Occupational Exposure to Blood or Body Fluids

Millions of people in the United States are infected with bloodborne pathogens. As of the end of 2012, 1.2 million people age 13 or over had HIV infection; an estimated 13% had not been diagnosed (CDC “HIV/AIDS”). Roughly 800,000 to 1.4 million people have chronic HBV infection. In 2011, an estimated 18,800 people were newly infected with HBV. (Schillie et al.) About 3.5 million people in the United States have chronic HCV infection. CDC estimates that about 30,000 cases of acute HCV infection occurred in 2013. (CDC “Hepatitis C”)

In the event of exposure to body fluids infected with bloodborne pathogens, the risk of transmission depends on many factors, such as the exposure route, the type and quantity of potentially infectious body fluid involved, the concentration of infectious virus particles in the body fluid, the bloodborne pathogens that are present, and the exposed person’s immunity status (if applicable).

HIV. For healthcare personnel, the risk of acquiring HIV infection on the job is remote. The average risk of occupational HIV transmission is 0.3% after percutaneous exposure to HIV-infected blood and 0.09% after mucous membrane exposure. Although HIV transmission after exposure to nonintact skin has been documented but not quantified, such exposures are believed to pose a lower risk than mucous membrane exposures. The risk of transmission posed by exposure to fluids or tissues other than blood is believed to be much lower than the risk for blood exposures. (Kuhar et al.) Antiretroviral agents currently used to treat HIV-positive patients often lower the viral load of the patient, in turn reducing the risk of transmission to others (Trossman).

State health departments, with help from CDC, investigate cases of HIV infection among healthcare workers that may have been occupationally acquired. A case is classified as "confirmed" if it is related to a specific exposure to a known HIV-positive source, and a case is classified as "possible" if no specific workplace exposure was documented. From 1985 to 2013, 58 confirmed cases and 150 possible cases of occupationally acquired HIV infection were reported to CDC. But notably, only one of the confirmed cases has occurred since 1999. (Joyce et al.)

Among the 58 confirmed cases, the routes of exposure were as follows:

The body fluid was blood in 49 cases, concentrated virus in a laboratory in 4 cases, visibly bloody fluid in 1 case, and an unspecified fluid in 4 cases. Nurses, clinical laboratory workers, and nonsurgical physicians accounted for the highest number of documented cases, but cases were reported among nonclinical workers (e.g., housekeepers, maintenance workers) as well. (Joyce...