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1. OCCUPATIONAL EXPOSURE TO
BLOODBORNE PATHOGENS
Dr. Faisal Al Haddad
Consultant Family Medicine &
Occupational Health
Director of Saudi Board Program
CBAHI Surveyor

2. BACKGROUND
Most effective means to prevent transmission of BBP in healthcare:
Hepatitis B vaccination
Use of appropriate barriers to prevent blood & body fluid contact
Preventing percutaneous injuries by eliminating unnecessary needle use
Implementing devices with safety features
Using safe work practices when handling needles & other sharp devices
Safely disposing of sharps & blood-contaminated materials

3. Exposure to BBP
Percutaneous injury or contact of MM/nonintact skin with blood,
tissue, or other body fluids that are potentially infectious
Percutaneous injury (e.g. needlestick or cut with a sharp object)
Nonintact skin (e.g. skin chapped, abraded, or afflicted with dermatitis)
Potentially infectious (CSF, synovial fluid, pleural fluid, peritoneal fluid,
pericardial fluid & amniotic fluid)
Any direct contact (without barrier protection) to concentrated virus in a
research laboratory or production facility is considered an exposure.

4. Exposure to BBP
Probability of infection after exposure to BBP depends on:
Route of exposure
Concentration of infectious virions in the implicated body fluid
Volume of infective material transferred
Susceptibility of the exposed person

5. HBV Prevention &Control
Prevention of HBV Infection:
– Standard Precautions
– Use of sharps with safety features
– Hepatitis B vaccination
– Use of PEP
Hepatitis B vaccination is the most effective measure to prevent
HBV infection & its consequences.
OSHA mandates provision of Hepatitis B vaccine at no cost to all
HCP & others at occupational risk for blood exposure.

6. HBV Prevention &Control
Hepatitis B vaccine provides both pre & postexposure protection
against HBV infection.
Three IM doses of Hepatitis B vaccine induce a protective Ab
response in >90% of healthy recipients.
Risk factors for nonresponse include:
– Age
– Smoking
– Obesity
– Immunosuppression
– Renal failure
– Family history of nonresponse

7. HBV Prevention &Control
 HCP at ongoing risk for percutaneous injuries should be tested
for anti-HBs 1-2 months after completion of the three-dose
vaccination series.
 Persons who do not experience response to the primary
vaccine series should receive a 2nd
three-dose series
 If the worker is still a nonresponder, then test for HBsAg to
make sure the worker does not have chronic antigemia.
 Booster doses of Hepatitis B vaccine & periodic serologic
testing to monitor Ab concentrations after completion of the
vaccine series are not recommended.

8. HBV PEP
 An exposure to HBV is defined as the source person being
HBsAg positive or the person's status being unknown.
 The need for prophylaxis for persons sustaining percutaneous
or mucosal exposures to blood is based on:
– HBsAg status of the source
– Hepatitis B vaccination
– Vaccine-response status of the exposed person.
 Any blood or body fluid exposure to unvaccinated HCP should
lead to initiation of the Hepatitis B vaccine series.

9. HBV PEP
When HBIG or Hepatitis B vaccine are indicated, they should be
administered as soon as possible after exposure (preferably within
24 hours).
Hepatitis B vaccine can be administered simultaneously with
HBIG at a separate site (vaccine administered in deltoid muscle)
For exposed persons who are in the process of being vaccinated
but have not completed the vaccination series, vaccination should
be completed as scheduled & HBIG should be added as indicated.

10. HBV PEP (CDC(
Status of Exposed HCP Source HBsAg
Positive
Source HBsAg
Negative
Source
Unknown
or
Not Available
Unvaccinated HBIG ×1 & initiate
Hepatitis B
vaccine series
Initiate
Hepatitis B
vaccine series
Initiate Hepatitis
B vaccine series
Previously vaccinated
Known responder
No treatment No treatment No treatment
Previously vaccinated
Known non-responder
HBIG ×1 & initiate
revaccination
or
HBIG ×2
No treatment If known high-risk
source, treat as if
source were
HBsAg positive

11. HBV PEP (CDC(
Status of
Exposed
HCP
Source HBsAg
Positive
Source HBsAg
Negative
Source
Unknown
or
Not Available
Previously
vaccinated
Antibody
response
unknown
Test exposed person
for anti-HBs:
1.If adequate, no
treatment is
necessary
2.If inadequate
HBIG ×1 & vaccine
booster
No treatment Test exposed person
for anti-HBs:
1.If adequate, no
treatment is
necessary
2.If inadequate,
administer vaccine
booster

12. HCV Prevention & Control
 No vaccine against HCV infection exists.
 CDC Recommendations for Prevention & Control of HCV
Infection:
– Screening & testing of blood donors
– Viral inactivation of plasma-derived products
– Risk-reduction counseling & screening of persons at risk for HCV
infection
– Adherence to Standard Precautions & safe work practices

13. HCV PEP
 PEP with IG, antiviral agents or immunomodulators is not
recommended after exposure to HCV-positive blood.
 The intent of current U.S. recommendations for post exposure
management is to:
– Achieve early identification of chronic infection
– If present, referral to a specialist knowledgeable in this area
for additional follow-up and medical management.

