Occupational Exposure to HIV: Advice for Health Care Workers

HIV stands for human immunodeficiency virus. It is an infection that attacks your body’s immune system. The infection can lead to AIDS (acquired immunodeficiency syndrome).

Health care workers are at risk of viral exposure in the workplace. HIV is one type of exposure. It is transmitted through certain body fluids of an infected person. This includes blood, vomit, semen, vaginal discharge, breast milk, or pus. Clear fluids, such as tears, saliva, sweat, and urine, contain little or no virus. They cannot transmit HIV unless mixed with blood.

The risk of getting HIV from a needlestick injury is less than 1%. The risk of exposure from direct skin contact with the fluid is less than 0.1%. The risk of infection from a human bite is between 0.1% and 1%.

Path to Improved Health

There are many ways to prevent occupational exposure to HIV. To start, health care workers should treat all body fluids the same way. You should assume they are infected and take precautions, including:

  • Use protective covering, such as gloves and goggles. You always should do this when dealing with blood and body fluids.
  • Wash your hands and other skin areas right after contact with blood and body fluids.
  • Be careful when handling and disposing of needles and sharp instruments.
  • Use available safety devices to prevent needlestick injuries.
  • Be aware of your employer’s postexposure processes.

Be aware of your organization’s policies and procedures to follow when an exposure occurs. If it does occur, follow the basic steps below:

  • For a skin puncture, induce bleeding at the wound site. Do this by applying gentle pressure as you wash the area with soap and water.
  • For a skin or mucous splash, rinse the area with water.
  • Get the infected person’s information. This includes name, address, phone number, and HIV status. If a patient, get their doctor’s contact information.
  • Notify your supervisor and coworkers. If your place of work has other procedures in place, follow those (incident reporting, etc.).
  • Seek immediate medical care. Go to your employee health unit, emergency department, or personal doctor.

Once you are with medical professionals, they will assess the exposure. If you have a skin puncture or cut, you may need a tetanus toxoid booster. Take anti-HIV medicine right away, if needed. At this point, the doctor will ask about the incident. The following are example questions he or she may ask.

For a skin puncture:

  • Is it shallow or deep?
  • If caused by a needle, what gauge was it? Was the needle solid (suturing) or hollow?
  • If caused by an instrument, what was it?
  • Was there blood or bloody material on the surface of the object?
  • Was the object in prior contact with the infected person’s body fluids?
  • If blood was injected in you, how much?
  • Were you wearing protective covering?

For a skin or mucous splash:

  • What type of body fluid were you exposed to, and how much?
  • On what part of your body were you exposed?
  • What size area was the contact?
  • What was the length of contact time?
  • Was there a break in your skin?
  • Was there a rash, bite, or open wound?
  • Were you wearing protective covering?

About the infected person (source):

  • Is the source HIV negative or positive? (If the source is HIV negative, they could be infected but not know yet. They may be in the window period or seroconversion. Seroconversion is the period of time when a person infected with HIV begins to develop antibodies.)
  • If the source is HIV positive, do they have AIDS?
  • Has the source taken anti-HIV therapy? If so, what medicines?
  • Is the source at the end of their disease? (If yes, they’ll have a higher quantity of virus in their body fluids.)
  • Is the source or their partner an intravenous drug user?
  • Is your source homosexual or bisexual, or have they had multiple partners?
  • Did your source have a blood transfusion between 1980 and 1985? Have they received a blood transfusion recently?
  • Does the source agree to be tested, or retested?

About yourself:

  • Have you been exposed to HIV before? If so, when and how? What were the results?
  • Are you sexually active?
  • What kind of relationship are you in?
  • Are you pregnant or breastfeeding?
  • Do you have any health conditions?
  • What medicines are you taking?
  • Are you allergic to anything?
  • Do you agree to HIV testing? Do you agree to document the incident?

Your exposure treatment is based on answers to the questions above. Your doctor may have you take medicine to reduce your risk of getting HIV. They also might prescribe medicine to protect against hepatitis and syphilis. You’ll need to get blood work done. It will check your liver, kidney, and bone marrow function.

Another option is post-exposure prophylaxis (PEP). This treatment suppresses the HIV virus to prevent infection. If you still test positive, the treatment can help decrease the virus’ strength and progression. Prophylaxis medicines have some side effects. Gastrointestinal symptoms are common, such as nausea, diarrhea, and stomach pain or discomfort. Zidovudine (an HIV anti-viral medicine) may cause headaches, fatigue, or insomnia. In rare cases, lamivudine (HIV anti-viral) can lead to pancreatitis. Indinavir (HIV anti-viral) has been linked to kidney stones. You should drink two quarts of fluid daily to reduce this risk.

You should avoid contact until HIV infection is ruled out. Refrain from blood or organ donation, and do not exchange body fluids during sex. If you are trying to get pregnant, postpone it. If you are breastfeeding, you should switch to feeding your baby formula.

Things to Consider

After HIV exposure, your first test likely will be negative. However, this doesn’t mean you aren’t or won’t be infected. There is a period of time called seroconversion. It can last as short as 1 to 3 weeks from the exposure. In rare cases, it can take up to 6 months or 1 year. During this time, your body develops HIV antibodies to attack the virus. You may have flu-like symptoms, such as fever, aches, rash, and swollen lymph nodes. This typically indicates the presence of HIV infection.

Because of seroconversion, you’ll need repeated HIV testing. Your doctor can tell you how often to get testing. The Centers for Disease Control and Prevention recommends retesting up to 6 months after exposure.

It is natural to have strong emotions after an exposure to HIV in your workplace. You might feel anger, fear, blame, or depression. During the difficult time of prevention treatment and waiting, you may want to seek support. Try an employee-assistance program or local mental health expert.

Questions to Ask Your Doctor

  • What do you consider to be an occupational exposure?
  • If I’m exposed to HIV from blood or body fluids in my workplace, what are the chances I will get infected?
  • When and how will I know for sure if I’m HIV negative or positive?
  • Can I still work during the window period or seroconversion?