Information from the

Centers for Disease Control and Prevention

National Center for Infectious Diseases

Divison of Healthcare Quality Promotion and

Division of Viral Hepatitis

For additional brochures contact:

The Public Health Foundation

877-252-1200 (toll free)

or http://bookstore.phf.org

Exposure

to

Blood

What Healthcare

Personnel Need to 

Know

Department of Health & Human Services
Cover Photo: Human Red Blood Cells,

Copyright Dennis Kunkel, University of Hawaii

OTHER SOURCES OF INFORMATION

HBV and HCV

For additional information about hepatitis B and hepatitis C, call the hepatitis 

information line at 1-888-4-HEPCDC (1-888–443-7232) or visit CDC’s hepatitis 

website at www.cdc.gov/hepatitis. 

Any reaction or adverse health event after getting hepatitis B vaccine sould be 

reported to your healthcare provider. The Vaccine Adverse Event Reporting 

System (1-800-822-7967) receives reports from healthcare providers and others 

about vaccine side effects.

HIV

Information specialists who staff the CDC National AIDS Hotline (1-800-

342-2437) can answer questions or provide information on HIV infection and 

AIDS and the resources available in your area. The HIV/AIDS Treatment 

Information Service (1-800-448-0440) can also be contacted for information on 

the clinical treatment of HIV/AIDS. For free copies of printed material on 

HIV infection and AIDS, please call or write the CDC National Prevention 

Information Network, P.O. Box 6003, Rockville, MD 20849-6003, telephone 

1-800-458-5231, Internet address www.cdcnpin.org. Additional information 

about occupational exposures to bloodborne pathogens is available on CDC’s 

Division of Healthcare Quality Promotion’s website at www.cdc.gov/ncidod/hip 

or by calling 1-800-893-0485 and on CDC’s National Institute of Occupational 

Safety and Health’s website at www.cdc.gov/niosh or call 1-800-35 NIOSH

(1-800-356-4674).

HBV-HCV-HIV

PEPline (the National Clinicians’ Postexposure Prophylaxis Hotline) is a 24-

hour, 7-day-a-week consultation service for clinicians managing occupational 

exposures. This service is supported by the Health Resources and Services 

Administration Ryan White CARE Act and the AIDS Education and Training 

Centers and CDC. PEPline can be contacted by phone at (888) 448-4911 (toll 

free) or on the Internet at http://pepline.ucsf.edu/pepline.
1

Exposure to Blood

What Healthcare Personnel Need to Know

OCCUPATIONAL EXPOSURES TO BLOOD

Introduction

Healthcare personnel are at risk for occupational exposure to bloodborne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human 

immunodefi ciency virus (HIV). Exposures occur through needlesticks or cuts 

from other sharp instruments contaminated with an infected patient's blood or 

through contact of the eye, nose, mouth, or skin with a patient's blood. Important 

factors that infl uence the overall risk for occupational exposures to bloodborne 

pathogens include the number of infected individuals in the patient population 

and the type and number of blood contacts. Most exposures do not result in 

infection. Following a specifi c exposure, the risk of infection may vary with 

factors such as these:

  The pathogen involved

  The type of exposure

  The amount of blood involved in the exposure

  The amount of virus in the patient's blood at the time of exposure

Your employer should have in place a system for reporting exposures in order to 

quickly evaluate the risk of infection, inform you about treatments available to 

help prevent infection, monitor you for side effects of treatments, and determine 

if infection occurs. This may involve testing your blood and that of the source 

patient and offering appropriate postexposure treatment.

How can occupational exposures be prevented?

Many needlesticks and other cuts can be prevented by using safer techniques 

(for example, not recapping needles by hand), disposing of used needles in 

appropriate sharps disposal containers, and using medical devices with safety 

features designed to prevent injuries. Using appropriate barriers such as gloves, 

eye and face protection, or gowns when contact with blood is expected can 

prevent many exposures to the eyes, nose, mouth, or skin.
2

IF AN EXPOSURE OCCURS

What should I do if I am exposed to the blood of a patient?

