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
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
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 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
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
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
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
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.