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Infection prevention and control guidelines

8. Exposure to blood and other body substances

Summary of steps for managing an exposure incident involving a staff member or patient

      1. Summary of steps for managing an exposure incident involving a staff member or patient

Last revised: 18 Aug 2023

Summary of steps for managing an exposure incident involving a staff member or patient

Blood or body substance exposure must be assessed and managed immediately to reduce the risk of infection.

Response to an exposure incident includes both care of the exposed person, and actions directed towards the person whose blood or body substances were involved in the incident (source person), if known.

Recommended steps include:

  • immediate decontamination of the exposed area and treatment of any wounds
  • immediate reporting of the exposure to the infection prevention and control coordinator or designated responsible person
  • immediate assessment of the risk of transmission of infection. The practice may choose to refer the exposed person to an occupational health physician or transfer them to a hospital emergency department for this assessment and counselling.
  • prompt treatment if indicated, eg post-exposure prophylaxis against a known or suspected blood-borne virus, tetanus vaccination or immunoglobulin, as required. If the exposed person is referred for assessment, treatment is administered or arranged by the hospital or consulting physician. (Post-exposure prophylaxis is not delayed while waiting for results of testing of the source person, but is administered immediately when indicated on the basis of the assessment.)
  • confidential counselling for the source person and testing for hepatitis B virus, hepatitis C virus and HIV (or verifying documented carrier status). The practice may choose to refer the source person to an infectious disease physician for counselling and testing.
  • documentation of the exposure incident
  • testing the exposed person for blood-borne viruses.

Some steps must be done within the practice. These include decontamination, documentation, analysis, risk reduction and staff education.

Allocation of responsibilities for other steps depends on the individual practice’s policy. Practices may choose to refer to external providers (eg occupational health physicians or hospital emergency departments) for blood-borne virus testing, risk assessment, post-exposure prophylaxis, and counselling (Table 8.2. Summary of responsibilities when preparing for and responding to a blood/other body substance exposure incident).

Table 8.2. Summary of responsibilities when preparing for and responding to a blood/other body substance exposure incident

Before an incident (always)

All staff: Use standard precautions and follow safe work practices.

Clinical staff: Keep up to date on knowledge of blood-borne diseases and current procedures for immediate actions in managing blood or body substance exposure, including current prophylaxis measures.

The practice:* Establish clear policies and educate staff on:

  • correct use of safety-engineered medical devices or safe-sharp devices.
  • safe handling and disposal of sharps and waste.
  • safe handling and transport of specimens.
  • environmental cleaning, including appropriate management of blood and body substance spills.
  • safe handling and cleaning of reusable medical devices.

Immediately after exposure

Exposed person (staff member or patient):

  • Decontaminate exposed area, (eg wash wound, rinse eyes if splashed).
  • Report exposure immediately.
  • Obtain or arrange referral for assessment and possible prophylaxis immediately.
  • Ensure the incident is documented.

Clinician managing incident:

  • Verify that an exposure has actually occurred. (Body fluid contact with intact skin, or accidental skin penetration by an unused sharp will not necessitate. management as an exposure incident.)
  • Ensure the exposed site has been decontaminated.
  • Arrange or perform risk assessment, testing and counselling for the source person. Contact the source person’s treating clinician for information about risk.
  • Arrange or perform wound care, counselling and post-exposure prophylaxis for the exposed person, as indicated according to the risk assessment.

The practice:*

  • Ensure risk assessment is completed for the incident.
  • Arrange/provide immediate assessment and treatment of the exposed person.
  • Ensure that the incident is documented. 

Follow-up after exposure

Exposed person (staff member or patient): Follow all instructions

Clinician managing incident:

  • Arrange referral to infectious disease specialist, if necessary.
  • Arrange testing for blood-borne viruses.

The practice:*

  • Perform a risk analysis to determine any need for a change to systems.
  • Make any changes necessary.
  • Reassess to ensure changes are effective in preventing recurrence.

* Duties assumed by the infection prevention and control coordinator, practice manager or owner.

 

Immediate decontamination of exposed area – within the practice

Skin: wash with soap and water or a skin disinfectant product. Do not squeeze the wound. Do not use caustic agents (eg bleach) as these may compromise skin integrity.

Mouth, nose, or eyes: rinse well with water or saline.

Treat the wound as appropriate (eg suturing, dressing).

Immediate reporting of the incident by the practice

Report exposure to a doctor to ensure prompt and appropriate commencement of treatment.

Note: If possible, the exposed person must then be referred outside the practice (eg to an emergency department or specialist).

The following information describes the steps that are usually performed by an external provider.

Testing the exposed person for blood-borne viruses and providing instructions and information  This step is performed by an external provider such as an emergency department or specialist.

