Blood and Bodily Fluid Exposures

Hepatitis B Virus (HBV)

For persons who have received Hepatitis B vaccine and have developed immunity to the virus, there is virtually no risk for infection. For people with no immunity, the risk of infection with HBV following a needle stick or cut exposure (from an infected source) is 6-30%. In the case of human bites where the skin is broken, the risk of infection (for the person who is bitten) is unknown but is likely to be quite low since the concentration of HBV is 1000 times lower in saliva than in blood.

Hepatitis C Virus (HCV)

The risk of HCV infection following a needle stick or cut exposure, where the source is known to be infected, is approximately 1.8%. The risk of infection from an exposure to mucous membranes or non-intact skin is unknown but is believed to be very small. There is no vaccine against HCV and no treatment available after an exposure that will prevent infection.

Human Immunodeficiency Virus (HIV) 

The risk of HIV infection following a needle stick or cut exposure, where the source is known to be infected, is currently estimated at 0.3% (1 in 300). The risk after exposure of the eye, nose, or mouth to blood infected with HIV is estimated to be approximately 0.1% (1 in 1,000). The risk after exposure of non-intact skin to blood infected with HIV is estimated to be less than 0.1%. A small amount of blood on intact skin likely poses no risk at all. 

Source Risk Factors 

Highest risk factors are people infected with HBV, HCV or HIV.  If the source persons status is unknown, higher risk factors include injection drug use, men who have sex with men, having a sexual partner who is a known positive, being born from an infected mother, being born outside of Canada, having a history of jail time, having tattoos or body piercings, or having received blood or blood products before 1990. 

Initial First Aid 

Needlestick or wound:

• Allow the wound to bleed freely.
• Do not promote bleeding by squeezing the wound, this may damage the tissues and increase uptake of any virus.
• Wash well with soap and water.

Mucous membrane or eye:

• Irrigate (rinse) with water or normal saline.

Skin:

• Wash well with soap and water, do not apply bleach to the wound.

Clothing:

• Remove any clothing that is contaminated with blood or bodily fluids.

Report and Seek Medical Assessment

Occupational exposures should be reported right away to your employer. If you are an emergency service worker, report to your Designated Officer or Supervisor who will help assess the exposure and support the follow-up process.

It is important to seek medical attention right away for assessment (ER visit). This assessment should not be delayed. If preventative treatment (post-exposure prophylaxis) is recommended, it needs to be started within certain timelines to work. It is also important to have baseline bloodwork drawn as soon as possible after the potential exposure.  

Post-Exposure Prophylaxis (PEP) 

Hepatitis B

Hepatitis B vaccine and Hepatitis B Immune Globulin (HBIg) can provide susceptible individuals with protection from HBV infection after exposure when given within certain timeframe. Immunization history and blood testing will help guide decision if PEP is indicated or not.

Hepatitis C

There is currently no PEP available.

HIV

HIV antiretrovirals can prevent HIV infection and may be offered to individuals who have had higher risk exposures. Ideally, PEP should be started 1-2 hours after exposure, but it can still be effective if started within 72 hours from exposure. Delaying the start of PEP is not recommended. It can be discontinued if needed once more information becomes available.

Counselling and Follow-up Testing

At the direction of your healthcare provider, follow-up blood testing may be recommended at three weeks, six weeks, three months and six months after an exposure. It is important to repeat the blood testing as directed because certain infections may take longer to show up as a positive result.

Until all testing has been completed:

• Do not donate blood, semen, tissues, or organs
• Use barrier protection (such as condoms) for sexual activity.
• Delay pregnancy or consult with your primary care provider if planning to become pregnant.
• Do not share personal items that may contain blood (for example, toothbrush, razors, nail clippers).

Information on Bites

Severe bites can carry a risk of transmitting bloodborne virus and bacterial infections. An individual who has been bitten should watch the wound over the next few days for signs of infection (redness, warmth, swelling and purulent drainage) and contact their healthcare provider if this occurs. See Initial First Aid for additional information.

For more information on bites in childcare from the National Library of Medicine.

Childcare Setting

Severe bites are unusual in a day care setting and almost never lead to infection. In the childcare setting, the usual precautions of wound care should decrease the risk of a bacterial infection to almost zero. See the section “What to do After an Exposure – Initial First Aid” for additional information.

The literature suggests that it is extremely unlikely, although possible that injury involving blood exposure in children will result in the transmission of hepatitis B or C and HIV.

• Hepatitis B: Ensure vaccines are up to date
• Hepatitis C: Infection is rare in young children and has never been reported in a childcare setting
• HIV: The chance of transmission through a bite of a child (break in skin) is extremely unlikely and has never been reported in a childcare setting. Giving a child anti-HIV drugs after a bite is not recommended. 

Mandatory Blood Testing Act (MBTA)

For information on the Mandatory Blood Testing Act, including who is eligible to make an application and how to submit an application see: Mandatory Blood Testing Act.

