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What to do Next…

EMT first responder performing CPR

Your guide for the next 6 to 12 months after an exposure to potential blood borne infections.

An Anxious Time

Bloor borne pathogens are infectious viruses present in the blood that can cause disease in humans. These pathogens include:

People exposed to blood borne pathogens are at a possible risk for getting these infections. Risks include:

  • Puncture wounds from contaminated needle or other sharp object.
  • Splash and or ingestion in the mouth.
  • Splash into the eyes.
  • Human bite breaking the skin.
  • Prolonged skin exposure when skin is in poor condition (open wounds, cuts and cracked hands).

This page was developed to help guide you through the 6 to 12 months after an exposure.

My Risks

According to Ontario Hospital Association and Ontario Medical Association’s Blood-Borne Diseases Surveillance Protocol for Ontario Hospitals (2016), Hepatitis B is transmitted much more easily than HIV.  They estimate that after a needle-stick injury from a needle contaminated with Hepatitis B, there is a 6 to 30% chance that the exposed person will be infected. They also estimate that in a similar situation with HIV, there is about a 0.3% chance of infection. Getting Hepatitis C infection after a workplace blood exposure is documented at approximately a 1.8% risk.

Risks are related to the type of injury, the severity, the source infection status and viral loads. Talking to your health care provider will help you gauge your risks.

My Baseline

The Emergency Department will ask you to let the wound bleed freely and not to apply direct pressure. The wound should be gently and thoroughly cleaned with antiseptic or soap and water as soon as possible. If the exposure happens to mucous membranes including the eyes, nose, and mouth, the area should be flushed immediately with water or saline for 10 to 15 minutes. The emergency department will take your blood to create a “baseline” for you.  Baseline blood work determines your current Hepatitis B, C, and HIV status. These results identify if you had these infections before the injury. Doing this blood work also helps determine if you have protection against Hepatitis B. It also helps you with future claims for compensation is you get an occupationally-acquired infection of Hepatitis B, C, or HIV. Not doing this baseline blood work may jeopardize any future claims.

Your family doctor may obtain these results by calling the main Public Health Laboratory customer service line at 1-877-604-4567 or you may request the hospital medical records department to forward copies of your results to your family doctor.

Treatment in Emergency Department

Hepatitis B

The emergency room staff will assess whether you have previously been vaccinated against Hepatitis B (in school or before travel) in order to determine whether any further vaccine is needed. If you’ve never received the Hepatitis B vaccine, it will be recommended that you get Hepatitis B Immune Globulin (HBIG) and start the Hepatitis B vaccine. HBIG is human immune globulin prepared from plasma of donors who have high antibody levels to Hepatitis B. It provides temporary but immediate immunity. It is also recommended that you complete the Hepatitis B vaccine series. If a person is immune to Hepatitis B, no further Hepatitis B testing is required.

Hepatitis C

There is no prophylaxis or vaccination for preventing Hepatitis C infection. Effective medication with antiviral regimens are available to those who develop infection. Post-exposure follow-up focuses on early detection and treatment.

Tetanus

Although tetanus is not a blood borne infection, it is often assessed and you may be treated with a vaccine as part of the regular first aid for injuries to skin. Emergency room staff will ask when your last tetanus vaccine was given. It may be recommended that you get a tetanus vaccine, especially if the wound was dirty or deep.

HIV Post Exposure Prophylaxis (PEP)

There are medications the emergency department may prescribe that may help prevent the transmission of HIV. Post exposure prophylaxis (PEP) treatment is based on limited but supportive studies.

Medication can be discontinued after more information becomes available; however, delaying the start of PEP is not recommended. Ideally, it should be started 1 to 2 hours after exposure, but needs to be started within 72 hours from exposure to be effective. The long-term toxicity of PEP appears minimal; however, data is limited. Side effects may range from nausea, headache, diarrhea, fatigue, anemia, and pancreatitis. One month of PEP is required. For it to be effective, the person taking PEP must comply with medication regimen (right doses at the right time for the prescribed amount of time).

Anyone starting PEP should contact the HIV Care Program. The HIV Care Program pharmacy will fill prescribed medication for PEP and answer your questions. PEP is optional. The decision to start PEP will be based on the individual exposure, severity of the exposure, the source HIV status, risks involved, and the preference of the patient and the clinician.

