DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

Summary

Patient care puts paramedics at 

risk of exposure to blood. These 

exposures carry the risk of infection from bloodborne pathogens 

such as hepatitis B virus (HBV), 

hepatitis C virus (HCV), and 

human immunodeficiency virus 

(HIV), which causes AIDS. 

A national survey of 2,664 paramedics contributed new information about their risk of exposure to blood and identified opportunities to control exposures 

and prevent infections.

Preventing Exposures to Bloodborne 

Pathogens among Paramedics

Description of 

Exposure

Paramedics, the most highly trained 

emergency medical technicians 

(EMTs), can be exposed to blood 

because they treat trauma victims 

and perform advanced life support 

procedures using needles and other 

sharp instruments.

Paramedics often work under unpredictable, adverse conditions where 

patients may be experiencing uncontrolled bleeding or disorientation.

Exposure to blood can occur from a 

sharps injury, such as a needlestick 

after use on a patient or a cut from a 

contaminated sharp object.

Exposure can also occur from a 

splash to the eyes, nose, or mouth; 

contact on non-intact (broken or 

cracked) skin; or a human bite.

National Survey of 

Paramedics

Constella Group and NIOSH conducted a national survey of paramedics between 2002–2003 to measure the incidence of exposure to blood among 

paramedics [Leiss et al. 2006, 2009; 

Boal et al. 2008, 2010; Mathews et 

al. 2008]. 

We analyzed the results for California paramedics separately because 

Paramedics attend to a patient. Photo courtesy of 911imaging.
California had a needlestick prevention law several years 

before there was a similar national law.

Survey Findings

Exposure rates

Twenty-two percent of all the paramedics surveyed had at 

least one exposure to blood in the previous year. California 

paramedics had one-quarter the national rate of needlesticks 

and half the national rate of all exposures to blood. The national sharps injury rate for paramedics was also high compared with most hospital workers. Also, exposure of broken 

skin to blood was extremely high among paramedics. 

Use of safety devices

Safety devices have engineered sharps injury protections; 

non-safety devices do not. 

Eighty percent of needlesticks involved non-safety devices. 

The use of safety devices was much higher among California 

paramedics compared with paramedics nationally. 

The main predictor for use of safety devices was whether employers provided them. Many paramedics said they 

needed more training in the use of safety devices.

Use of personal protective 

equipment (PPE)

Major factors for eye and nose exposures to blood included: the patient vomited, spit, or coughed; the patient was uncooperative, combative, or being resuscitated; or the blood/body fluid splashed.

Although more than 80% of paramedics said their employers provided safety goggles and face/surgical masks, 

most splashes to the eye or nose occurred when protection was not used.

Most exposures to broken skin were on the hand, but 

one-third were on the arm.

One-fifth of paramedics said they needed more training in 

how to use PPE, and one-fourth said they needed betterdesigned PPE or additional PPE to protect themselves.

Special situations

Forty percent of exposures to broken skin happened 

when a patient was being extricated. Uncooperative or 

combative patients were a major factor for exposures to 

the eye, nose, and broken skin.

Safety procedures

Paramedics had significantly fewer exposures to blood 

if their supervisors emphasized following Universal/

Standard Precautions and if paramedics were evaluated 

on following safety procedures.

Reporting exposures to management

Our survey found exposures were underreported. Only 

72% of needlesticks, 29% of exposures to broken skin, and 

49% of exposures overall were reported to employers.

The most common reason paramedics gave for not reporting an exposure was that they did not consider it a 

significant exposure.

In particular, they did not seem to think contact of their 

broken skin with patient’s blood was serious enough to 

warrant reporting.

Survey results suggested paramedics were less likely to 

report needlesticks if they thought the exposure was 

their own fault.

The Importance of Reporting

Immediate reporting to management of all potential exposures is important for the following reasons:

 Exposures should be medically evaluated immediately 

(some treatments, such as for HIV exposure, should be 

started as soon as possible, preferably within hours). 

 Infected workers who remain undiagnosed could place 

others, especially sexual partners, at risk of infection.

 HIV, HBV, and HCV have all been transmitted 

through broken skin; thus, these exposures have an infection risk and should be reported.

 Workers who develop occupational infections may not 

be eligible for workers’ compensation if the exposure 

has not been documented.

 Employers need to know about exposures so they can 

implement effective prevention strategies, such as 

changing work practices, buying different safety devices or PPE, or improving employee training.

Recommendations

Employers

 Show employees that safety is a core value in your organization. Require workers to follow all safety procedures and include this in their job performance evaluations.
Conclusions

Nationally, paramedics have high rates of occupational 

exposure to blood. Lower exposure rates among California paramedics and among most hospital workers suggest 

that practical steps can be taken to effectively reduce exposures. This includes always providing and using appropriate safety devices and PPE and promoting adherence 

to safety procedures.

These steps will help protect the health of paramedics, 

their co-workers and family members, and the general 

public.

