Curriculum · Infection Control
Blood and body fluid splash exposure
What it is
An occupational exposure is defined as a percutaneous exposure (a needlestick or cut with a sharp object), a mucous membrane exposure (eye, nose and mouth), or a non-intact skin exposure (exposed skin that is chapped, abraded, or afflicted with dermatitis) to blood or body fluids that occurs during the course of an individual's employment. It mainly applies to HCWs in health care settings; however, other workers, such as emergency rescue staff, waste disposal workers, law enforcement personnel and fire fighters, may also be exposed.
So a splash to the eye or the mouth is an occupational exposure in the same sense a needlestick or a cut with a sharp object is.
Causes and risk
Not every fluid carries the same risk. The high risk body fluids are blood, any visibly blood-stained fluid or substance, semen, vaginal secretions, amniotic fluid, cerebrospinal fluid, pericardial fluid, pleural fluid and synovial fluid, and within that row semen and vaginal secretions are marked as fluids that have not been implicated in occupational transmission. The no-risk body fluids are saliva, urine, feces, vomit, sweat, tears, sputum and nasal secretions, and they are no-risk unless visibly blood-stained. Blood has the highest risk, and if no-risk fluids were visibly blood-stained they will be considered risky.
The risk also depends on the route and on the virus. For HIV the estimated risk is 0.3% percutaneous, 0.09% mucous membrane and under 0.09% for non-intact skin. For HCV percutaneous exposure it is 1.8%. For HBV it is 22%-31% when the source is HBsAg positive and HBeAg positive, and 1-6% when the source is HBsAg positive and HBeAg negative. Two orders come out of that table and are worth holding: HBV is above HCV, which is above HIV; and percutaneous is above mucous membrane, which is above non-intact skin. A splash therefore carries real risk, but less than a needle. The viruses behind that risk are set out side by side. Hepatitis B, C and D have blood and blood-derived body fluids as their source, and their route is percutaneous and permucosal, while hepatitis A and E have feces as their source and are fecal-oral. Chronic infection follows B, C and D, and does not follow A or E. Prevention differs with that: pre and post-exposure immunization for A and B, blood donor screening with risk behavior modification for C, pre and post-exposure immunization with risk behavior modification for D, and safe drinking water for E.