Repeat Blood Testing

You will need to do follow-up blood tests at certain times to cover your “window periods” (having early infection but not showing up in the blood yet). The reason it’s important to do these extra blood tests is that certain infections may take longer to show up. For example, Hepatitis may take up to 6 months to show up in a blood test and HIV may take up to 12 weeks to show up in a blood test. Early medical treatment is pertinent.

Your perseverance and compliance with follow-up blood tests and visits to your family doctor are important to ensure your future well-being.

The Following Blood Tests are recommended

Baseline (Upon Exposure)

HIV, Hepatitis B (HBsAg, antiHBs & anti HBc), Hepatitis C, and liver function tests.

6 Weeks

HIV, Hepatitis B (if required) and Hepatitis C

3 Months

HIV, Hepatitis B (if required), Hepatitis C, and liver function tests.

6 Months

HIV, Hepatitis B (if required), Hepatitis C, and liver function tests.

1 Year

HIV (if source has both Hepatitis C and HIV or it PEP is being used)

Source Testing

Ideally, testing the source is the most reliable way to assess risk. The source may themselves be in the “window period”; therefore, interpret any negative results with caution. When an injury has happened and the source is known, the person should be tested for HIV, Hepatitis B, and Hepatitis C as soon as possible if the give their informed consent. Consent must include the need to reveal the test results to the exposed person. Health care providers are able to explain to the source that an exposure has occurred and inform them why a blood test for HIV, Hepatitis B, and Hepatitis C is needed from them in order for the injured person to make medical decisions for him/herself (to use Post Exposure Prophylaxis Medication)

The source has the right to refuse consent. Some people, depending upon occupation, are eligible to apply for mandatory blood testing of the source through the local Medical Officer of Health. (see Mandatory Blood Testing Act for more information)

Health Care Provider

Your health care provider will help you complete your follow-up blood tests, monitor any symptoms and help you fill out any forms required from Workplace Safety and Insurance Board (WSIB).

No Health Care Provider

If you don’t have a health care provider, you may book an appointment at the Windsor-Essex County Health Unit, Clinical Services Department to complete the recommended bloodwork and any Hepatitis B vaccines (if you need the 2nd and 3rd vaccine for Hepatitis B).

Precautions to Prevent Potential Infections During the Window Periods

Precautions should be taken to prevent possible spread of the infections, especially for a significant exposure. This means living for the next 6 months as if you may have the infections. Hepatitis B and HIV are both spread through blood and body fluids. Hepatitis C is spread blood to blood.

In the next 6 months, you should:

  • Discuss using condoms with your partner as safer sex practices are advised.
  • Avoid pregnancy and discontinue breastfeeding or have further consultation with your health care provider or obstetrician.
  • Refrain from donating any blood, semen or organs.
  • Avoid sharing razors, toothbrushes or nail clippers and files as trace amounts of blood may be on them.

These precautions should be followed until your health care provider advises you that they are no longer required.

Mandatory Blood Testing Act 2006

A person may apply (within 7 days of contact) to a Medical Officer of Health to have a blood sample of another person tested if her or she has come into contact with a bodily substance from that person in any of the following circumstances:

  • As a result of being a victim of crime.
  • While providing emergency health care services or emergency first aid to the person.
  • In the course of his or her duties, if the person belongs to an identified group of individuals, including:
    • Members of the College of Nurses of Ontario
    • Members of the College of Physicians and Surgeons of Ontario
    • Medical students in training.
    • Firefighters (including volunteer firefighters)
    • Paramedics and emergency medical attendants
    • Paramedic students engaged in field training
    • Persons who are employed in a correctional institution, place of open custody, or place of secure custody.
    • Police officers, civilian employees of a police service.
    • First Nations constables and auxiliary members of a police service.

Forms and more information is available at:

Remember that both application and physician reports need to be completed and submitted together.

Deliver completed application forms to:

Medical Officer of Health
Windsor-Essex County Health Unit
1005 Ouellette Avenue
Windsor, Ontario
N9A 4J8
519-258-2146
519-973-4510 after hours, weekends, and holidays

Reminders…

Did I fill out an incident report at work?

Did I report to the Occupational Health Office Nurse?

For more information

You may call and speak to a Public Health Nurse at the Windsor-Essex County Health Unit if you have questions or concerns about blood borne infections and follow-up after an exposure at

519-258-2146 ext. 3220.