What Is the Most Common Risk of Exposure to Bloodborne Pathogens for Healthcare Workers?

Needlesticks and other sharps injuries are a major risk of occupational exposure to bloodborne pathogens for healthcare workers. These percutaneous injuries can expose workers to infected blood when a contaminated needle, scalpel, or other sharp object punctures or cuts the skin.

In this blog, we'll look at how occupational exposure happens in healthcare facilities, why needlesticks and sharps injuries are a significant concern, which workers may be at risk, and how healthcare organizations and employees can help prevent exposure.

How Are Healthcare Workers Exposed to Bloodborne Pathogens?

Healthcare workers can encounter blood and OPIM while performing routine patient-care activities. According to the CDC, occupational exposures can include percutaneous injuries, such as needlesticks, as well as splashes or sprays that expose mucous membranes or non-intact skin to potential pathogens.

Common healthcare exposure scenarios include:

• Needlesticks involving used needles
• Cuts or punctures from contaminated scalpels and other sharps
• Blood or body fluid splashes to the eyes, nose, or mouth
• Contact between blood or OPIM and cuts, abrasions, dermatitis, or other non-intact skin
• Handling contaminated equipment or instruments
• Improper handling or disposal of used sharps

Healthcare employees whose duties involve reasonably anticipated occupational exposure need to understand these risks and the precautions required for their jobs. Appropriate bloodborne pathogens training for healthcare workers can help employees recognize exposure hazards and understand workplace prevention procedures.

Needlestick and Sharps Injuries

A needlestick occurs when a needle punctures a worker's skin. However, needles aren't the only concern. Contaminated scalpels, broken glass, exposed dental wires, broken capillary tubes, and other objects capable of penetrating the skin can also create a sharps exposure.

These are known as percutaneous exposures because the contaminated object penetrates the skin. When the sharp is contaminated with infected blood, the injury may provide a direct route for a bloodborne pathogen to enter the worker's body.

The CDC estimates that approximately 385,000 needlesticks and other sharps-related injuries occur each year among hospital-based healthcare personnel. Similar injuries also occur in nursing homes, clinics, emergency medical services, home healthcare, and other healthcare environments.

Blood or Body Fluid Splashes

Not every occupational exposure involves a puncture wound. Blood or OPIM can also reach the mucous membranes of a healthcare worker's eyes, nose, or mouth. Splashes and sprays can occur during procedures, emergency treatment, surgery, laboratory work, specimen handling, and other activities involving blood or body fluids.

The risk of infection following a mucous membrane exposure varies based on factors such as the pathogen, the material involved, and the nature of the exposure. Appropriate eye and face protection can help prevent these exposures when splashes or sprays are reasonably anticipated.

Contact With Non-Intact Skin

Blood or OPIM may also create an exposure risk when it contacts non-intact skin.

Cuts, abrasions, dermatitis, and other breaks in the skin can compromise the body's normal protective barrier. Healthcare workers should therefore protect areas of non-intact skin from anticipated contact with blood or potentially infectious materials and follow appropriate workplace procedures.

Contact with healthy, intact skin is not classified the same way as an exposure involving non-intact skin. OSHA defines an exposure incident as specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or OPIM resulting from an employee's duties.

Why Are Needlestick Injuries a Major Exposure Risk?

Needlesticks and other sharps injuries are particularly important because they can introduce contaminated blood through the skin. Hollow-bore needles can present particular concerns because blood may remain inside the needle after use.

A sharps injury can happen at multiple points during patient care, not just while a needle is being inserted. OSHA notes that studies have found that as many as one-third of hospital sharps injuries occur during sharps disposal.

Common scenarios that may lead to a needlestick or other sharps injury include:

• Administering injections or drawing blood
• Starting or removing intravenous lines
• Performing surgical or other invasive procedures
• Passing or manipulating sharps during procedures
• Handling needles or sharps after use
• Improperly recapping contaminated needles
• Disassembling or manipulating equipment containing sharps
• Cleaning up after procedures
• Placing used sharps into disposal containers
• Encountering improperly discarded needles or other sharps
• Handling overfilled or improperly positioned sharps containers

These injuries are not limited to hospitals. CDC notes that sharps-related injuries also occur in clinics, nursing homes, emergency care services, private homes, and other healthcare settings.

Which Healthcare Workers Face Bloodborne Pathogen Exposure?

