Synopsis
Give immediate first aid, classify blood-borne-virus exposure by fluid and route, start indicated HIV PEP inside its window, and arrange hepatitis and follow-up care.
- First aid is immediate: encourage gentle bleeding from a puncture, wash with soap and running water, irrigate eyes or mouth with water, and never suck, scrub or use bleach on the wound.
- A significant occupational route is percutaneous inoculation, mucous-membrane splash or contact with non-intact skin; intact-skin contact alone is not an HIV exposure.
- Potentially infectious material includes blood and visibly blood-stained fluid. Urine, saliva, vomit, sweat, tears and faeces without visible blood do not justify HIV PEP.
Key red flags
A deep injury, hollow-bore needle, device visibly contaminated with blood or needle previously in a vessel increases inoculum and urgency.
Blood splash to eye or mouth, or blood contacting eczema, abrasion or another break in skin, is a mucocutaneous exposure even without a needle.
Known untreated or detectably viraemic HIV in the source makes a qualifying route high priority; do not wait for full resistance information. PEP is generally not recommended for a treated source only when ART has been taken for at least six months, the last HIV RNA is below 200 copies/mL and was measured within the previous six months, and adherence is good. Seek expert advice for stale or uncertain data, resistance or a major inoculation.
The source may carry hepatitis B or C even when HIV risk is low; complete a three-virus assessment and verify hepatitis B vaccination response.
The exposed worker may be pregnant, have renal disease or take interacting medicines; tailor the regimen without delaying an indicated first dose.
Needlestick, scalpel injury or bite that breaks skin and involves blood creates direct access to tissue and requires urgent BBV assessment.
Blood entering an eye, mouth or nose is a qualifying route; irrigate immediately and assess source infectivity and volume.
Blood contacting eczema, abrasion, dermatitis or an open wound can qualify even when the worker did not feel a sharp injury.
Deep injury, hollow-bore device, visible blood and prior placement in an artery or vein increase the amount potentially transmitted.
Investigation priorities
Record time, device, depth, fluid, route, protective equipment and source HIV, HBV and HCV information.
Management branches
A sharp injury or splash occurs while handling blood or body fluid at work.
- Stop the task safely, encourage gentle bleeding of a puncture, wash with soap and water or irrigate exposed mucosa, and avoid caustic chemicals.
- Report immediately through occupational health or the out-of-hours route; document fluid, route, time, device and inoculum features.