Blood Contact on Intact Skin: Hazard Assessment

Definition of Hazardous Exposure

The Centers for Disease Control and Prevention (CDC) defines an exposure requiring clinical evaluation and consideration of post-exposure prophylaxis (PEP) as percutaneous injury, contact with mucous membranes, contact with nonintact skin, or contact with intact skin when the duration is prolonged or involves an extensive area 1, 2, 3, 4
The CDC guidelines specify that an exposure requiring PEP includes percutaneous injury (needlestick or sharp object penetration) 3
The CDC guidelines also specify that an exposure requiring PEP includes contact with mucous membranes (eyes, nose, mouth) 5
The CDC guidelines specify that an exposure requiring PEP includes contact with nonintact skin (chapped, abraded, or afflicted with dermatitis) 3

The risk for HIV transmission through intact skin exposure is estimated to be less than the 0.09% risk associated with mucous membrane exposures, according to the CDC 1, 3, 6

For brief contact with blood on intact skin, the CDC recommends washing the area thoroughly with soap and water 5
The CDC does not indicate post-exposure prophylaxis for brief intact skin contact with blood 6
The CDC does not require follow-up testing for brief intact skin contact with blood 6

Postexposure follow-up may be considered on a case-by-case basis if the contact is prolonged (several minutes or more), according to the CDC 3
Postexposure follow-up may be considered on a case-by-case basis if the contact involves a large area of intact skin, according to the CDC 3
The CDC recommends considering postexposure follow-up if the healthcare worker specifically requests evaluation 1

Follow-up is indicated when skin integrity is compromised, such as in the presence of dermatitis, according to the CDC 5
Follow-up is indicated when skin integrity is compromised, such as in the presence of abrasions or cuts, according to the CDC 5
Follow-up is indicated when skin integrity is compromised, such as in the presence of open wounds, according to the CDC 5
Follow-up is indicated when skin integrity is compromised, such as in the presence of chapped skin, according to the CDC 3

The CDC defines exposures requiring consideration of post-exposure prophylaxis as: percutaneous injury (needlestick/sharp penetration), mucous membrane contact (eyes, nose, mouth), or contact with nonintact skin (chapped, abraded, dermatitis, or open wounds) 7
Amniotic fluid is classified as a body fluid with undetermined risk for HIV transmission, but this classification applies to exposures through percutaneous injury or mucous membrane contact, not intact skin contact 7

The quantified risks for HIV transmission to healthcare workers are: Percutaneous (needlestick) exposure: 0.3% 7
The quantified risks for HIV transmission to healthcare workers are: Mucous membrane exposure: 0.09% 7
The quantified risks for HIV transmission to healthcare workers are: Intact skin exposure: Less than 0.09% and not precisely quantifiable because no documented seroconversions have occurred through this route in prospective studies 7

Post-exposure prophylaxis is most effective when started within 72 hours of exposure, ideally within 1-2 hours 8

No healthcare workers enrolled in prospective CDC studies have seroconverted after isolated intact skin exposure to HIV-infected blood or body fluids 7