It is becoming increasingly common to downplay or overlook completely the possibility of bloodborne virus infection after sharps injury or other blood or bloodstained body fluid exposure.
The low incidence of recorded infection leads to a false sense of security. Sharps injury and other exposures continue to occur though in the absence of any proven infections the link might seem to be somewhat tenuous. However, it is the very problem of recognition of infections which may become apparent long after exposure, for workers on short term contracts or casual employment possibly through an agency.
Who makes the link? Where workers are mobile, passing through not only many employers but in many different sectors the link to exposure through clinical wastes is sometimes impossible to identify. This, together with attempts by Environment Agency to down-regulate many clinical wastes based on the broadest generalisations of risk.
What is required is a wholesale shift to properly risk-based segregation based on and supporting the CDC Universal and Standard Precautions. This more meaningful risk assessment basis would categorise bloodstained wastes as hazardous by risk of infection with most other wastes more logically down-regulated as less hazardous wastes.
To highlight the potential risk, there is now a report of three more HIV seroconversions:
Upjohn LM, Stuart RL, Korman TM, Woolley IJ. New HIV diagnosis after occupational exposure screening: the importance of reporting needlestick injuries. Internal Medicine Journal. 2012; 42(2):202-4
These authors describe 3 new diagnoses of HIV infection as a direct result of testing following occupational exposures (NSIs) in a low-prevalence setting. In each case the finding was unexpected. This series provides a reminder of the importance of prompt reporting of NSIs by healthcare workers, access to rapid HIV testing and post-exposure prophylaxis with antiretrovirals to prevent transmission.
The impending introduction of safety sharps will help healthcare professionals reduce the incidence of sharps injury but is unlikely to help waste handlers and ancillary staff.
Exposures will continue to occur; many go almost unnoticed and reporting will be far less than 100%. The response in A&E will be sometimes helpful though more commonly slow and sometimes dismissive despite knowledge of the risks involved.
Waste handlers should attend A&E for any sharps injury or blood/bloodstained body fluid exposure involving broken skin or splashes to face and eyes. Do not be fobbed off with a long wait for a trivial incident. If post-exposure prophylaxis is required, hours make a huge difference in its efficacy and it will sometimes be necessary to make a fuss in order to get seen, first by the A&E staff and then by an Infectious Diseases specialist.