Occupational Exposures

Working in occupational (AKA employee) health, I see my share of bloodborne pathogen exposures (BBPE). These are usually in the form of needlesticks, splashes, and bites. The most common injuries that I see occur when someone is drawing blood from a patient and that patient moves popping the needle out of their vein and into the finger of the health care provider.

Fortunately, the devices today are engineered to help minimize the chance of injury with the addition of some form of a safety mechanism. Yet, accidents still occur. Sometimes this happens when providers avoid properly using the devices or try to circumvent the safety mechanism altogether. This is usually a recipe for disaster.

Two of the most concerning infections when a BBPE occurs are HIV and Hepatitis C (and to a lesser extent Hepatitis B because many health care providers are immunized for Hep B). The CDC estimates the transmission rate of HIV from a HIV-infected needle to be 0.3%  and 0.09% from a mucous membrane exposure. The transmission for Hepatitis C is a bit higher at 1.8% but there have been no reported transmission through mucous membrane contact in the occupational setting.

Nonetheless, having one of these incidents happen can be quite stressful. Our first goal is to get consent from the source patient to test for HIV. Source patients can refuse this testing and there are instances when a needlestick occurs from an unknown source. This happens when a used needle is improperly disposed of and someone else comes along at some point and gets stuck with it. This is a double whammy since the safety mechanism wasn’t activated and it wasn’t properly placed in the sharps container. For the unknown sources (we can not assume that it is negative) and for the sources positive for HIV, we initiate post exposure prophylaxis medication for the employee for 30 days following the exposure. Weekly bloodwork needs to be done on the individual exposed since the medications can cause some serious side effects. The most common side effects of the medication are nausea, vomiting and diarrhea.

Unfortunately, there is no current treatment, prophylaxis, or vaccine for Hepatitis C. Therefore we monitor those individuals more frequently with blood work.

I urge anyone working with sharps (needles, scalpels, etc) or if there is any likelihood to come into contact with blood or other potentially infectious materials to use extreme caution and to use proper personal protective equipment (gowns, gloves, eye protection, etc) when and where necessary.

As long as we are working with sharp devices, the potential exists to have an accident. While current engineering methods have helped to reduce the risk of these accidents, they still occur. A little common sense and the use of universal precautions can go a long way in helping to avoid these accidents altogether.