Occupational exposure to potentially contaminated material: what to do?

1. Needle stick injury or incision

Clean the damaged area with water and soap

2. Contact with the skin or mucous membranes

Rinse immediately and thoroughly using water or a saline solution

3. Direct contact with injured skin

Clean the affected area with soap and water and disinfect

It is not recommended to apply caustic agents or an injection of antiseptics or disinfectants in wounds

4. The healthcare professional should

Suspend all activity immediately

A blood sample of the patient involved in the accident should be immediately taken, with his/her permission, for HBV, HCV and HIV1 and 2 testing

The injured healthcare professional should go to the emergency department to collect a blood sample, even in the case of an unknown source, taking whenever possible the patient sample duly identified and with relevant clinical information

Report the event to his/her superior

5. Contact the occupational health service

The occupational health service should be contacted as soon as possible for an assessment of the circumstances of the accident and to take the necessary preventive measures

Potential HBV infection

1. Healthcare professional is unvaccinated or the vaccination is in course

Patient HBsAg positive

Hepatitis B immunoglobulin (HBIG) (0.06 ml/kg IM; administered up to 72h after the event)

Start or complement vaccination (accelerated scheme); start within 24h of exposure

Patient HBsAg negative

Start or complement vaccination (accelerated scheme)

Unknown patient

HBIG is optional

Start or complement vaccination (accelerated scheme)

2. Healthcare professional is vaccinated

Antibodies anti-HBs ≥ 10 mIU/ml: no action

Antibodies anti-HBs < 10 mIU/ml

Patient HBsAg positive

No immunological response after two complete vaccinations: HBIG recommended

No immunological response after one vaccination: HBIG must be administered and start revaccination (accelerated scheme)

Patient HBsAg negative

Start revaccination in the case of only one vaccination

Unknown patient

If the event suggests risk of exposure, treat as HBsAg positive

3. Unknown response to vaccine 

Patient HBsAg positive

Antibodies anti-HBs ≥ 10 mIU/ml: no action

Antibodies anti-HBs < 10 mIU/ml: act as non-immunized

Patient HBsAg negative

Antibodies anti-HBs < 10 mIU/ml: act as non-immunized

Unknown patient

Antibodies anti-HBs < 10 mIU/ml: act as non-immunized

Potential HVC infection

There is no effective drug prophylaxis for HCV

Nonetheless, evaluation of antibodies anti-HCV and transaminases is recommended

Potential HIV infection

Post-exposure prophylaxis for HIV should start as early as possible; it is more effective if administered within the first 2h after exposure

During the first 6-12 weeks the healthcare professional should:

Use condoms or not have sex to prevent potential sexual transmission and pregnancy

Do not donate blood, tissues or sperm

Suspend breastfeeding

Three (or more) tolerable antiretroviral agents should be administered for all occupational exposures to HIV

Prophylactic treatment is not indicated for an unknown patient, unless the accident circumstances suggest high risk

Source: Adapted from Administração Regional de Saúde do Centro “Exposição acidental a material potencialmente contaminado protocolo de atuação”.