14. HCV Postexposure Management
U.S. Public Health Service guidelines
HCP who have been exposed to an HCV-positive source should have:
Baseline testing for anti-HCV & ALT
Testing for anti-HCV & ALT at 4-6 months after the exposure
Testing for HCV RNA may be performed 4-6 weeks after exposure if
earlier detection of infection is desired.

15. HCV Postexposure Management
 A worker who has been exposed to HCV should refrain from
donating blood, plasma, organs, tissue, or semen.
 There is no need for modification of sexual practices, refraining
from becoming pregnant, or special precautions to prevent
secondary transmission.
 There are no existing recommendations regarding restricting
the professional activities of HCP with HCV infection.

16. HOW?

17. HIV PEP
U.S. Public Health Service
Workers sustaining parenteral exposures to HIV should undergo:
– Baseline testing
– Follow-up testing for 6 months after exposure (e.g. 6 weeks,
3 months & 6 months).
Recommend PEP after certain percutaneous, MM & non-intact
skin exposures to HIV-infected sources

18. HIV PEP
 Antiviral activity is diminished when treatment is delayed for
more than 24 hrs. Immediate access to chemoprophylaxis is
recommended.
 Testing to determine the HIV infection status of an exposure
source should be performed as soon as possible.
 Use of rapid HIV-antibody test kit should be considered if
testing by EIA cannot be completed within 24-48 hrs.

19. HIV PEP
 CBC and renal & hepatic profiles should be done at baseline &
2 weeks after initiation of PEP to monitoring for PEP toxicity.
 PEP regimen should be discontinued or modified & expert
consultation obtained if PEP toxicity develops.
 CDC recommends that occupationally exposed personnel:
– Practice safer sex by using condoms
– Avoid pregnancy, breastfeeding, and blood & organ
donation for 6 months after exposure.

20. HIV PEP (Percutaneous Injuries(
Exposure
Type
HIV
Positive
Class 1
HIV
Positive
Class 2
Known
Source
(Unknown
HIV Status(
Unknown
Source
HIV
Negative
Less severe basic two-
drug PEP
expanded
three-drug
PEP
No PEP
warranted
Consider basic
two-drug PEP
for source with
HIV risk
factors
No PEP
warranted
Consider basic
two-drug PEP in
settings where
exposure to
HIV-infected
persons is likely
No PEP
warranted
More severe expanded
three-drug
PEP
expanded
three-drug
PEP
Same Same Same

21. HIV PEP (MM & Nonintact Skin
Exposures(
Exposure
Type
HIV
Positive
Class 1
HIV
Positive
Class 2
Known
Source
Unknown HIV
Status
Unknown Source HIV
Negative
Small
volume
Consider
basic two-
drug PEP
basic
two-drug
PEP
No PEP
warranted
consider basic
two-drug PEP
for source with
HIV risk factors
No PEP warranted
consider basic
two-drug PEP in
settings where
exposure to HIV-
infected persons is
likely
No PEP
warranted
Large
volume
basic two-
drug PEP
expanded
three-
drug PEP
Same Same Same

22. Practice
Because there is no vaccine for Hepatitis C, there have been national
recommendations for prevention and control of HCV infections. These
include all but which recommendation?
a. Screening and testing of blood donors
b. Risk-reduction counseling and screening of persons at risk for HCV
infection
c. A national registry for all healthcare personnel known to be Hepatitis C
antibody positive
d. Adherence to Standard Precautions and safe work practices in
healthcare settings

23. Practice
An employee is exposed to a patient known to have chronic Hepatitis B.
The employee is a known responder to the Hepatitis B vaccine, which was
given to him as a student 5 years ago. What is the recommended
postexposure treatment for the employee?
a. Test the employee and all close personal contacts for Hepatitis B
b. Start the Hepatitis B series on the employee because of the length of
time since vaccination
c. No treatment is recommended for a known responder
d. Recommend giving the employee the Hepatitis A vaccine

24. Practice
An employee has sustained a needlestick injury from a blood
contaminated needle. The source patient was HBV positive, and the
employee had completed one of the three vaccinations in the Hepatitis B
series. Which of the following is the correct PEP for this patient?
a. Complete the Hepatitis B vaccine series
b. Complete the Hepatitis B vaccine series and provide Hepatitis B
immunoglobulin
c. Provide Hepatitis B immunoglobulin and begin interferon therapy
d. No PEP is needed

25. Practice
An employee is exposed to a known HIV-positive patient's blood via needlestick after
giving an intramuscular injection. The patient has a known high viral load. After the
employee has thoroughly washed the exposed area with soap and water.
What is the next step that should be taken following this exposure?
a. The employee needs to be counseled about using safer sex practices and to avoid
pregnancy, breast-feeding, and blood and organ donation for 3 months after exposure
b. The employee should be treated as soon as possible with expanded multidrug PEP
c. The employee should have baseline testing for HIV, Hepatitis B antigen, and
Hepatitis B antibody
d. The employee should be counseled by a clinician knowledgeable about HIV
transmission risks

26. Thank you