1. Immediately following an exposure to blood:

  Wash needlesticks and cuts with soap and water

  Flush splashes to the nose, mouth, or skin with water

  Irrigate eyes with clean water, saline, or sterile irrigants 

No scientifi c evidence shows that using antiseptics or squeezing the wound will 

reduce the risk of transmission of a bloodborne pathogen. Using a caustic agent 

such as bleach is not recommended.

2. Report the exposure to the department (e.g., occupational health, infection control) responsible for managing exposures. Prompt reporting is essential 

because, in some cases, postexposure treatment may be recommended and it 

should be started as soon as possible. Discuss the possible risks of acquiring 

HBV, HCV, and HIV and the need for postexposure treatment with the provider 

managing your exposure. You should have already received hepatitis B vaccine, 

which is extremely safe and effective in preventing HBV infection.

RISK OF INFECTION AFTER EXPOSURE

What is the risk of infection after an occupational exposure?

HBV

Healthcare personnel who have received hepatitis B vaccine and developed 

immunity to the virus are at virtually no risk for infection. For a susceptible 

person, the risk from a single needlestick or cut exposure to HBV-infected blood 

ranges from 6-30% and depends on the hepatitis B e antigen (HBeAg) status of 

the source individual. Hepatitis B surface antigen (HBsAg)-positive individuals who are HBeAg positive have more virus in their blood and are more likely 

to transmit HBV than those who are HBeAg negative. While there is a risk for 

HBV infection from exposures of mucous membranes or nonintact skin, there is 

no known risk for HBV infection from exposure to intact skin.
3

HCV

The average risk for infection after a needlestick or cut exposure to HCVinfected blood is approximately 1.8%. The risk following a blood exposure 

to the eye, nose or mouth is unknown, but is believed to be very small; 

however, HCV infection from blood splash to the eye has been reported. 

There also has been a report of HCV transmission that may have resulted 

from exposure to nonintact skin, but no known risk from exposure to intact skin.

HIV 

  The average risk of HIV infection after a needlestick or cut 

 exposure to HlV-infected blood is 0.3% (i.e., three-tenths of one 

 percent, or about 1 in 300). Stated another way, 99.7% of 

 needlestick/cut exposures do not lead to infection.

  The risk after exposure of the eye, nose, or mouth to HIV-infected 

 blood is estimated to be, on average, 0.1% (1 in 1,000).

  The risk after exposure of non-intact skin to HlV-infected blood is 

estimated to be less than 0.1%. A small amount of blood on intact skin 

probably poses no risk at all. There have been no documented cases of 

HIV transmission due to an exposure involving a small amount of blood 

on intact skin (a few drops of blood on skin for a short period of time).

How many healthcare personnel have been infected with bloodborne pathogens?

HBV

The annual number of occupational infections has decreased 95% since hepatitis 

B vaccine became available in 1982, from >10,000 in 1983 to <400 in 2001 

(CDC, unpublished data).

HCV

There are no exact estimates on the number of healthcare personnel occupationally infected with HCV. However, studies have shown that 1% of hospital 

healthcare personnel have evidence of HCV infection (about 3% of the U.S. 

population has evidence of infection). The number of these workers who may 

have been infected through an occupational exposure is unknown.

HIV
4

As of December 2001, CDC had received reports of 57 documented cases and 

138 possible cases of occupationally acquired HIV infection among healthcare 

personnel in the United States since reporting began in 1985. 

TREATMENT FOR THE EXPOSURE 

Is vaccine or treatment available to prevent infections with bloodborne pathogens?

HBV

 As mentioned above, hepatitis B vaccine has been available since 1982 to prevent HBV infection. All healthcare personnel who have a reasonable chance of 

exposure to blood or body fl uids should receive hepatitis B vaccine. Vaccination 

ideally should occur during the healthcare worker’s training period. Workers 

should be tested 1-2 months after the vaccine series is complete to make sure 

that vaccination has provided immunity to HBV infection. Hepatitis B immune 

globulin (HBIG) alone or in combination with vaccine (if not previously vaccinated) is effective in preventing HBV infection after an exposure. The decision 

to begin treatment is based on several factors, such as:

  Whether the source individual is positive for hepatitis B surface 

 antigen

  Whether you have been vaccinated

  Whether the vaccine provided you immunity

HCV

There is no vaccine against hepatitis C and no treatment after an exposure that 

will prevent infection. Neither immune globulin nor antiviral therapy is recommended after exposure. For these reasons, following recommended infection 

control practices to prevent percutaneous injuries is imperative.

