Simard EP, Miller JT, George PA, et al. Hepatitis B vaccination coverage levels among healthcare workers in the United States, 2002-2003. Infect Control Hosp Epidemiol. 2007 Jul. 28(7):783-90. [QxMD MEDLINE Link]. [Full Text].

Most exposures are caused by a departure from universal precautions on some level, whether they are the result of recapping or of failure to use personal protective equipment or are due to a sharp unintentionally left in an inappropriate place or placed in the wrong container for disposal. (See Presentation.)

Marcus R. Surveillance of health care workers exposed to blood from patients infected with the human immunodeficiency virus. N Engl J Med. 1988 Oct 27. 319(17):1118-23. [QxMD MEDLINE Link].

Occupational transmission of blood-borne infections may also occur through parenteral, mucous membrane, and non-intact skin exposure. The greatest risk for transdermal transmission is via a skin penetration injury that is fairly deep and sustained with a sharp hollow-bore needle that has visible blood on it that had recently been removed from a blood vessel of a patient with a high viral load. [3] Although many infectious agents may be transmitted by such contact, the most consequential include HBV, HCV, and HIV. (See Pathophysiology and Prognosis.)

Stewardson DA, Burke FJ, Elkhazindar MM, et al. The incidence of occupational exposures among students in four UK dental schools. Int Dent J. 2004 Feb. 54(1):26-32. [QxMD MEDLINE Link].

After initial exposure, animal models have shown that HIV replicates within dendritic cells of the skin and mucosa within the first 48 hours before spreading through lymphatic vessels and becoming a systemic infection. This interval from initial introduction of the virus to systemic spread provides an opportunity to inhibit the replication of the virus using PEP. [17] In addition, some individuals who are exposed to HIV or HCV may have the ability to clear these infections due to inherent cellular immunity and may not demonstrate an antibody response to these organisms. This is referred to as aborted infection. [13]

Non–healthcare personnel may be exposed by way of social interaction, sexual encounters (including sexual assault), trauma scenarios, intentional inoculations consistent with contemporary terrorist activity, or drug abuse. A flow chart for the management of body fluid exposure is shown below.

Fortunately, viral transmission is rare in cases of occupational HIV exposures. Intact keratinized skin does not possess the mucous membrane characteristics that encourage the transmission of HIV, and it is virtually impermeable unless disrupted.

Lohiya GS, Tan-Figueroa L, Lohiya S, Lohiya S. Human bites: bloodborne pathogen risk and postexposure follow-up algorithm. J Natl Med Assoc. 2013 Spring. 105(1):92-5. [QxMD MEDLINE Link].

Blood and any body fluid visibly contaminated with blood should be considered capable of transmitting hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Semen and vaginal secretions should also be considered potentially able to transmit these viruses. Similarly, cerebrospinal fluid, amniotic fluid, pleural fluid, synovial fluid, and peritoneal and pericardial fluids carry a significant risk of transmitting these viruses.

[Guideline] New York State Department of Health AIDS Institute. Recommendations for HIV Postexposure Prophylaxis (PEP). 2008. Available at https://www.hivguidelines.org.

In contrast, unless blood is visibly present, saliva, sputum, sweat, tears, feces, nasal secretions, urine, and vomitus carry a very low risk for transmission of HCV and HIV. It should be noted that saliva can also carry HBV. [1] (See Pathophysiology.) Federal guidelines do not recommend testing for and giving Post-Exposure Prophylaxis (PEP) for HIV for exposure to non-bloody saliva. However, the federal guidelines are not clear regarding testing and prophylaxis for HBV and HCV for saliva exposure. The PEP Quick Guide for Occupational Exposure/National Clinician Consultation Center does not recommend testing or treating for HBV and HCV exposure for non-bloody saliva but does not recommend against it. [2]

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. for: Medscape.

Merchant RC, Nettleton JE, Mayer KH, Becker BM. Blood or body fluid exposures and HIV postexposure prophylaxis utilization among first responders. Prehosp Emerg Care. 2009 Jan-Mar. 13(1):6-13. [QxMD MEDLINE Link].

Robert LM, Bell DM. HIV transmission in the health-care setting. Risks to health-care workers and patients. Infect Dis Clin North Am. 1994 Jun. 8(2):319-29. [QxMD MEDLINE Link].