Bloodborne pathogen exposure isn't limited to doctors and nurses. OSHA requirements are based on whether an employee has reasonably anticipated occupational exposure to blood or OPIM as a result of performing their job duties.

Depending on their responsibilities, healthcare workers who may experience occupational exposure include:

• Nurses and nursing assistants
• Physicians and surgeons
• Phlebotomists
• Emergency medical technicians and paramedics
• Dentists, dental hygienists, and dental assistants
• Surgical and operating room personnel
• Laboratory workers
• Dialysis personnel
• Home healthcare workers
• Hospice and long-term care employees
• Medical technicians
• Environmental services and housekeeping employees
• Sterile processing personnel
• Employees who handle medical waste or contaminated laundry

Risk varies considerably among roles and tasks. A worker who routinely draws blood or uses sharps will have different exposure scenarios than an environmental services employee who could encounter improperly discarded sharps or contaminated materials.

Healthcare employers should therefore evaluate job classifications and tasks to determine which employees have occupational exposure rather than assuming that every employee in a healthcare facility has the same level of risk.

How Can Healthcare Workers Prevent Bloodborne Pathogen Exposure?

Protecting healthcare workers from exposure to bloodborne pathogens requires multiple layers of protection. Healthcare facilities should prioritize strategies that eliminate or minimize environmental exposure rather than relying exclusively on workers to avoid injuries.

Important prevention measures include:

• Using safer needle and sharps devices
• Disposing of contaminated sharps promptly in appropriate containers
• Following safe injection and sharps-handling practices
• Wearing PPE appropriate to the anticipated exposure
• Following Standard Precautions during patient care
• Practicing proper hand hygiene
• Using engineering and work practice controls
• Following the facility's Exposure Control Plan
• Reporting safety hazards and sharps injuries
• Completing required bloodborne pathogen training

Use Safer Sharps Practices

Safe handling starts before a sharp is used and continues through its disposal.

Healthcare workers should use safety-engineered devices as intended, activate safety features when applicable, and dispose of contaminated sharps immediately or as soon as feasible in appropriate sharps containers.

Contaminated needles generally should not be bent, recapped, or removed. OSHA permits these actions only under limited circumstances, such as when no feasible alternative exists or a specific medical or dental procedure requires it. When permitted, the procedure must use a mechanical device or one-handed technique. Sharps containers should also be easily accessible and located as close as feasible to where sharps are used or likely to be found.

Wear Appropriate PPE

Personal protective equipment provides an important barrier against anticipated exposure to blood and other potentially infectious materials.

The appropriate PPE depends on the task and expected exposure. It may include:

• Gloves
• Gowns or other protective clothing
• Masks
• Goggles
• Face shields

CDC recommends gloves when contact with blood, OPIM, mucous membranes, non-intact skin, or contaminated equipment can reasonably be anticipated. Protective eyewear with a mask or a face shield should be used during activities likely to generate splashes or sprays that could reach the eyes, nose, or mouth.

PPE does not replace safer equipment and work practices. OSHA requires engineering and work practice controls to be used to eliminate or minimize employee exposure, with appropriate PPE used when occupational exposure remains.

Follow Standard Precautions

The CDC's Standard Precautions apply to all patient care and are based on assessing the potential for exposure to infectious materials.

Standard Precautions include practices such as:

• Hand hygiene
• Appropriate use of PPE
• Safe injection practices
• Proper handling of needles and sharps
• Appropriate cleaning and disinfection of equipment and the environment
• Safe handling of potentially contaminated textiles and laundry

Healthcare workers should follow these precautions regardless of whether a patient is known to have a bloodborne infection. A person's infection status may be unknown, so prevention practices should not depend on assumptions about individual patients.

OSHA's Bloodborne Pathogens Standard separately uses the term Universal Precautions, which requires human blood and certain body fluids to be treated as though they are known to be infectious for HIV, HBV, and other bloodborne pathogens.

Use Engineering and Work Practice Controls

Engineering controls isolate or remove hazards from the workplace. In healthcare environments, examples include:

• Needleless systems
• Self-sheathing needles
• Sharps with engineered sharps injury protections
• Accessible sharps disposal containers

Work practice controls reduce exposure by changing how employees perform tasks. Examples include proper sharps disposal and avoiding prohibited two-handed needle recapping.

OSHA requires engineering and work practice controls to be used to eliminate or minimize occupational exposure. Employers with employees exposed to contaminated sharps must also consider and implement appropriate, commercially available, safer medical devices.

