Immediate Management of Skin Exposure to Bloodborne Pathogens

Initial Response

The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend immediately washing the exposed skin area thoroughly with soap and water, which is the most critical first step in preventing infection transmission 1, 2
If splashes to mucous membranes (eyes, nose, mouth) occur, flush the involved area with clean water, saline, or sterile irrigants, as recommended by the Centers for Disease Control and Prevention 1, 2
Document the exposure details including type of fluid, source of exposure (if known), and condition of the skin (intact vs. non-intact), as suggested by the Centers for Disease Control and Prevention 3

Exposure through non-intact skin (chapped, abraded, or with dermatitis) poses higher risk than exposure to intact skin, according to the American Academy of Pediatrics and the Centers for Disease Control and Prevention 1, 4
Body fluids considered potentially infectious include: blood, visibly bloody fluids, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid, as defined by the American Academy of Pediatrics 1
Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus are not considered potentially infectious unless they contain visible blood, as stated by the American Academy of Pediatrics 1

Determine vaccination status of the exposed person, as recommended by the Centers for Disease Control and Prevention 2
For unvaccinated individuals or those with unknown antibody response, administer hepatitis B vaccine and consider hepatitis B immune globulin (HBIG) if the source is HBsAg-positive or unknown, according to the American Academy of Pediatrics and the Centers for Disease Control and Prevention 1, 2
HBIG should be administered within 24 hours when indicated, but can be given up to 7 days after exposure, as suggested by the Centers for Disease Control and Prevention 2

No post-exposure prophylaxis is currently recommended for HCV exposure, as stated by the Centers for Disease Control and Prevention 2
Baseline testing for anti-HCV and liver enzyme levels should be performed, as recommended by the Centers for Disease Control and Prevention 2, 5
Follow-up testing for anti-HCV and liver enzyme levels should be conducted 4-6 months after exposure, according to the Centers for Disease Control and Prevention 2, 5

For skin exposure to potentially HIV-contaminated blood, post-exposure prophylaxis (PEP) is generally not recommended for intact skin exposure, as stated by the Centers for Disease Control and Prevention 5, 6
PEP might be considered if exposure involves non-intact skin and the source is known to be HIV-positive, according to the Centers for Disease Control and Prevention 2, 6
If PEP is deemed necessary, it should be initiated as soon as possible (ideally within hours), as recommended by the Centers for Disease Control and Prevention 2, 6

Document the exposure thoroughly, as suggested by the Centers for Disease Control and Prevention 3
Arrange for follow-up testing based on the specific pathogens of concern, as recommended by the Centers for Disease Control and Prevention 2
Provide counseling about potential infection risks, symptoms to watch for, and precautions to prevent secondary transmission, according to the Centers for Disease Control and Prevention 2, 7
Advise the exposed person to seek medical evaluation for any acute illness occurring during the follow-up period, as recommended by the Centers for Disease Control and Prevention 7, 8