Landovitz RJ, Currier JS. Clinical practice. Postexposure prophylaxis for HIV infection. N Engl J Med. 2009 Oct 29. 361(18):1768-75. [QxMD MEDLINE Link].

The risk for HCV transmission from a known HCV-positive source by a sharps injury is 0%-7%. Approximately 80% of those infected with HCV will develop active liver disease, and 10%-20% will develop cirrhosis; 1%-5% of cirrhosis cases will lead to liver cancer over a period of years. [27]

Kuhar DT, Henderson DK, Struble KA, Heneine W, Thomas V, Cheever LW, et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013 Sep. 34(9):875-92. [QxMD MEDLINE Link].

[Guideline] CDC. Guidelines for prevention of transmission of human immunodeficiency virus and hepatitis B virus to health-care and public-safety workers. MMWR Morb Mortal Wkly Rep. 1989 Jun 23. 38 Suppl 6:1-37. [QxMD MEDLINE Link].

CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management. MMWR Recomm Rep. 2013 Dec 20. 62:1-19. [QxMD MEDLINE Link].

Joel R Gernsheimer, MD, FACEP Visiting Associate Professor, Department of Emergency Medicine, Attending Physician and Director of Geriatric Emergency Medicine, State University of New York Downstate Medical Center Joel R Gernsheimer, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Geriatrics SocietyDisclosure: Nothing to disclose.

Katsevman GA, Braca JA 3rd, Sedney CL, Hatchett L. Needlestick injuries among healthcare professionals in training: using the surgical 'time-out' and hand-off protocols to deter high-risk needlesticks. J Hosp Infect. 2017 Jan. 95 (1):103-104. [QxMD MEDLINE Link].

In the United States, sharps injuries occur at a rate of 1.8 per year per physician and 0.98 per year per nurse while working on the same medical ward. Statistically, however, twice as many nurses as doctors have been reported with occupationally acquired HIV infection. Whether this is a function of the significance of the exposure (ie, severity of the stick) or the route of exposure remains to be studied.

Prognosis is associated with risk for infection and its sequelae. This is difficult to specify in any given patient. However, since the risk for HIV transmission is less than 1%, the prognosis of any given patient exposed to HIV may be listed as good but may remain so only with vigilant follow-up and consistent use of prophylaxis against infection.

Lanphear BP. Trends and patterns in the transmission of bloodborne pathogens to health care workers. Epidemiol Rev. 1994. 16(2):437-50. [QxMD MEDLINE Link].

The main complication of body fluid exposure is acquisition of hepatitis and HIV infection. Acquiring a significant bacterial skin infection from a needlestick also is possible. The risk of acquiring tetanus is extremely low.

Verbeek JH, Ijaz S, Mischke C, Ruotsalainen JH, Mäkelä E, Neuvonen K, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2016 Apr 19. 4:CD011621. [QxMD MEDLINE Link].

Mallin R, Sinclair D. Needlestick injuries and potential body fluid exposure in the emergency department. CJEM. 2003 Jan. 5(1):36-7. [QxMD MEDLINE Link]. [Full Text].

Interstitialfluid

Henderson DK, Fahey BJ, Willy M, Schmitt JM, Carey K, Koziol DE. Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures. A prospective evaluation. Ann Intern Med. 1990 Nov 15. 113(10):740-6. [QxMD MEDLINE Link].

Education regarding universal precautions and safety protocols to employees prior to any body fluid exposure may prevent exposures. Although universal guidelines have decreased the incidence of needlesticks, these injuries have continued to occur, albeit at a much lower rate. The healthcare workers at highest risk include surgeons, emergency room personnel, laboratory room professionals, and nurses. In many cases, the needlestick injuries occur because of failure to follow safety guidelines on the proper use and disposal of sharps. Many needlesticks are preventable by strictly following established procedures. [29]

body fluids中文

Shkrum MJ, Kent J. An Autopsy Checklist: A Monitor of Safety and Risk Management. Am J Forensic Med Pathol. 2016 Sep. 37 (3):152-7. [QxMD MEDLINE Link].

van Tongeren M, Mee T, Whatmough P, Broad L, Maslanyj M, Allen S. Assessing occupational and domestic ELF magnetic field exposure in the uk adult brain tumour study: results of a feasibility study. Radiat Prot Dosimetry. 2004. 108(3):227-36. [QxMD MEDLINE Link]. [Full Text].

