Occupational Health and Safety: Long-term Care and Home Care

A BBFE occurs when a person is exposed to a potentially infectious blood or bodily fluid through one of the following events:

• Puncture of the skin by a needle or sharp object that has had contact with blood and bodily fluids
• Contact with mucous membrane (eyes, nose, mouth) such as a splash
• Non-intact skin – open sores, eczema, scratches

1. Cleanse wound thoroughly with soap and water, allow to bleed freely.
   Do not promote bleeding by squeezing the wound as this can damage tissues and increase uptake of pathogens.
2. If eyes, nose or mouth are involved flush them immediately with large amounts of water or saline solution.
3. Notify proper personnel (i.e. supervisor / manager).
4. When possible, test the source of the exposure for Hep B, Hep C and HIV.
   • Obtain required orders to test the source (i.e. patient, client, resident) from the LTC / appropriate physician
   • To test the source, the individual must be adequately informed and capable of providing informed consent
   • On the lab requisition to test the source of exposure the following should be selected: HBsAg, HCV antibody and HIV antibody.
5. The exposed employee is recommended to report the nearest emergency department as soon as possible to have baseline bloodwork obtained if:
   • Patient is known HIV+, Hep B+, Hep C +, or has risk factors
   • Employee does not know their immunization status for Hep B / Tetanus
   • Employee has had a high-risk exposure such as the following:
     1. A deep, percutaneous injury
     2. Injury with a device that was inserted directly into the patient’s artery or vein
     3. Injury with a large bore, hollow needle

The employee can expect the following:

1. Baseline blood work will be drawn to assess HBV surface antibody and antigen (HBsAB & HBsAG), HBC antibody (anti-HCV), HIV antibody, CBC, creatinine, AST, ALT. Additional bloodwork may be recommended based on exposure.
2. Assess immunization status for tetanus. Tdap should be administered if not given within the past 10 years.
3. Post exposure assessment form will be completed with ER staff to determine HIV risk associated with the exposure.
4. PEP guidelines will be reviewed if necessary to determine the need for post exposure prophylaxis.
5. You may be recommended to complete bloodwork at 3- & 6-months post exposure.

The risk of infection with Hepatitis B, Hepatitis C, or HIV is dependent on a variety of factors:

1. The amount of fluid you’ve been exposed to → more fluid = higher risk
2. The amount of time you were in contact with the fluid → more time = higher risk
3. The patient you’ve been exposed to → the more ill with the disease (Hepatitis or HIV) = higher risk
4. The type of device → injury with a hollow bore, blood-filled needle = higher risk
5. The type of fluid you’ve been exposed to → blood = higher risk

• A deep, percutaneous injury
• Injury with a device that was inserted directly into the patient’s artery or vein
• Injury with a large bore, hollow needle

• Source has no risk factors
• Solid bore percutaneous injury is less risk than a hollow bore
• Injury is superficial
• Small amount of bodily fluid / blood exposure to mucous membranes

The risk of a needlestick injury can be minimized by the following:

• Dispose of used sharps in appropriate containers
• Do not reach into sharps containers in attempt to retrieve any objects
• Do not recap needles by hand after use - use safety features of the specific device

Exposures to the eyes, nose and mouth can be prevented through the proper use of personal protective equipment (PPE).

• An exposure of urine, sweat, spit, tears, feces or vomit is not considered infectious unless the fluid is visually contaminated with blood.

• To minimize your risk on a daily basis it is very important to know your vaccine status! Visit VaxRecordsNS for tips to find your vaccine status and Nova Scotia Health’s Immunizations site for information on obtaining a vaccine.