A bloodborne pathogen (BBP) exposure incident occurs when blood or other potentially infectious material (OPIM) contacts non-intact skin, a mucous membrane, or causes a percutaneous injury. This exposure risks transmitting viruses like Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV). Immediate action is necessary to minimize the risk of infection. This guide provides a step-by-step process for managing a BBP exposure incident, from initial first aid to medical follow-up.
Managing the Exposure Site Immediately
The first response to a BBP exposure must focus on cleaning the site of contact immediately. For a percutaneous injury, such as a needlestick or cut, wash the wound thoroughly with soap and water. Allow the injury to bleed freely, but avoid forcefully squeezing the wound, as this may push infectious material deeper into the tissue.
If the exposure involves a splash to mucous membranes, such as the eyes, nose, or mouth, flush the area with large amounts of clean water or saline. Continuous irrigation for at least five to fifteen minutes is advised to ensure the removal of infectious fluid. Do not use strong disinfectants or alcohol on the wound for any type of exposure, as this can cause tissue damage.
Official Reporting and Documentation Requirements
After immediate first aid, report the incident to the appropriate authority, typically a supervisor or the occupational health department. Timely reporting is necessary for administrative and medical follow-up. It allows the employer to arrange an immediate confidential medical evaluation at no cost to the exposed person, often mandated by regulatory bodies like OSHA.
The incident must be meticulously documented, detailing the circumstances of the exposure. Documentation must include the date, time, location, and a description of the procedure being performed. The report must also specify the route of exposure, such as a needlestick or mucosal splash, and identify the source individual whose blood or body fluid was involved, if known. This documentation is required for proper medical risk assessment and regulatory compliance.
Determining the Risk and Required Testing
A medical evaluation by a healthcare professional must follow the initial reporting to determine the risk of infection transmission. The risk assessment considers the type of exposure, such as injury depth or volume of blood, and the type of fluid involved, as blood and visibly bloody fluids carry the highest risk. The infectious status of the source person for HIV, HBV, and HCV is a major determinant, and efforts should be made to test the source individual with informed consent.
Baseline testing for HIV, HBV, and HCV antibodies and antigens is performed on the exposed individual as soon as possible, preferably within 48 hours. This initial testing establishes the person’s status before the exposure. The exposed person must give informed consent for all testing, including HIV testing. The final decision regarding post-exposure treatment is based on an evaluation of the exposure type and the viral status of the source person.
Initiating and Monitoring Post-Exposure Prophylaxis
Post-Exposure Prophylaxis (PEP) is a short-term treatment involving antiviral medication to prevent infection after a bloodborne pathogen exposure. PEP is available for HIV and HBV, but there is currently no recommended PEP for HCV. For HIV, PEP must be started as quickly as possible, ideally within the first two hours and definitely within a 72-hour window, as effectiveness diminishes rapidly after this time.
HIV PEP typically involves a regimen of two or three antiretroviral drugs taken for 28 days. This treatment is associated with potential side effects such as nausea, fatigue, and headache, which a healthcare provider should monitor. Follow-up testing is necessary to confirm the absence of infection, with repeat HIV testing performed at six weeks, three months, and six months post-exposure. Adherence to the full 28-day course of medication and all scheduled follow-up appointments is necessary for the treatment to be effective.