self-sheathing needles.
Work Practice Controls and OSHA
Work practice controls alter the manner in which tasks are performed to reduce exposure likelihood. These include safe injection practices, avoiding two-handed recapping of needles, and properly handling and disposing of contaminated items. The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard (29 CFR 1910.1030) mandates these controls and requires employers to implement an exposure control plan.
Vaccination
Vaccination against Hepatitis B is a key preventive measure. OSHA requires employers to offer this vaccine to at-risk healthcare personnel.
Post-Exposure Protocols
Should an exposure to bloodborne pathogens occur, immediate action is necessary. The first step involves prompt first aid, such as washing needlestick or cut injuries with soap and water, and flushing splashes to mucous membranes (eyes, nose, mouth) with clean water or saline. This initial cleansing helps reduce the potential for infection.
Following first aid, the incident must be reported to a supervisor or the designated occupational health service. Timely reporting is important for initiating a post-exposure evaluation, which includes assessing the risk of transmission based on the type of exposure and the source patient’s infection status. Testing of both the exposed worker and the source patient for HBV, HCV, and HIV is conducted.
Post-exposure prophylaxis (PEP) may be recommended, particularly for HIV and HBV exposures, to prevent infection. PEP for HIV usually involves a course of antiretroviral drugs, ideally initiated within hours of exposure and continued for four weeks. For HBV, PEP may include Hepatitis B immune globulin (HBIG) and the Hepatitis B vaccine, depending on the exposed person’s vaccination status and the source’s infection status. There is currently no PEP available for HCV.