HIV

There is no vaccine against HIV. However, results from a small number of studies suggest that the use of some antiretroviral drugs after certain occupational 

exposures may reduce the chance of HIV transmission. Postexposure prophylaxis (PEP) is recommended for certain occupational exposures that pose a risk 

of transmission. However, for those exposures without risk of HIV infection, 

PEP is not recommended because the drugs used to prevent infection may have 

serious side effects. You should discuss the risks and side effects with your 

healthcare provider before starting PEP for HIV.

How are exposures to blood from an individual whose infection 
5

status is unknown handled? 

HBV–HCV–HIV

If the source individual cannot be identifi ed or tested, decisions regarding 

follow-up should be based on the exposure risk and whether the source is 

likely to be infected with a bloodborne pathogen. Follow-up testing should be 

available to all personnel who are concerned about possible infection through 

occupational exposure.

What specifi c drugs are recommended for postexposure treatment?

HBV

If you have not been vaccinated, then hepatitis B vaccination is recommended 

for any exposure regardless of the source person’s HBV status. HBIG and/or 

hepatitis B vaccine may be recommended depending on the source person’s 

infection status, your vaccination status and, if vaccinated, your response to the 

vaccine.

HCV

There is no postexposure treatment that will prevent HCV infection. 

HIV

The Public Health Service recommends a 4-week course of a combination of 

either two antiretroviral drugs for most HIV exposures, or three antiretroviral 

drugs for exposures that may pose a greater risk for transmitting HIV (such as 

those involving a larger volume of blood with a larger amount of HIV or a 

concern about drug-resistant HIV). Differences in side effects associated with 

the use of these drugs may infl uence which drugs are selected in a specifi c 

situation. These recommendations are intended to provide guidance to clinicians 

and may be modifi ed on a case-by-case basis. Determining which drugs and 

how many drugs to use or when to change a treatment regimen is largely a matter 

of judgment. Whenever possible, consulting an expert with experience in the use 

of antiviral drugs is advised, especially if a recommended drug is not available, 

if the source patient's virus is likely to be resistant to one or more recommended 

drugs, or if the drugs are poorly tolerated.

How soon after exposure to a bloodborne pathogen should 

treatment start?

HBV

Postexposure treatment should begin as soon as possible after exposure, preferably within 24 hours, and no later than 7 days.
6

HIV

Treatment should be started as soon as possible, preferably within hours as 

opposed to days, after the exposure. Although animal studies suggest that 

treatment is less effective when started more than 24-36 hours after exposure, the 

time frame after which no benefi t is gained in humans is not known. Starting 

treatment after a longer period (e.g., 1 week) may be considered for exposures 

that represent an increased risk of transmission.

Has the FDA approved these drugs to prevent bloodborne virus 

infection following an occupational exposure?

HBV

Yes. Both hepatitis B vaccine and HBIG are approved for this use.

HIV

No. The FDA has approved these drugs only for the treatment of existing HIV 

infection, but not as a treatment to prevent infection. However, physicians may 

prescribe any approved drug when, in their professional judgment, the use of 

the drug is warranted.

What is known about the safety and side effects of these drugs?

HBV

Hepatitis B vaccine and HBIG are very safe. There is no information that the 

vaccine causes any chronic illnesses. Most illnesses reported after a hepatitis 

B vaccination are related to other causes and not the vaccine. However, you 

should report to your healthcare provider any unusual reaction after a hepatitis 

B vaccination. 

