Sources of blood-borne infection

Effective control of blood-borne viruses starts with the ability to recognise accurately the potential sources of infection. It is a fundamental infection control principle, particularly within the healthcare setting, to treat all blood and body fluids as potentially infected with BBV.

Sources of blood-borne viruses are varied, and without recognition and precaution can pose a health threat to workers in industries where they could be potentially exposed to infection.

Large numbers of needlestick injuries (NSIs) are still reported in the UK, and the Health Protection Agency's Eye of the Needle report found that dutyholders need to do more to help bring statistics down - it is vital that dutyholders get the guidance they need to help them apply the safe working practices overview needed to reduce the incidence of these injuries.

The increased use of suitable equipment, for example, safer needle technology, may help to reduce the instances of NSIs. An increasing number of devices and systems are available on the market, including:

blood lancets;
syringes and needles;
blood collection systems;
needle-free devices; and
safety cannulae.

These devices are available through the NHS Supply Chain.

Improved education and training, as well as increased awareness of the risks and preventive measures, are also likely to contribute to reducing the numbers of needlestick injuries in the UK.

Sharps-related injuries are covered under the Biological Agents at Work Directive 2000/54/EC (BAD), which is implemented under COSHH.

Infected people - the public, patients, clients

Transmission of blood-borne viruses to workers or the public is very unlikely through everyday social contact with BBV-infected individuals. Transmission happens via direct exposure to blood or body fluids, delivered through the protective skin barrier.

In the occupational setting, this is most likely to result from a penetrating injury with a contaminated sharp instrument - such as a needle, broken glass or contaminated machinery/vehicles - and more rarely when there is contamination of broken skin or mucous membranes.

Sport, however, may constitute social and/or work exposure, and carries a potential risk of transmitting blood-borne viruses. There are impact injuries associated with sports such as wrestling, football and rugby, which result in bloody injuries and a potential risk of blood-borne transmission of hepatitis B and C, and human immunodeficiency virus (HIV). Recommendations have been made that those involved in contact sport should receive hepatitis B immunisation.

Infected cadavers

Whilst hygienic preparation is acceptable, current HSE guidance stipulates that blood-borne virus-infected bodies should not be embalmed, as this presents significant risk of exposure to workers.

Equipment (including medical devices)

Medical, dental, laboratory or other equipment that is reusable and has been in contact with blood or body fluids, which has not been decontaminated adequately, may present a risk of infection for both workers and patients. Reusable devices must be decontaminated between uses on different individuals.

If an item of equipment is to be sent for examination or repair, it should, wherever possible, be decontaminated before despatch. In some instances, eg for delicate items where electrical components are present, some methods of decontamination may cause damage to the equipment. To avoid this, the most appropriate method must be chosen.

Contaminated objects

Any article contaminated with blood or blood products from an infected person must be regarded as a potential source of BBV infection for those handling it, if a means of delivering the virus into the body exists. Examples include sharp objects but also 'soft' waste, such as discarded dressings, contaminated clothing, linen and furnishings. The surfaces of damaged motor vehicles can also harbour contamination following road traffic accidents, specifically if those involved have suffered trauma injury and blood loss.

For situations such as those described above, it must be assumed that there is a risk of infection, unless the item concerned has been decontaminated by effective means.

Healthcare organisations will have policies to manage and follow-up recognised incidents of sharps injuries during surgical and needle-related procedures.

Environmental contamination

Blood and body fluids may contaminate the site of industrial and road traffic accidents, playgrounds and sporting events. Provided that there is no direct contact, there is no risk for those in the vicinity. However, it should be remembered that the viability of blood-borne viruses on surfaces might continue for extended periods, subject to environmental conditions.

The use of simple personal protective measures, avoidance of sharps injuries and appropriate decontamination will minimise the risk for those dealing with the contamination. After cleaning up, it is essential to dispose of contaminated waste safely.

Motor vehicles

Vehicles involved in traffic and rail accidents are commonly contaminated with blood and human tissue. Sharp metal and broken glass at an accident scene present an added infection risk from any puncture wounds sustained by those first attending the trauma scene.

The need for added awareness also extends, in principle, to subsequent vehicle recovery and repair work, which may potentially involve contact with contaminated vehicles. However, data indicates that there are currently no confirmed reports of blood-borne virus transmission for the motor vehicle recovery and maintenance industry, and that most industry-specific problems are related to musculoskeletal injury, slips and trips, fume, dusts, noise and vibration.

Discarded hypodermic needles are sometimes found in upholstery and glove compartments in cars sent for repair and servicing. Workers need to be aware of this, even during routine maintenance work. Precautions are essential in all cases.