Schillie S, Murphy TV, Sawyer M, Ly K, Hughes E, Jiles R, et al. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Recomm Rep. 2013 Dec 20. 62:1-19. [QxMD MEDLINE Link].

Paz-Bailey G, Rosenberg ES, Sharp TM. Persistence of Zika Virus in Body Fluids - Final Report. N Engl J Med. 2019 Jan 10. 380 (2):198-199. [QxMD MEDLINE Link].

Human body

Patients who develop hepatitis or HIV infection face significant morbidity and mortality. However, meaningful treatments now exist for HIV, HBV, and HCV infections.

[Guideline] National Institutes of health consensus development conference statement: management of hepatitis C. June 10-12, 2002. Available at https://consensus.nih.gov/2002/2002hepatitisc2002116html.htm.

Zika virus has emerged as a pathogen of greater notice, as the incidence of this infection has increased in the Caribbean and Brazil. Consequently, there is greater interest of Zika virus being imported into the Unites States by travelers from these areas. Although most individuals with Zika virus infection are asymptomatic or have a benign viral illness characterized by fever, rash, arthralgia, and conjunctivitis, it can cause severe brain defects, such as microcephaly, in the fetuses of women who become infected with Zika virus during pregnancy. These defects may cause fetal demise. Zika virus infection in adults has been associated with Guillain-Barré syndrome and meningoencephalitis.

Although the incidence of body fluid exposures and percutaneous injuries have been significantly reduced overall, likely owing to safety-engineered devices, these devices are still associated with a significant number of percutaneous injuries. More prevention strategies and education are still needed in this area. [20] One strategy that may help prevent these injuries is calling a “surgical time out” and making a “high-risk announcement” when there is a high risk for needlestick injuries during a surgical procedure. Procedures that were found to be high risk included administering skin injections, placing intravenous catheters, drawing blood, recapping needles, and using sharp suture needles. [21]

Chaiwarith R, Ngamsrikam T, Fupinwong S, Sirisanthana T. Occupational exposure to blood and body fluids among healthcare workers in a teaching hospital: an experience from northern Thailand. Jpn J Infect Dis. 2013. 66(2):121-5. [QxMD MEDLINE Link].

Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine

Recently, because of the Ebola virus and severe acute respiratory syndrome (SARS) outbreaks, there has been a great deal of publicity concerning the use of personal protection equipment (PPE). Unfortunately, no high-quality studies have addressed which types of equipment protect best, the best way to don and doff the PPE, and how to ensure that healthcare workers (HCWs), who are at a higher risk for these diseases than the general population, use them properly. It appears that more active training on the use of PPE is needed by HCWs. [23] One method for studying the effectiveness of PPE, along with the best way to don and doff this equipment by providers, is by using UV tracers. [24]

Darrell G Looney, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and National Medical Association

Alter MJ. Occupational exposure to hepatitis C virus: a dilemma. Infect Control Hosp Epidemiol. 1994 Dec. 15(12):742-4. [QxMD MEDLINE Link].

Centers for Disease Control and Prevention. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Recomm Rep. 1991 Nov 22. 40:1-25. [QxMD MEDLINE Link].

Richard Dee Shih, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Gerberding JL, Henderson DK. Management of occupational exposures to bloodborne pathogens: hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. Clin Infect Dis. 1992 Jun. 14(6):1179-85. [QxMD MEDLINE Link].

Healthcare personnel include employees, volunteers, attending clinicians, students, contractors, and any public safety workers whose activities involve contact with patients and their environment such that exposure to blood or other body fluids can occur. Nurses, trainees, and students are at especially high risk for significant morbidity from these exposures. [6, 7, 8] There are about 385,000 percutaneous injuries a year in US Hospitals. [9]  About two-thirds of procedures performed in the ED have the potential to result in healthcare personnel exposure to blood or body fluid, and most of those involve the hands. [10]

Henderson DK. Management of needlestick injuries: a house officer who has a needlestick. JAMA. 2012 Jan 4. 307 (1):75-84. [QxMD MEDLINE Link].

