What is Body Fluid Exposures?
Health care workers are often concerned about coming into contact with bodily fluids. When incidents like these occur, it opens them up to risks such as catching communicable diseases. Examples of these diseases include the human immune deficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Accidental exposures like these have been viewed as an occupational hazard since 1978 and contribute to significant public health risks.
Within the healthcare profession, it’s interesting to note that nurses and nursing students have the highest exposure rates at 45%. Doctors and other providers follow, with a 17% exposure rate. Breaking that down further: of these healthcare providers, surgeons are most likely to be exposed. Despite this, studies show that both healthcare providers and nurses generally understand and follow the appropriate safety procedures when dealing with potential exposure to bodily fluids. Nurses, in fact, even practice better safety standards than doctors.
Something else to consider is that these accidental exposures can stir up fear in healthcare workers. They might worry about catching an infection, or losing their jobs because of the exposure. Unfortunately, despite having protocols around these incidents, many healthcare workers are either not aware of them or unsure how to act if exposure occurs. For instance, some workers feel that their employers don’t take non-needle-related exposures seriously. Apart from the infection risk, exposed workers also face potential harm psychologically. Recent research now aims to improve recognition and proper assessment of bodily fluid exposures.
What Causes Body Fluid Exposures?
Healthcare workers often face exposure to blood and bodily fluids through incidents like injuries from needles or cuts that happen while they’re working. These avoidable situations lead to around 1000 infections each year from more than 20 different infectious agents that are carried in the blood. Hepatitis B is the most common one found in these cases.
Because these infectious agents are becoming more common, and because needle injuries happen so often, the risk to healthcare workers is serious. The National Institute of Occupational Safety and Health has highlighted several factors that make these injuries more likely, including using too much injectable medication, unnecessary sharp instruments, lack of appropriate safety gear, reusing needles, not disposing of sharp objects properly, and inadequately trained staff.
Other risks come from not having enough safe needle devices, passing instruments in the operating room, and simply not being aware of the dangers. There are also other ways to be exposed to infectious agents that don’t involve puncture wounds. Many healthcare workers studied didn’t report exposure unless it was from a needle injury as they felt the risk was low, despite the potential danger. It’s also been found that longer shifts increase the risk with almost a quarter of these incidents happening to workers on shifts of 12 hours or longer.
Risk Factors and Frequency for Body Fluid Exposures
Health care workers are frequently exposed to bodily fluids at work, representing a significant public health concern. There are about 3 million skin-piercing (or “percutaneous”) exposures amongst health care workers globally every year, besides other exposures to things like urine, vomit, saliva, or feces. These incidents are notably higher in developing countries, where over 90% of such exposures occur.
- After a skin-piercing exposure, the risk of contracting hepatitis C is 3%, hepatitis B is 30%, and HIV is 0.3%.
- Other types of exposure to non-bloody bodily fluids carry almost no risk of transmitting these diseases.
- Hepatitis B is 50 to 100 times more likely to be transmitted and cause an infection compared to HIV.
- Around the world, 40% of Hepatitis B and Hepatitis C cases among health care workers, as well as 2.5% of HIV cases, are due to accidental occupational exposure.
Signs and Symptoms of Body Fluid Exposures
In the event of potential exposure to infectious diseases through bodily fluids, it’s important to gather certain information about the person’s exposure history. Also, it is necessary to get detailed information about their lifestyle and previous health choices. Such information includes:
- History of vaccinations
- Presence of tattoos, body piercings, or other body modifications
- Sexual history
- Travel history, particularly recent international travel
- Drug use history
- Any previous blood transfusions or history of hemodialysis
It’s also essential to interview the patient from whom body fluids originated, if applicable, to identify any potential risks. This comprehensive approach improves our understanding of the patient’s risk and helps guide treatment.
Physically, healthcare professionals need to check the site of potential exposure for signs of trauma, foreign objects, or signs of local infection. If an eye has been exposed, it should be examined thoroughly. Examinations of the heart, lungs, abdomen, and lymph nodes should be done as a baseline for potential future complications. However, it’s worth noting that signs of infection or other issues might not be immediately apparent and could surface later.
Testing for Body Fluid Exposures
If you’ve been exposed to bodily fluids, your doctor will usually only need to thoroughly examine and question you about the situation. What steps are taken next depends on how you were exposed and who or what caused the exposure. For example, if you’ve suffered a wound that broke the skin, your doctor will check to see if any foreign objects have gone into the wound.
In some cases, you might need to undergo imaging tests, such as x-rays or ultrasounds, to investigate further. The type of imaging test used would depend on where on the body the exposure happened, and if there is a suspicion that a foreign object might be present.
