The occupational risks resulting from needlestick blood exposures from intravenous (IV) catheter devices have been well documented for more than a decade. However, other blood exposure risks related to peripheral IV catheters have flown largely under the radar—until now.
A recent study by the International Healthcare Worker Safety Center found that one in two nurses experienced blood exposure at least once a month when inserting and removing peripheral IV catheters. These risks were related to blood exposure on the skin or in the eyes, nose, or mouth.
According to the Centers for Disease Control and Prevention (CDC), at-risk blood exposures are those that involve “contact of mucous membranes or nonintact skin (such as exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or other body fluids that are potentially infectious.”
In the study of 404 nurses, the total rate of such at-risk exposures was 128 per 100,000 insertions. These included nonintact skin and mucous membrane exposures. For comparison, the exposure rate for needlestick injuries was 6.6 per 100,000 devices with conventional IV catheters and 1.2 per 100,000 with safety-engineered catheters.
The health risks of exposure to blood include infection with human immunodeficiency virus (HIV), hepatitis B virus, hepatitis C virus, and methicillin-resistant Staphylococcus aureus (MRSA). Yet the study revealed that many nonintact skin and mucous membrane exposures were preventable and most went unreported. Reasons for not reporting the incidents included not thinking the exposure was significant enough to report, being too busy, and being concerned about others’ perceptions.
Among those who reported exposures, the study found that none received HIV post-exposure prophylaxis (PEP). Reasons given by this group for not receiving PEP included a belief that the exposure was either low risk or that PEP was not indicated, the patient was HIV-negative, and PEP was unavailable (or not offered) at their facility. This is particularly noteworthy because the Occupational Safety and Health Administration (OSHA) requires facilities to inform employees of PEP protocols and to have PEP readily available at all times.
To help prevent blood exposure to nonintact skin and mucous membranes, follow these guidelines:
• Wear eye and face protection during IV catheter procedures. Because conjunctival exposures are most frequently associated with pathogen transmission in blood, be sure to use eye protection with a seal to prevent blood from dripping into the eyes from the forehead.
• Always wear gloves for catheter insertion or removal. Systematic use of appropriate personal protective equipment is the best protection against bloodborne pathogens.
• Remember that the risks of blood exposure during IV catheter insertion and removal are not limited to needlesticks. Although needlestick injuries have been reduced greatly in recent years, other risks remain.
• Use devices with safety features. Catheters that minimize blood leakage and splatter during insertion and removal include BD InsyteTM AutoguardTM BC with Blood Control Technology and the BD NexivaTM Closed IV Catheter System.
If blood exposure occurs despite taking the best prevention efforts, manage it effectively. Report the exposure and expect your employer to follow OSHA requirements and provide care at no charge that includes:
• confidential medical evaluation, including blood tests and laboratory work
• PEP, if indicated
• appropriate counseling and follow-up.