Occupational Health Service (OHS) performs the evaluation and treatment of body substance exposures for employees at UMHS. This service can be accessed 24/7 by paging the Occupational Health Service pager #5356 (call 734-936-6266, pager #5356, if you don't have access to the paging website). During OHS hours the Occupational Health nurse will return your page. After OHS hours, the pager will be forwarded to the appropriate staff in the Emergency Department (ED). An assessment will be completed for HIV risk to determine whether post exposure prophylaxis for HIV is warranted. For any exposures that are evaluated during off-hours, Employees must follow up with OHS on the next business day.
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 fluids are Hepatitis B, HIV, and Hepatitis C.
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 may not 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, 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.
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 may 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. 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. Body substance precautions is a method of using personal protective equipment such as gloves, gowns, masks, eye and face shields, 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. Appropriate safety sharps devices must be used. The Body Substance Exposure Policy includes useful information on recommended barriers to be used when performing specific patient care activities.
The risk of getting infections with bloodborne pathogens depends on three things:
- The type of exposure (transfusion, needle stick, splash)
- How much virus is in the blood or body fluid of the source
- The ability of that particular virus to cause infection
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, 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.
Healthcare workers who have received Hepatitis B vaccine and developed immunity to the virus are at virtually no risk for infection. For a susceptible person, the risk from a single needlestick or cut exposure to HBV- infected blood ranges from 6-30%. For Hepatitis C, the average risk for infection after a needlestick or cut exposure to HCV-infected blood is approximately 1.8%. The risk following a blood exposure to the eye, nose or mouth is unknown, but is believed to be very small; however, HCV infection from a blood splash to the eye has been reported. For HIV, the average risk of HIV infection after a needlestick or cut exposure to HIV-infected blood is 0.3% (about 1 in 300). The risk after an exposure of the eye, nose or mouth to HIV-infected blood is estimated to be on average, 0.1% (about 1 in 1000).
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, there were 57 documented cases and 138 possible cases of occupationally acquired HIV infection among healthcare personnel in the United States since reporting began in 1985. No new documented cases of occupationally acquired HIV/AIDS have been reported since December 2001.
How will I know when to return to OHS for follow up blood work?
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. 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. If your exposure was high risk for a bloodborne pathogen, we will provide appropriate follow up.
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 OHS.
HBV – HCV Postexposure Counseling:
Refrain from donating blood, plasma, organs, tissue, or semen.
No need for: modification of sexual practices or refraining from becoming pregnant; special precautions to prevent secondary infection; modification to patient care responsibilities for exposed person. (CDC 2001)
HIV Postexposure Counseling:
Prevention of secondary infection: sexual abstinence or condom use; no blood/tissue donation (CDC 2001)