Acknowledgments

The principal contributors to this document were 

Winifred L. Boal, National Institute for Occupational 

Safety and Health, and Jack K. Leiss, Cedar Grove Institute for Sustainable Communities. NIOSH also acknowledges the valuable assistance of Celia Fishman, 

National Association of Emergency Medical Technicians; 

and Joe Grafft, National Association of Emergency Medical Services Educators. 

References

Boal WL, Leiss JK, Sousa S, Lyden JT, Li J, Jagger J [2008]. 

The national study to prevent blood exposure in paramedics: exposure reporting. Am J Ind Med 51(3):213–222. 

Boal WL, Leiss JK, Ratcliffe JM, Sousa S, Lyden JT, Li J, 

Jagger J [2010]. The national study to prevent blood exposure in paramedics: rates of exposure to blood. Int Arch 

Occup Environ Health 83:191–199.

CFR. Code of Federal regulations. Washington, DC: U.S. 

Government Printing Office, Office of the Federal Register. 

Leiss JK, Ratcliffe JM, Lyden JT, Sousa S, Orelien JG, Boal 

WL, Jagger J [2006]. Blood exposure among paramedics: 

incidence rates from the national study to prevent blood 

exposure in paramedics. Ann Epidemiol 16(9):720–725. 

Leiss JK, Sousa S, Boal WL [2009]. Circumstances surrounding occupational blood exposure events in the national study to prevent blood exposure in paramedics. Industrial Health 47(2):139–144. 

Mathews R, Leiss JK, Lyden JT, Sousa S, Ratcliffe JM, Jagger J [2008]. Provision and use of personal protective 

equipment and safety devices in the national study to prevent blood exposure in paramedics. Am J Infect Control 

36(10):743–749.

 Train employees about bloodborne pathogens, safe 

work practices, the proper use of safety devices and 

PPE, and other topics required by the Bloodborne 

Pathogens standard [29 CFR* 1910.1030]. Include 

the opportunity for questions and answers with the 

trainer.

 Have a written Exposure Control Plan and update it 

annually. 

 Provide effective medical safety devices and involve 

frontline workers in their selection. 

 Provide appropriate PPE and encourage its use. PPE 

includes gloves; impermeable clothing; face shields 

or surgical face masks and eye protection; and mouthpieces, resuscitation bags, pocket masks, or other ventilation devices.

 Develop effective techniques for extricating patients 

from enclosed places, handling combative or uncooperative patients, and avoiding vomitus.

 Encourage workers to report all blood or body fluid 

exposures. Identify and address any barriers or attitudes that discourage reporting.

 Review exposures to identify patterns and opportunities for prevention. Inform workers of the findings.

 Implement a procedure for post-exposure evaluation 

and follow-up. 

 Offer free hepatitis B virus vaccinations, and encourage workers to get vaccinated.

Paramedics

 Follow Universal/Standard Precautions and other safety 

procedures (see www.cdc.gov/ncidod/dhqp/bp_universal_

precautions.html).

 Attend bloodborne pathogens and other safety training.

 Use appropriate safety devices provided by your employer. 

 Dispose of sharps properly.

 Use appropriate PPE provided by your employer.

 Avoid skin contact with blood, including on the arms.

 Wash skin visibly soiled with body fluids with soap and 

water.

 After skin contact with body fluids, even if skin is not 

visibly soiled, use antimicrobial soap and water or 

alcohol-based sanitizer.

 Report all exposures to blood and other potentially infectious materials to management.

 Get vaccinated against hepatitis B virus.

*Code of Federal Regulations. See CFR in References.
DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

4676 Columbia Parkway

Cincinnati, OH 45226–1998

Official Business

Penalty for Private Use $300

More information about bloodborne pathogens is available on 

the NIOSH Web site at www.cdc.gov/niosh/topics/bbp and 

on the OSHA Web site at www.osha.gov/SLTC/bloodbornepathogens/index.html. 

More information for healthcare workers is available on the 

NIOSH Web site at www.cdc.gov/niosh/topics/healthcare/. 

To receive information about other occupational safety and 

health topics, contact NIOSH at

Telephone: 1–800–CDC–INFO (1–800–232–4636)

TTY: 1–888–232–6348  E-mail: cdcinfo@cdc.gov

or visit the NIOSH Web site at www.cdc.gov/niosh.

For a monthly update on news at NIOSH, subscribe to NIOSH 

eNews by visiting www.cdc.gov/niosh/eNews.

Mention of any company or product does not constitute endorsement by NIOSH. In addition, citations to Web sites external to NIOSH do not constitute NIOSH endorsement of the 

sponsoring organizations or their programs or products. Furthermore, NIOSH is not responsible for the content of these Web 

sites. 

This document is in the public domain and may be 

freely copied or reprinted. NIOSH encourages all 

readers of the Workplace Solutions to make them 

available to all interested employers and workers.

As part of the Centers for Disease Control and Prevention, 

NIOSH is the Federal agency responsible for conducting research and making recommendations to prevent work-related illnesses and injuries. All Workplace Solutions are based on 

research studies that show how worker exposures to hazardous agents or activities can be significantly reduced.

Preventing Exposures to Bloodborne Pathogens 

among Paramedics

DHHS (NIOSH) Publication No. 2010–139

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