It’s also standard practice to do lab tests for HIV, hepatitis B, and hepatitis C after such an exposure. These are done to provide a comparison point, or “baseline”, at the time of injury. Depending on the protocols of your local hospital and how common certain infections are in your area, additional tests may be needed.
Treatment Options for Body Fluid Exposures
Protocols for handling exposure to potentially infectious blood can vary from one healthcare facility to another. Typically, these guidelines recommend taking blood samples from both the healthcare worker who was exposed and the individual from whom the blood originated. Despite knowing the importance of testing in such situations, many healthcare workers decide to skip testing and immediately start preventive treatment. The perception is that formal risk assessment adds little value to the overall outcome. This perspective is also shared in healthcare settings in African countries.
If it’s known that the individual whose blood the healthcare worker came into contact with is HIV positive, post-exposure-prophylaxis (PEP), a preventive treatment, is initiated. It is generally recommended to start PEP within 2 hours of potential HIV exposure, although it may be considered even 72 hours after exposure in high-risk situations. The prevention treatment should be continued for four weeks. The Centers for Disease Control and Prevention (CDC) currently recommend a specific PEP regimen which includes two types of antiretroviral drugs (specifically, two nucleoside reverse transcriptase inhibitors and a protease inhibitor).
If the blood source individual is HCV (hepatitis C virus) positive, further tests may be carried out up to 6 months, depending on the specifics of the healthcare worker’s exposure. If the individual is HBV (hepatitis B virus) positive, the healthcare worker’s hepatitis B vaccination status should be checked. If the worker has been vaccinated against hepatitis B or has previously had an HBV infection, no immediate action is usually necessary. However, if the healthcare worker’s antibody levels are too low, indicating ineffective vaccination and lack of immunity, the worker might need to receive a hepatitis B immunoglobulin injection and start a new course of hepatitis B vaccinations. Follow-ups in such cases are usually handled by the occupational health department of the healthcare facility in the United States.
One of the significant emotional concerns for healthcare workers following such exposure is the anxiety about the possibility of having contracted a serious blood-borne pathogen while waiting for the test results.
What else can Body Fluid Exposures be?
If a healthcare worker is exposed to a patient’s bodily fluids, the steps to determine the risks and next steps depend on what type of fluid the worker was exposed to, and which viruses or bacteria could potentially be in that fluid. Normally, tests would be done for Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Human Immunodeficiency Virus (HIV). However, the healthcare worker should also be careful about new or emerging infections in the area, which might have been introduced by people traveling from other regions.
What to expect with Body Fluid Exposures
If healthcare workers can quickly identify when they’ve been exposed to body fluids, and if they get the right tests done afterwards, their outlook is generally positive following such an exposure. The risk of being infected with Hepatitis B (HBV), Hepatitis C (HCV), and HIV after being pricked with a needle, is decreasing in developed countries.
However, new and less common pathogens, or disease-causing microorganisms, are emerging in developing countries. This means that healthcare workers need to remain alert and vigilant at all times.
Possible Complications When Diagnosed with Body Fluid Exposures
When someone is exposed to body fluids, several complications can arise. The most serious is the transmission of various pathogens, or disease-causing microorganisms. Sometimes, the area of the body where the exposure happened can become infected. Accidental needle pricks can cause nerve damage, or sometimes the needle might even break off in the skin. Being exposed to body fluids can be very distressing, leading to significant anxiety and depression.
Common Complications:
- Transmission of pathogens
- Localized infection at the exposure site
- Nerve damage from an accidental needle prick
- Broken needle left in the skin
- Anxiety and depression following the traumatic event
Preventing Body Fluid Exposures
It’s extremely important to continue learning about how to use protective gear and safe ways to handle bodily fluids, as it helps lower the risk of infections. Regular training sessions on using personal protective equipment, or clothing worn to protect against infectious materials, are essential for healthcare workers. Having plenty of this safety gear easily accessible for healthcare staff is crucial.
Handwashing after caring for each patient is critical. Using gloves when handling bodily fluids or during procedures where exposure may happen is advised. If there’s a chance of liquid or spray from bodily fluids, it’s essential to use protective eyewear and masks. Needles shouldn’t be recapped, but if it’s absolutely necessary, you should not hold the cap in your hand. Instead, place it on a sturdy surface, then insert the needle and lift the whole system.
Healthcare workers who have been exposed to bodily fluids shouldn’t be scared to report their exposure. Getting tested promptly can reduce worry and lead to better outcomes if any infection has been transmitted. Keeping an eye on the types of germs found in bodily fluids can guide healthcare providers in treating patients who have been exposed to these fluids.