Post Exposure Blood Work Testing of Exposed Person

Baseline Bloodwork (to assess for pre-existing infection or Hep B immunity)

• Hepatitis B Surface Antigen (HBsAg) and anti-HBs (titre) if unvaccinated or titre is unknown.
  • If an exposed person has ever had a positive Anti-HBs titre (and they are not immunocompromised), they are considered immune and no testing for HBV is required. Titre levels decrease in most people over time, but a positive result at any time in the past indicates lifelong protection due to immune memory.
• Anti-HCV and ALT
• HIV Ag/Ab combo screen
• If HIV PEP will be administered test:
  • ALT
  • AST
  • CBC
  • Platelets
  • BUN
  • Creatinine
  • bHCG (females)

Follow-up Testing

Hepatitis B (for those who are not immune)

• Anti-HBs (titre) 1-6 months after last dose of vaccine series (if HBIg was also given, wait 6 months to allow HBIg antibodies to wane)
• HBsAgG and Anti-HBc at 3 and 6 months following exposure

Hepatitis C

• HCV RNA (if exposure was high risk) 6 weeks following exposure
• Anti-HCV and ALT 3 months and 6 months following exposure

HIV

• If no PEP was administered: HIV Ag/Ab 3 weeks (65-70% sensitivity) and 6 weeks (>99% sensitivity) following exposure
• If PEP was administered: HIV Ag/Ab 3 weeks and 6 weeks following exposure after the person completes the 28 day course of PEP

Different testing intervals are required if only rapid point of care or self-tests are used. See the Ontario Guidelines for Providers Offering HIV Testing, 2024 for additional information.

Laboratory Requisitions

• To order testing for hepatitis B and hepatitis C use PHO's General Test Requisition.
• To order testing for HIV use PHO's HIV Serology and PCR Test Requisition.

Post Exposure Prophylaxis (PEP) Regimens

More information about tetanus.

• Ensure tetanus vaccination is up to date.
• In unvaccinated or inadequately vaccinated individuals, tetanus immune globulin (TIg) is recommended post-exposure in certain situations. This should be given at a separate site from Td/Tdap).

Immune globulin Immune Globulin is ordered by hospitals through the Canadian Blood Services and is often administered in hospital emergency departments. Locally, it is available or can be ordered at the following locations:

• North Bay Regional Health Centre
• West Nipissing General Hospital (call before presenting for potential immune globulin to ensure availability)
• West Parry Sound Health Centre

Clean, minor wounds

• Tetanus toxoid-containing vaccine should be offered when an individual has:
  • Unknown vaccination status
  • Less than 3 doses in a vaccine series
  • Three or more dose vaccine series and it has been more than 10 years since their last booster dose

For additional information related to the schedule for tetanus toxoid-containing vaccines, see The Canadian Immunization Guide’s Schedule and the Recommendations for Use based on age.

• No TIg is indicated for clean, minor wounds

All other wounds

• Tetanus toxoid-containing vaccine should be offered when an individual has:
  • Unknown vaccination status
  • Three or more doses in a vaccine series and it’s been more than five years since their last booster dose

• TIg is recommended when an individual has:
  • Unknown vaccination status
  • Less than 3 doses in a vaccine series
  • Is known to have a humoral immune deficiency state

If administering both TIg and a tetanus toxoid-containing vaccine, use different injection sites using separate needles and syringes.

For additional information related to the schedule for tetanus toxoid-containing vaccines, and about the administration of TIg, see the Canadian Immunization Guide's: Tetanus toxoid chapter.

Hepatitis B

• More information on Hepatitis B
• For recommendations related to when to provide hepatitis B vaccines and hepatitis B immune globulin (HBIg) see the Canadian Immunization Guide’s:
  • Figure 1: Management of Individuals with Percutaneous or Mucosal Exposure to an Infected or High-Risk Source
  • Figure 2: Management of Individuals with Percutaneous or Mucosal Exposure to an Uninfected or Low Risk Source

• Immune Globulin is ordered by hospitals through the Canadian Blood Services and is often administered in hospital emergency departments. Locally, it is available or can be ordered at the following locations:
• North Bay Regional Health Centre
• West Nipissing General Hospital (call before presenting for potential immune globulin to ensure availability)
• West Parry Sound Health Centre

• Hepatitis B vaccine complete series can be obtained by primary health care provider or local Public Health Unit 

Hepatitis CMore Information on Hepatitis C 

There is no currently recommended post exposure prophylaxis for hepatitis C.

HIV

More information on HIV

Canadian PEP guidelines outline practical advice for physicians providing PEP, including how to assess risk in people who present for PEP, how to provide monitoring and follow-up, and recommended drug regimens:

• Canadian guideline on HIV pre- and postexposure prophylaxis: 2025 update | CMAJ
• Appendix 1: Canadian Guideline on HIV Pre-exposure prophylaxis and Post Exposure Prophylaxis

HIV PEP starter kits can be accessed at the following locations:

• North Bay Regional Health Centre Emergency Department
• West Parry Sound Health Centre Emergency Department

Counselling

Individuals should receive counselling regarding the risk of transmission following a significant exposure. To minimize secondary transmission during the first 12 weeks post-exposure, the individual should be counselled to:

• Do not donate blood, semen, tissues, or organs
• Prevent sexual transmission (for example, using barrier protection such as condoms)
• Defer pregnancy or consult with their primary care provider.
• Not to share personal items that may contain blood (for example, toothbrush, razors, nail clippers)

Source Testing and Mandatory Blood Testing Act (MBTA)

Voluntary Source Testing

If an exposed person or designate requests that the source person be tested for blood borne illnesses, a healthcare provider can order HIV Ag/Ab, Anti-HCV and HBsAG (unless the exposed person is known to be immune to hepatitis B) with the sources consent. If the source person provides consent for the healthcare provider to release results of their testing to the exposed person, the healthcare provider can then disclose results of this testing to the exposed person.

MBTA

If the source refuses to be tested and have results of their testing disclosed to the exposed person, the exposed person can submit an application under the Mandatory Blood Testing Act within 30 days of their exposure provided they are eligible. See Mandatory Blood Testing Act for additional information.