Health protection – guidance

Bloodborne viruses in healthcare workers: report exposures and reduce risks

Monitoring significant occupational exposures to HIV, hepatitis B and hepatitis C in healthcare workers, and advising on avoiding injuries.

PHE’s Health Protection Services monitors significant occupational exposures to HIV, hepatitis B and hepatitis C among healthcare workers and those working within the healthcare settings.

This guide explains how:

NHS Trusts and healthcare providers can provide voluntary confidential reports of significant occupational exposures
healthcare workers can reduce the risk of exposure to bloodborne viruses (BBVs) at work

Every report is important. To find out about the surveillance scheme, and how to become a reporting site, contact significant.exposures@phe.gov.uk.

Exposure risks to healthcare workers

Healthcare workers are potentailly exposed to BBVs while they work via:

percutaneous routes, where a sharp object cuts or penetrates the skin
mucocutaneous routes, which include contamination of the nose, eyes, broken skin or mouth

Healthcare workers include:

clinical staff who have regular clinical contact with patients
laboratory staff who have direct contact with potentially infectious clinical specimens
non-clinical support staff who may have contact with patients, but not usually of a prolonged or close nature

The risk of a BBV being transmitted depends on:

the viral load in the infected source patient
the depth of the injury
whether the procedure involved placing a needle in a patient’s vein or artery

Significant exposures

A significant exposure is a percutaneous or mucocutaneous exposure to blood or other body fluids from a source patient who is infected with:

HIV
hepatitis B surface antigen positive (HBsAg positive)
hepatitis C

Data collection

Health Protection Services needs your help to record all cases of significant occupational exposures.

The reporting process is voluntary and in strict medical confidence.

We monitor the numbers of healthcare workers exposed to viruses at work, and need as much detailed data as possible including:

the circumstances of the significant occupational exposure
the management of the exposure
outcomes, including whether the healthcare worker acquired a BBV

We also look for any incidents where the healthcare worker has started post exposure prophylaxis (PEP) for HIV, regardless of the HIV status of the source patient.

We accept reports from hospitals in England, Wales, and Northern Ireland. Reporting sites and reporters include:

occupational health departments
genitourinary medicine clinics
microbiologists
virologists
infection control nurses

Submit an exposure report: voluntary and confidential

Complete the initial report form around the time of the exposure incident, including the Unique Incident Identifier (UII).
Send the initial report form to PHE’s Health Protection Services, Centre for Infectious Disease Surveillance and Control using the pre-paid address label provided.
Keep a copy for the reporting site’s records.

The UII protects the anonymity of the healthcare worker involved, but allows the submitting site to relocate details of the incident and person involved. If Health Protection Services require further information about a particular incident we will refer to cases only by the UII.

See an example of Occupational exposure to bloodborne viruses: initial report form.

On receiving an initial report form, we request additional information 6 weeks and 6 months after the exposure. This information includes:

clinical management of exposures, including whether the health care worker received post exposure prophylaxis (PEP)
side effects of PEP
outcomes

Epidemiology

Eye of the needle is the PHE report on significant occupational exposures to bloodborne viruses in healthcare workers: includes a slideset on significant occupational exposures.

HIV

HIV: surveillance, data and management

HIV post-exposure prophylaxis: guidance from the UK Chief Medical Officers’ Expert Advisory Group on AIDS, DH, 2008.

HIV-infected health care workers: guidance on management and patient notification, DH 2005.

HIV-infected healthcare workers and exposure prone procedures

Hepatitis B

Hepatitis B: guidance data and analysis

See Immunisation against infectious diseases: the green book on vaccination against hepatitis B and immunisation of healthcare and laboratory staff.

Hepatitis B infected healthcare workers and antiviral therapy DH, 2007.

Hepatitis C

HSC 2002/010 - Health service circular and guidance on hepatitis C infected health care workers DH, 2002.

Guidance on the investigation and management of occupational exposure to hepatitis C, CDPH, 1999

Management of bloodborne viruses in healthcare workers

UK Advisory Panel for healthcare workers infected with bloodborne viruses gives advice about transmission and management of BBVs in healthcare workers, and keeps a confidential register of infected workers.

Good practice guidelines for renal dialysis/transplantation units: prevention and control of blood-borne virus infection DH, September 2002.

Guidance for clinical healthcare workers: protection against infection with bloodborne viruses DH, March 1998

Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: new healthcare workers DH, March 2007

RIDDOR: Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 from HSE.

Medical and dental students: health clearance for hepatitis B, hepatitis C, HIV and tuberculosis from Medical Schools Council, 2008.

Raising awareness of needlestick injuries in healthcare settings