If you’ve ever had to report a needle-stick injury, whether it was your own or a coworker’s, you’ve probably asked yourself: “What could I have done to prevent that?”
In this article, we take a look at bloodborne pathogens and the risks to healthcare workers; including what to do if you accidentally come in contact with HIV, HBV, or HCV via an exposure injury; the preventive treatments that are available post exposure; how to protect yourself against needle sticks and other exposure injuries, and the OSHA bloodborne pathogens training requirements for healthcare facility workers.
Note that this article covers all healthcare facility staff – period, but if you are interested in the best way to get physician bloodborne pathogens training implemented you will find extra useful information in the link.
Sharps injuries are common
According to published information from the CDC and the Association for Professionals in Infection Control and Epidemiology (APIC), over half a million needle sticks and other sharps-related injuries are sustained by nurses and hospital-based healthcare staff annually.
Exposure injuries are mainly associated with the transmission of the ‘big 3’ blood borne pathogens, these are HIV, hepatitis B (HBV), and hepatitis C (HCV), but they may also be involved in the transmission of as many as twenty other pathogens.
And sharps-related injuries aren’t the only way you can be exposed to bloodborne pathogens. If a patient’s blood or other potentially infectious bodily fluids come in contact with your eyes, nose, mouth or an area of open skin, you may also be at risk.
The risk of infection from contact with blood or body fluid varies depending on the pathogen involved, the type of exposure, the amount of blood or body fluid involved in the exposure and the amount of pathogen in the patient’s blood or body fluid at the time of exposure.
Classifying potentially infectious body fluids
An exposure, by definition, requires contact with a potentially infectious body fluid as defined by the Occupational Safety and Health Administration (OSHA).
Along with blood and any fluid contaminated with blood, these include:
- amniotic fluid
- cerebrospinal fluid
- semen and vaginal secretions
- synovial fluid
- pleural fluid
- peritoneal fluid
- pericardial fluid
Materials that aren’t considered potentially infectious include feces, sputum, sweat, urine, vomitus, nasal secretions, saliva (except during dental procedures), and tears.
How bloodborne pathogens enter the body
Exposure also requires a point of entry. This is either through nonintact skin or through the mucous membranes. Deciding whether exposure has occurred can be challenging in cases of body fluid splashes on apparently intact skin or needle sticks that don’t draw blood.
If you’re exposed or are at the scene of an exposure incident, be aware of the emotional component of occupational exposure. Because you know the risks, you may panic; however, remember that disease transmission via blood or potentially infectious body fluid exposure is uncommon and that you can take steps to minimize transmission risks.
Immediately after an exposure
You should take the following steps Immediately following an exposure:
- Wash the needle stick or other puncture injury sites and cuts with soap and water
- Rinse mucous membranes with high volumes of water or normal saline solution
- Flush splashes to your nose, mouth, or skin with water
- Irrigate eyes with clean water, saline solution, or other sterile solutions.
There is no evidence to indicate that squeezing a wound or washing with an antiseptic or a caustic solution reduces the risk of disease transmission.
The CDC states that using antiseptics isn’t contraindicated, but doesn’t recommend the application of caustic solutions such as bleach or the injection of antiseptics into a wound.
Who to notify after an incident
As soon as possible after first aid has been administered, notify your supervisor or manager and fill out any notification form(s) that your healthcare facility requires.
Prompt reporting to the department that manages exposures is also essential because PEP may be necessary and some decisions about PEP should be made within hours of exposure.
The provider managing your exposure will need to advise you of your facility’s protocol for PEP.
Do you need PEP?
To determine whether you need to receive post-exposure prophylaxis (PEP) it must first be determined if a true exposure to blood or potentially infectious body fluid has occurred.
For example, being splashed with blood or any fluid containing blood is considered a potential exposure. Being splashed with urine, feces, or vomitus isn’t because these substances aren’t considered to be potentially infectious body fluids.
Then it must be determined if the blood or other potentially infectious body fluid had a portal of entry.
You’ve probably already received the HBV vaccine as part of your employer’s adherence to the bloodborne pathogen standard, which is safe and extremely effective in preventing HBV infection.
All healthcare personnel who have a reasonable chance of blood and body fluid exposure should be offered this free vaccination. If you never received the HBV vaccine series, you should undergo HBsAb and HBsAg testing. You should also be offered free Bloodborne Pathogens training by your employer.
Prevention is number one
Preventing occupational exposure can prevent occupational infections. That means using appropriate barriers, such as gloves, gowns, and eye protection; safely handling needles and other sharp instruments; and using devices with safety features.
Keeping focused on the task when administering and disposing of needles and sharps will help prevent accidental injuries. For surgical nurses and technicians, extra care should be taken to ensure minimal interruptions during surgical procedures.
A sharps injury prevention program should be integrated into existing performance improvement, infection prevention and control, and safety programs. To this end, the CDC has published the five steps it has deemed crucial to sharps injury prevention programs:
- Develop an institution-wide culture of safety in the work environment
- promote reporting of sharps injuries and injury hazards
- analyze sharps injury data for prevention planning
- select and evaluate sharps injury prevention devices
- educate and train healthcare personnel.
The last step can be vitally important in preventing bloodborne pathogens and body fluid exposure.
OSHA has also published its suggestions for prevention of sharps injuries:
- Eliminate the use of needle devices where practical
- promote safety awareness
- plan for safe handling and disposal of used needles and sharps
- prohibit recapping and bending needles
- analyze injuries to identify hazards and trends
Safety is key
Safety is key in the prevention of blood and body fluid exposure and the management of bloodborne pathogen transmission risk.
Use the utmost care in handling needles, sharps, and potentially infectious body fluids; wear appropriate PPE as needed; anticipate the special needs of your patient, and follow your facility’s policies on proper disposal of potentially infectious body fluids and sharps.
HBV Vaccination Rights
OSHA regulations require offering the HBV vaccine to all healthcare workers who may be exposed to blood or other potentially infectious body fluids on the job. These vaccinations have dramatically decreased the transmission of HBV via occupational exposure. However, some healthcare workers do not accept the offer of the vaccine or do not complete the vaccine series.
If a healthcare worker decides later that they to wish to take up the HBV vaccination offer their employer must offer it to them as soon as it is practical.
As a healthcare facility worker, you are at greater risk of exposure to bloodborne pathogens via human blood and OPIM.
By following your employer’s control plan, completing OSHA mandated bloodborne pathogens healthcare worker training, and taking up the offer of free HBV vaccination you can feel a lot more secure.
You can take our OSHA compliant course for healthcare workers right now 100% free, just register and start training.
For employers looking to get your healthcare staff OSHA bloodborne pathogens certification, take a look at our online group training options.