Body Fluid Exposure (Healthcare Worker) 

Two serious illnesses can be transmitted to a healthcare worker through body fluid exposure:

  • HIV

  • Hepatitis (types B, C, and D)

Most healthcare workers exposed to a patient's body fluid don't get infected from it. But exposure must be taken very seriously. Both HIV and hepatitis virus infection can lead to chronic illness and death.

Transmission risk depends on the type of exposure and the level of infection in the source patient. 

  • The risk of transmission after a needle stick from an HIV positive source is historically estimated at 0.3% (3 out of 1,000 exposures), but this will vary widely based on the type of needle stick, the amount of blood exposure, and the degree of HIV control in the source patient.

  • The risk of transmission after a mucous membrane exposure to the blood of an HIV positive source is historically estimated at 0.09% (9 out of 10,000 exposures), but this will also vary widely based on the degree of exposure to infected fluid and the degree of HIV control in the source patient.

  • Transmission risk from a source patient with active hepatitis B infection to a non-immunized worker after a needle-stick injury is 6% to 30% (6 to 30 out of 100 exposures).

  • Transmission risk from a source patient with active hepatitis C infection after a needle-stick injury is 0% to 7% (0 to 7 out of 100 exposures), and is rare with mucous membrane exposure.

If you are in a sexual relationship, discuss your exposure and its risks with your partner. Consider abstaining from sex or using condoms and avoiding pregnancy until test results of the person who exposed you is negative, or your follow-up testing is done. Don't donate blood, tissue, or semen. If you are a woman who is breast feeding, discuss the risks to your infant with your doctor.

Testing

Initial testing for HIV and hepatitis status will be done both on you and the source, if known. This will establish your HIV and hepatitis status today. If the source is positive or unknown, and your initial results are negative, you will need follow-up blood tests to find out if transmission has occurred. It can take up to 3 months for blood tests to turn positive for hepatitis. If HIV infection has occurred, the test usually becomes positive by 3 months after exposure, but a positive result could be rarely be delayed up to 4 to 6 months after exposure if preventive therapy is taken. Therefore, repeat HIV testing may be done in 6 and 12 weeks, and possibly again at 4 to 6 months after exposure, according to your employer's policies. If tests are negative for hepatitis and HIV on final follow-up testing, you can assume that you were not infected as a result of this exposure.

Post-exposure prophylaxis (PEP)

If you have not already been immunized against hepatitis B, you will be offered the vaccine. If you have already been immunized, your antibody status will be determined. Treatment advice will be given based on your antibody status and that of the source patient, if known. 

There is no preventive treatment or vaccine for hepatitis C or D.  

Based on the time since exposure, the type of  exposure and the HIV status of the patient, if known, preventive treatment with antiviral medicine may be offered. Treatment consists of 3 oral medicines taken 1 to 2 times a day for 4 weeks. It's recommended to start the treatment as soon as possible after the exposure, particularly in the first 24 to 72 hours, as PEP treatment is likely less effective after that time. Since treatment may be started before test results are known, treatment can be stopped if the source patient test results are negative.

Facts you need to know before making a treatment decision

  • There is relatively limited information about the effectiveness of drugs used for HIV post-exposure prophylaxis, however if treatment is started early and taken to completion, HIV infection rarely occurs in the exposed person.

  • Although the short-term toxicity of anti-viral drugs is usually limited, serious adverse events have rarely occurred.

  • Be sure you understand the risk of transmission of disease and the risks of treatment before making your decision. If you are not sure, you can discuss this further with the Employee Health Staff. They can guide you to additional resources.

  • You may refuse or stop post-exposure prophylaxis treatment at any time.

When to seek medical advice

Call your healthcare provider right away if any of these occur:

  • Unexplained fever over 100.4°F (38.0°C) or as advised

  • Swollen lymph glands

  • Sore throat

  • Rash

  • Muscle or joint aching

  • Prolonged or recurring diarrhea, nausea, or vomiting

  • Frequent headaches

  • Dark urine or light colored stools; or, jaundice (yellow color to skin or eyes)

  • Abdominal pain

  • Unusual and prolonged fatigue

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