If the source (patient on whose blood or body substances the person was exposed to) is unknown, the exposed person is tested for blood-borne viral infections. Baseline tests for antibody levels of HIV, hepatitis B virus and hepatitis C virus are performed to establish the person’s immune status and identify previously acquired infection. The request should be marked as urgent and fast-tracking of results should be arranged with the laboratory.

Privacy legislation and public health guidelines for handling the exposed person’s personal information and maintaining confidentiality must be followed.

An exposed staff member may choose to have these tests performed outside the practice (eg at a different general practice, hospital emergency department, infectious diseases consultant, or sexually transmitted infection clinic).

If post-exposure prophylaxis is required, it should commence within 48 hours. This is normally provided by a hospital, specialist clinic or s100 prescribers.

The exposed person should avoid unprotected sex (eg use a barrier method, such as condoms) until their results are known and discussed and the source patient’s risk history have been reviewed.

The exposed person must be given the phone number for the state/territory health department communicable/infectious diseases unit (see Links).

If the injury is high risk, or if the source patient has risk factors for blood-borne viral infections, the exposed person should be referred to an infectious diseases specialist and/or s100 prescriber, where relevant.

Assessing risk of infection transmission  This step is performed by an external provider such as an emergency department or specialist.

The degree of risk of infection transmission after exposure to blood or other body substances depends on the type of injury, the type and volume of body substance, and the source patient’s infection status.

The highest risk is associated with percutaneous exposure to blood from an infected person with a high titre of hepatitis B virus, hepatitis C virus or HIV. The risk of transmission of blood-borne viruses is very low after exposure to faeces, nasal secretions, saliva, sputum, sweat, tears, urine and vomitus, unless the substance is visibly bloody.2

Practices must contact health authorities for advice on risk level in a specific case, or refer the injured person for expert risk assessment.

Post-exposure prophylaxis  This step is performed by an external provider such as an emergency department or specialist.

Post-exposure prophylaxis can include HIV prophylaxis, hepatitis B immunoglobulin, hepatitis B vaccine, tetanus-containing vaccination and/or immunoglobulin.

Prophylaxis is normally arranged by the infectious diseases referral clinic/hospital. If it is not possible to refer the exposed person for specialist assessment and treatment, practices must consult their state/territory health department communicable disease unit for advice about appropriate post-exposure prophylaxis (see Links).

More information: caring for the source person  This step is performed by an external provider such as an emergency department or specialist.

Explaining the process

If the source is known and contactable, the practice must explain to the source that a health professional was inadvertently exposed to their blood or body substance, and that assessment and testing is required because:

  • every healthcare facility follows this protocol after an exposure of a health professional to blood or body substances
  • all sources are assessed and tested – there is no discrimination
  • it would be of benefit to the exposed health professional, eg to help their managing clinician decide if any follow-up is needed.

If relevant, the source should be reassured that they are not responsible for the accident, that they have not been exposed, and that there will be no cost to them.

The practice should explain that the incident is being investigated to prevent a recurrence, and reassure the source that their confidentiality will be maintained within privacy and public health guidelines.

Arranging pre-test counselling for the source person  This step is performed by an external provider such as an emergency department or specialist.

Pre-test counselling should be offered to the source. This is required by legislation in some states and territories. Counselling must be provided by a qualified person.

The source should be informed about the expected waiting time for test results, and that this lag time is the reason it is necessary to ask them personal questions about activities that are known to carry risk of viral transmission.

Taking a history from the source person  This step is performed by an external provider such as an emergency department or specialist.

Taking a history from the source will help identify the likely risk of disease exposure to the exposed person.

The history aims to identify risk-associated activities or previous exposure, especially in the past 6 months. These include:

  • unprotected sexual intercourse, multiple partners, or partners from a high-risk region
  • sharing injecting needles or inhalation equipment
  • tattoos or body piercing
  • sharing razor blades or toothbrushes
  • blood or body substance exposure of mucous membranes or nonintact skin
  • blood transfusion before February 1990 (for hepatitis C virus)
  • previously diagnosed infection with HIV, hepatitis B or hepatitis C.

Testing the source person for blood-borne viruses  This step is performed by an external provider such as an emergency department or specialist.

Most patients will agree to a blood test if they are approached in a sensitive manner. In some states and territories there is legislation that includes mechanisms requiring testing if the source refuses or is unable to consent to testing.

Informed consent must be obtained from the source for testing for hepatitis B, hepatitis C and HIV.

The source’s blood should be tested as soon as possible. Results can be available within 1 hour if received at an appropriate testing laboratory. The referring hospital or specialist clinic would normally conduct this testing.

Commencement of prophylaxis, if required, should not be delayed while waiting for blood test results.

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