What Should Healthcare Workers Do After an Exposure?

A needlestick, sharps injury, or other potential bloodborne pathogen exposure should be addressed promptly. The appropriate medical response depends on the type of exposure and the pathogen involved.

Healthcare workers should:

1. Clean the exposed area immediately. Wash needlesticks and cuts with soap and water. Flush splashes to the nose, mouth, or skin with water. Irrigate the eyes with clean water, saline, or an appropriate sterile irrigant.
2. Report the exposure immediately. Notify the supervisor or department responsible for managing occupational exposures according to the facility's procedures.
3. Obtain prompt medical evaluation. A qualified healthcare professional should evaluate the exposure and determine what testing, treatment, or follow-up may be appropriate.
4. Provide information about the exposure. Details about how the incident occurred and the material involved can help with evaluating risk. Evaluation of the source individual may also be appropriate when permitted and required under applicable procedures and law.
5. Follow recommended post-exposure care. Management differs depending on the pathogen and circumstances. HIV post-exposure prophylaxis may be recommended after certain exposures, while HCV exposures involve testing and follow-up rather than routine PEP.
6. Complete required follow-up. Follow the medical provider's recommendations for subsequent testing, counseling, treatment, or other care.

Workers should not delay reporting while trying to determine for themselves whether an exposure is serious. OSHA requires covered employers to make confidential medical evaluation and follow-up immediately available at no cost following a reported exposure incident.

OSHA Bloodborne Pathogens Standard and Requirements for Occupational Exposure in Healthcare

OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030 , establishes safeguards for employees who have reasonably anticipated occupational exposure to blood or OPIM.

Depending on applicability, employer responsibilities include:

• Determining which job classifications and tasks involve occupational exposure
• Developing and maintaining a written Exposure Control Plan
• Following Universal Precautions
• Using engineering and work practice controls to eliminate or minimize exposure
• Providing appropriate PPE at no cost to employees
• Making hepatitis B vaccination available to eligible employees at no cost as required
• Providing post-exposure evaluation and follow-up
• Providing required employee training
• Maintaining applicable records, including required sharps injury records

The Needlestick Safety and Prevention Act led OSHA to revise its Bloodborne Pathogens Standard to make requirements concerning safer medical devices more explicit. Among other provisions, employers with employees exposed to contaminated sharps must document consideration and implementation of appropriate safer devices and obtain input from non-managerial employees responsible for direct patient care who may experience sharps injuries.

Employers and workers can review OSHA's bloodborne pathogens standards for regulatory information and our guide to bloodborne pathogens training requirements for a closer look at training obligations.

Which Bloodborne Pathogens Are Healthcare Workers Most Concerned About?

Three of the major bloodborne pathogens of occupational concern are:

• Hepatitis B virus (HBV) : Causes hepatitis B and can lead to acute or chronic liver disease and even liver cancer. An effective vaccine is available.
• Hepatitis C virus (HCV) : Causes hepatitis C and can lead to chronic liver disease or liver cancer. There is currently no HCV vaccine.
• Human immunodeficiency virus (HIV) : Attacks the immune system and can progress to AIDS without treatment.

Needlesticks and other sharps injuries have been associated with occupational transmission of all three. However, the likelihood of infection after an exposure differs substantially by pathogen, exposure route, source, vaccination or immune status, and other circumstances.

HBV, HCV, and HIV aren't the only infectious agents capable of transmission through blood. You can learn more about the most common bloodborne pathogens and the health risks associated with them in this related blog.

Protect Healthcare Workers From Exposure to Bloodborne Pathogens

Preventing bloodborne pathogen exposure requires both individual safety practices and organizational controls. Healthcare workers need appropriate training, PPE, safer equipment, clear procedures, and a way to promptly report and receive care for exposure incidents.

Healthcare organizations also have an important role in identifying hazards, implementing effective engineering and work practice controls, reviewing their Exposure Control Plans, involving frontline employees in selecting safer sharps devices where required, and ensuring workers understand the procedures that apply to their jobs.

For healthcare professionals who need training on bloodborne pathogens as well as patient privacy and security, 360training offers HIPAA and OSHA bloodborne pathogens training for healthcare workers . Build your understanding of occupational exposure risks and the practices used to help keep healthcare workers safer on the job by registering for a bloodborne pathogens course on our site today.