HIV

All of the antiviral drugs for treatment of HIV have been associated with 

side effects. The most common side effects include upset stomach (nausea, 

vomiting, diarrhea), tiredness, or headache. The few serious side effects that 

have been reported in healthcare personnel using combinations of antiviral drugs 

after exposure have included kidney stones, hepatitis, and suppressed blood 

cell production. Protease inhibitors (e.g., indinavir and nelfi navir) may interact 

with other medicines and cause serious side effects and should not be taken in 

combination with certain other drugs, such as non-sedating antihistamines, e.g., 

Claritin®. If you need to take antiviral drugs for an HIV exposure, it is important 

to tell the healthcare provider managing your exposure about any medications 

you are currently taking.
7

Can pregnant healthcare personnel take the drugs recommended 

for postexposure treatment?

HBV

Yes. Women who are pregnant or breast-feeding can receive the hepatitis B 

vaccine and/or HBIG. Pregnant women who are exposed to blood should be 

vaccinated against HBV infection, because infection during pregnancy can cause 

severe illness in the mother and a chronic infection in the newborn. The vaccine 

does not harm the fetus.

HIV

Pregnancy should not rule out the use of postexposure treatment when it is 

warranted. If you are pregnant you should understand what is known and not 

known regarding the potential benefi ts and risks associated with the use of antiviral drugs in order to make an informed decision about treatment. 

FOLLOW-UP AFTER AN EXPOSURE

What follow-up should be done after an exposure?

HBV

Because postexposure treatment is highly effective in preventing HBV infection, 

CDC does not recommend routine follow-up after treatment. However, any 

symptoms suggesting hepatitis (e.g., yellow eyes or skin, loss of appetite, 

nausea, vomiting, fever, stomach or joint pain, extreme tiredness) should be 

reported to your healthcare provider. If you receive hepatitis B vaccine, you 

should be tested 1-2 months after completing the vaccine series to determine if 

you have responded to the vaccine and are protected against HBV infection.

HCV

You should be tested for HCV antibody and liver enzyme levels (alanine aminotransferase or ALT) as soon as possible after the exposure (baseline) and at 4-6 

months after the exposure. To check for infection earlier, you can be tested for 

the virus (HCV RNA) 4-6 weeks after the exposure. Report any symptoms suggesting hepatitis (mentioned above) to your healthcare provider. 
8

HIV

You should be tested for HIV antibody as soon as possible after exposure (baseline) and periodically for at least 6 months after the exposure (e.g., at 6 weeks, 

12 weeks, and 6 months). If you take antiviral drugs for postexposure treatment, 

you should be checked for drug toxicity by having a complete blood count and 

kidney and liver function tests just before starting treatment and 2 weeks after 

starting treatment. You should report any sudden or severe fl u-like illness that 

occurs during the follow-up period, especially if it involves fever, rash, muscle 

aches, tiredness, malaise, or swollen glands. Any of these may suggest HIV 

infection, drug reaction, or other medical conditions. You should contact the 

healthcare provider managing your exposure if you have any questions or problems during the follow-up period.

What precautions should be taken during the follow-up period?

HBV

If you are exposed to HBV and receive postexposure treatment, it is unlikely 

that you will become infected and pass the infection on to others. No precautions 

are recommended.

HCV

Because the risk of becoming infected and passing the infection on to others 

after an exposure to HCV is low, no precautions are recommended.

HIV

During the follow-up period, especially the fi rst 6-12 weeks when most infected 

persons are expected to show signs of infection, you should follow recommendations for preventing transmission of HIV. These include not donating blood, 

semen, or organs and not having sexual intercourse. If you choose to have 

sexual intercourse, using a condom consistently and correctly may reduce the 

risk of HIV transmission. In addition, women should consider not breast-feeding infants during the follow-up period to prevent the possibility of exposing 

their infants to HIV that may be in breast milk.

PREVENTION OF OCCUPATIONAL INFECTIONS WITH HBV, HCV, 

OR HIV

Hepatitis B virus is largely preventable through vaccination. For HBV, HCV, 

and HIV, however, preventing occupational exposures to blood can prevent 

occupational infections with HBV, HCV, and HIV. This includes using appropriate barriers such as gown, gloves and eye protection as appropriate, safely 

handling needles and other sharp instruments, and using devices with safety 

features.