What to do when there is a blood exposure at work

Sandra Hardee, MD

Occupational Medicine

The risk of being exposed to blood at work probably seems limited to working in health care, but blood exposure can happen in just about any workplace, including in hospitality, education, law enforcement, sanitation and more. Sandra Hardee, MD, explained the risk of bloodborne pathogens and what to do if there is a blood exposure at work.

What are bloodborne pathogens?

Bloodborne pathogens are microorganisms found in human blood that can be infectious and cause diseases, such as hepatitis B, hepatitis C and HIV, the human immunodeficiency virus.

“About 12 million people in America are infected with hepatitis B. Many don’t know they have it,” Dr. Hardee said. “It’s a silent infection, and over time, it can do damage to the body. The important thing to know about hepatitis B is that the virus can remain alive for about a week in dried blood, so it can be transmitted more easily than the others.”

Hepatitis C is also a common chronic bloodborne infection found in the U.S. that can lead to chronic liver disease and death. Hepatitis B and hepatitis C have very similar symptoms, including nausea, vomiting, abdominal pain, jaundice (where the skin or whites of their eyes looks yellowish), weight loss and fatigue.

HIV can potentially lead to AIDS, which affects the body’s immune system.

“Once you have that virus, you’re infected for life,” Dr. Hardee said. “Fortunately, with HIV, there are some very good therapies now to keep it under control.”

How do blood exposures typically happen?

Needle sticks are very common. In health care, specialized capsule needles are used to help prevent this, but they can still occur. An example outside of health care is a police officer who gets stuck while frisking a potential assailant. Or a sanitation worker who is stuck by a needle through a garbage bag.

Cuts from sharp objects is another way blood exposures happen.

“For example,” Dr. Hardee said, “in law enforcement, an assailant goes through a window and gets cut. There’s blood on the glass that cuts the officer as they go through it.”

The last way blood exposures happen is through contact with mucous membranes in the mouth or broken skin that’s contaminated with blood. This includes open wounds and human bites.

How can employers protect their workforce?

“The OSHA requirements are very straightforward,” Dr. Hardee said. “You need to establish an exposure control plan.”

The exposure control plan includes all the policies about what constitutes an exposure and what happens after an exposure occurs. It also includes how work areas should be cleaned and decontaminated and how waste is disposed. The plan should be updated each year.

Another way employers can protect their workforce is by providing personal protective equipment. Depending on the workplace and what employees are exposed to, this can include masks, goggles, gloves or gowns.

“If you are in an environment where your employees are at a higher risk of a potential bloodborne pathogen, it recommended that you make hepatitis B vaccines available to your employees so they already have immunity in case they are exposed,” Dr. Hardee said.

Finally, as part of the exposure control plan, it’s important to know where to send employees for a post exposure evaluation and follow up with a health care provider.

What to do if an exposure occurs

For a needle stick or a cut, wash the area with soapy water for at least five minutes so it gets any viral load or bacteria out of the wound. If it’s more of a splash into the eyes, nose, mouth or on the skin, flush the area with as much water as you can for at least five minutes.

“This can be a challenge if you have to flush your eyes, but you do want to try to irrigate with water for at least five minutes,” Dr. Hardee said.

After that, notify your manager or supervisor immediately so they can follow the exposure control plan. Make sure everything is documented as to how the exposure occurred, and then seek care from a health care professional such as an occupational health provider.

How are blood exposures treated?

“When we see folks who have had an exposure, we start with a confidential evaluation,” Dr. Hardee said. “We talk about how they were exposed. How much blood was involved? Can you identify the source of the blood? This makes it easier to help determine what that employee was exposed to.”

Unfortunately, in a lot of situations, such as a sanitation worker being stuck by a needle through a bag, the source isn’t known.

“In those cases, we counsel them extensively over the risks of what they’ve been exposed to and what our recommendations would be,” Dr. Hardee said. “We might do some blood tests to look for serological status for hepatitis B, hepatitis C and HIV. And then once we get that information back, we can counsel them further on what the next steps are.”

There are instances where post exposure prophylaxis is recommended.

“If we feel like the exposure was significant, we may go ahead and start treating that individual, but it depends on the situation. And then if they need further follow up over the next several weeks, we’ll do that and counsel them along the way.”