Risk assessment – health care workers

Risk assessment is a key part of the ED clinician’s role and determines subsequent management.

Is the fluid involved significant?

Significant fluids are:

• Blood
• Internal body fluids
• Semen
• Vaginal secretions
• Saliva (dentists)

NOT urine or faeces.

Was the nature of the exposure significant?

Incidents considered to be significant include:

• Percutaneous injury from anything that breaks the skin ie. needles, instruments, bone fragments, bites.
• Splash exposure to broken skin, abrasions, wounds, eczema etc.
• Splash exposure to mucous membranes, most commonly the eye.

Four factors are associated with an increased risk of occupationally acquired HIV infection after needlestick injury (5).

• Deep injury.
• Visible blood on the device involved.
• Injury from a needle that has entered the source’s blood vessel.
• Terminal HIV-related illness in the source.

There is insufficient evidence to suggest double – gloving for procedures reduces the risk of sharps injury (6).

Is the source high risk?

Does the source patient have any previous results for HIV, hepatitis C, or hepatitis B?

The following factors would place the source in a high risk category:

• Intravenous drug user.
• Sex industry worker.
• Originally from sub-Saharan Africa.
• Regularly has unprotected sex with any of the above.
• If the source is a child, they are high risk if their mother has HIV.
• The source has, or is under investigation for, an AIDS defining illness.

If the source patient is unknown, then the usual approach is to assume a low risk exposure.

Learning bite

Risk assessment must take into account both the nature of the exposure and the risk profile of the source patient.

References

Cardo DM, Culver DH, Ciesielski CA, et al. A Case–Control Study of HIV Seroconversion in Health Care Workers after Percutaneous Exposure. N Engl J Med 1997; 337(21):1485-1490.

Tort S and Burch J. Do gloves, extra gloves, or special types of gloves help prevent percutaneous exposure injuries among healthcare personnel. Cochrane Clinical Answers 2020.