Higher vascularity coupled with a relatively permeable cellular layer gives rise to a presumed heightened risk for transmission of HBV, HCV, or HIV across mucous membranes and into the bloodstream.

In a retrospective study of first responders presenting to an ED for body fluid or blood exposure, the incidence was 23.29 ED visits per 100,000 ambulance runs. [25]

Kamili S, Krawczynski K, McCaustland K, Li X, Alter MJ. Infectivity of hepatitis C virus in plasma after drying and storing at room temperature. Infect Control Hosp Epidemiol. 2007 May. 28(5):519-24. [QxMD MEDLINE Link].

[Guideline] PEP Quick Guide for Occupational Exposures. The National Clinician Consultation Center. June 18, 2021. [Full Text].

As noted above, the rate of HIV transmission from a known infected individual via a sharps injury is 0.3%, whereas that for exposure to mucous membrane is 0.09%. [28] The rate is higher if the injury was sustained by a hollow-bore needle, if the injury was deeply penetrating, or if blood was injected during the injury. Risk to the injured health care worker is greater if the source patient had a high HIV viral load and/or a lower CD4 count.

intracellular fluid中文

Healthcare workers who have a significant exposure to HBV (ie, inoculation with an open-bore needle from a source known to have active HBV disease) but have not previously received HBV vaccine and do not receive PEP have a 6%-30% risk of becoming infected, depending on the presence of hepatitis B e antigen (HBeAg). The HBV viral DNA level correlates better with the infectivity of HBV than does the presence of HBeAg. [13]

Mast ST, Woolwine JD, Gerberding JL. Efficacy of gloves in reducing blood volumes transferred during simulated needlestick injury. J Infect Dis. 1993 Dec. 168(6):1589-92. [QxMD MEDLINE Link].

P PK, C S, K S, Shenbagasree. Occupational Exposure to Blood and Body Fluids among Post-graduate Students in Tamilnadu: A Cross-sectional Study. J Assoc Physicians India. 2019 Jan. 67 (1):18-20. [QxMD MEDLINE Link].

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician / Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Prisma Health Richland Hospital Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical AssociationDisclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor - Chief Editor for Medscape.

[Guideline] Panlilio AL, Cardo DM, Grohskopf LA, Heneine W, Ross CS. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep. 2005 Sep 30. 54:1-17. [QxMD MEDLINE Link].

O'Donnell S, Bhate TD, Grafstein E, Lau W, Stenstrom R, Scheuermeyer FX. Missed Opportunities for HIV Prophylaxis Among Emergency Department Patients With Occupational and Nonoccupational Body Fluid Exposures. Ann Emerg Med. 2016 Sep. 68 (3):315-323.e1. [QxMD MEDLINE Link].

Mauskopf JA, Bradley CJ, French MT. Benefit-cost analysis of hepatitis B vaccine programs for occupationally exposed workers. J Occup Med. 1991 Jun. 33(6):691-8. [QxMD MEDLINE Link].

Myers DJ, Lipscomb HJ, Epling C, Hunt D, Richardson W, Smith-Lovin L, et al. Surgical Procedure Characteristics and Risk of Sharps-Related Blood and Body Fluid Exposure. Infect Control Hosp Epidemiol. 2016 Jan. 37 (1):80-7. [QxMD MEDLINE Link].

Liang SY, Theodoro DL, Schuur JD, Marschall J. Infection prevention in the emergency department. Ann Emerg Med. 2014 Sep. 64 (3):299-313. [QxMD MEDLINE Link].

Kanamori H, Weber DJ, DiBiase LM, Pitman KL, Consoli SA, Hill J, et al. Impact of Safety-Engineered Devices on the Incidence of Occupational Blood and Body Fluid Exposures Among Healthcare Personnel in an Academic Facility, 2000-2014. Infect Control Hosp Epidemiol. 2016 May. 37 (5):497-504. [QxMD MEDLINE Link].

[Guideline] CDC. Protection against viral hepatitis. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Recomm Rep. 1990 Feb 9. 39:1-26. [QxMD MEDLINE Link].

Peter B Richman, MD is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

The presence of a moist mucous layer tends to prolong the viability of fragile viruses, such as HIV and HBV, which cannot survive long in drier environments. However, HBV has been found to be capable of surviving on countertops for 7 days, and HBV remains capable of causing infection, [15] whereas HCV has been shown to be able to survive on environmental surfaces for a minimum of 16 hours, but not for as long as 4 days. [16]

Stacey AW, Czyz CN, Kondapalli SS, Hill RH, Everman KR, Cahill KV, et al. Risk of ocular blood splatter during oculofacial plastic surgery. Ophthal Plast Reconstr Surg. 2015 May-Jun. 31 (3):182-6. [QxMD MEDLINE Link].

In addition, skin and soft-tissue infection at the site of the inoculation, through introduction of staphylococcal species, is an issue of concern and must not be neglected. Tetanus prophylaxis is also an important issue of concern. Another important issue is the fact that many medical institutions adopt clinical pathways, algorithms, and plans for management of their own health care personnel but are woefully lacking when faced with the outside individual at significant risk for these diseases from needlesticks, mucous membrane splashes, or sexual encounters. (See Treatment and Medication.)

It has also been recommended that oculofacial plastic surgeons strongly consider using eye protection during procedures that have the potential to cause “splash exposures." [19]

Human body wikipedia

Although Zika virus is mainly transmitted via infected mosquitos, it has also been shown to be transmitted by sexual contact (especially from men to women [including from asymptomatic men]) and by blood, including from mother to fetus. A 2019 study conducted in Puerto Rico showed that the 95th percentile for the time until the loss of Zika virus RNA detection was 54 days in serum, 34 days in urine, and 81 days in semen. Few participants had detectable Zika virus RNA in saliva or vaginal secretions. The CDC recommends that the minimum interval from potential exposure to Zika virus and blood donation is 120 days. The CDC also recommends that men with possible Zika virus exposure, regardless of symptom status, should abstain from sexual contact or should use condoms for at least 6 months. Finally, the CDC recommends that women who have been infected or exposed to Zika virus wait at least 8 weeks from symptom onset or last possible exposure to Zika virus before attempting conception. [4]  There are other diseases besides the above that can be transmitted by body fluids, including syphilis and other STI’s, monkeypox, malaria, Ebola, and other hemorrhagic fevers. Healthcare providers must be aware of emerging infections that may been brought from an affected region by travelers. [5]  In this chapter, we will mainly discuss HIV, HBV, and HCV infections.

[Guideline] Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002 Oct 25. 51:1-45, quiz CE1-4. [QxMD MEDLINE Link].

Nathalie Mathieu, MD Resident Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center

Body fluid exposures carry a risk of transmitting HIV, HBV, and HCV. The risk of developing HIV after a needlestick injury involving an HIV-infected patient is around 0.3%. Factors that increase the odds of HIV transmission after percutaneous exposure include a deep injury, the presence of visible blood on the instrument causing the exposure, injury via a needle that was placed in a vein or artery of the source patient, and terminal illness in the source patient. [11, 12] Viral titers are also very high during the initial stages of infection, when seroconversion is taking place. [13] Wearing gloves may reduce (>50%) the volume of blood introduced through an injury. (See Prognosis.)

Fluid

Farsi D, Zare MA, Hassani SA, Abbasi S, Emaminaini A, Hafezimoghadam P, et al. Prevalence of occupational exposure to blood and body secretions and its related effective factors among health care workers of three Emergency Departments in Tehran. J Res Med Sci. 2012 Jul. 17(7):656-61. [QxMD MEDLINE Link]. [Full Text].

Merchant RC, Becker BM, Mayer KH, Fuerch J, Schreck B. Emergency department blood or body fluid exposure evaluations and HIV postexposure prophylaxis usage. Acad Emerg Med. 2003 Dec. 10(12):1345-53. [QxMD MEDLINE Link].

Vu T. Standardization of Body Surface Area Calculations. 1999. halls.md. Available at https://www.halls.md/bsa/bsaVuReport.htm.

When dealing with blood and body fluid exposures, document whether the exposure represents a departure from universal precautions or Occupational Safety and Health Administration (OSHA) standards or whether it represents a true accident (eg, projectile vomiting, precipitous labor with spontaneous rupture of membranes). This information is vital to the institutional safety committee, whose function is to monitor the safety of the environment for the entire facility and make recommendations for upgrades and policy changes.

Body fluid exposures appear to be a significant problem in developing countries, but no reliable statistics are available. A 2019 study from India showed that fatigue due to working excessive hours was a major risk factor for needlesticks among junior medical officers. [26]

Drew JL, Turner J, Mugele J, Hasty G, Duncan T, Zaiser R, et al. Beating the Spread: Developing a Simulation Analog for Contagious Body Fluids. Simul Healthc. 2016 Apr. 11 (2):100-5. [QxMD MEDLINE Link].

When intact, the integumentary system serves as an effective physical barrier to the entry of infectious elements into the body. However, a special situation exists in terms of mucous membranes. Across these membranes lies a layer of mucus secreted by specialized columnar cells that are closely associated with each other through gap junctions. These junctions are little more than specialized cell surface projections that allow intercellular communication.

Richard Dee Shih, MD Associate Professor, Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey; Program Director, Department of Emergency Medicine, Morristown Memorial Hospital; Attending Physician, New Jersey Poison Center, Newark Beth Israel Medical Center

Note that the risk for HIV transmission in healthcare workers from exposure of the mucosa to HIV-infected fluids was extremely low (0.09%) and that no cases of HIV conversion after exposure of intact skin to HIV-contaminated fluids or from bites (unless visible blood was present) were reported. [14]

West CP, Tan AD, Shanafelt TD. Association of resident fatigue and distress with occupational blood and body fluid exposures and motor vehicle incidents. Mayo Clin Proc. 2012 Dec. 87(12):1138-44. [QxMD MEDLINE Link]. [Full Text].

Blood exposure is a particularly high risk during surgical procedures (up to 6.3 exposures per 1000 surgical procedures). Risk factors for blood exposure during surgical procedures increase with higher levels of patient blood loss, longer procedure duration, higher number of surgical personnel involved in the procedure, and the use of suture needles rather than other device types. The use of blunt surgical needles, when appropriate, reduced the risk for blood exposure from needlesticks, as did the use of double gloving for certain procedures. [18]

Kiyosawa K, Sodeyama T, Tanaka E, et al. Hepatitis C in hospital employees with needlestick injuries. Ann Intern Med. 1991 Sep 1. 115(5):367-9. [QxMD MEDLINE Link].

Once the patient has been exposed, the patient must be educated regarding the risks, in addition to the risks versus benefits of postexposure prophylaxis (PEP).

If the patient opts for HIV PEP, the importance of adherence for 28 days must be emphasized. Also, the patient should understand to return to the emergency department (ED) immediately for any complications of the body fluid exposure or the PEP regimen. The importance of outpatient follow-up should be stressed to the patient.

Weinbaum CM, Williams I, Mast EE, et al. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep. 2008 Sep 19. 57:1-20. [QxMD MEDLINE Link].

[Guideline] CDC. Public Health Service guidelines for the management of health-care worker exposures to HIV and recommendations for postexposure prophylaxis. Centers for Disease Control and Prevention. MMWR Recomm Rep. 1998 May 15. 47:1-33. [QxMD MEDLINE Link].

Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA Professor of Emergency Medicine and Clinical Pediatrics, Weill Cornell Medical College; Attending Physician, Departments of Emergency Medicine and Pediatrics, Lincoln Medical and Mental Health Center; Adjunct Professor of Emergency Medicine, Adjunct Professor of Pediatrics, St George's University School of Medicine, Grenada Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA is a member of the following medical societies: American Academy of Pediatrics, American Academy of Urgent Care Medicine, American College of Emergency Physicians, American Heart Association, American Medical Association, Association of Clinical Research Professionals, Public Responsibility in Medicine and Research, Society for Academic Emergency Medicine, Society for Simulation in HealthcareDisclosure: Nothing to disclose.

Safety during autopsies is another subject that has not received much publicity. The “Autopsy Checklist” is a standardized way of documenting safety and risk management issues during the autopsy process. However, the effectiveness of this procedure relies on the accurate completion of this list, which often goes undone. [22]

Henderson DK. Management of needlestick injuries: a house officer who has a needlestick. JAMA. 2012 Jan 4. 307(1):75-84. [QxMD MEDLINE Link].