Exposure-Prone Procedures and Limitation Thresholds
Definition of an exposure-prone procedure
SERTIH retains the Public Health Agency of Canada’s (2019) definition of an exposure-prone procedure:
“Exposure-prone procedures (EPPs) are invasive procedures where there is a risk that injury to the HCW [healthcare worker] may result in the exposure of the patient’s open tissues to the blood of the HCW. For transmission of a BBV [blood-borne virus] from an infected HCW to patient to occur during an EPP, three conditions are necessary:
- HCW must sustain an injury or have a condition that allows for exposure
- HCW’s blood must come in contact with a patient’s wound, traumatized tissue, mucous membranes, or similar portal of entry
- HCW must be sufficiently viremic
EPPs with risk of transmission include:
- Digital palpation of a needle tip in a body cavity (a hollow space within the body or one of its organs); or the simultaneous presence of the HCW’s fingers and a needle or other sharp instrument or object (such as bone splinters, sternal wires etc.) in a blind or highly confined anatomic site, e.g., as may occur during major abdominal, cardiothoracic, vaginal, pelvic and/or orthopedic operations
- Repair of major traumatic injuries
- Cutting or removal of any oral or perioral tissue, during which the patient’s open tissues may be exposed to the blood of an injured infected HCW.”1
Exposure-prone procedures are therefore performed in body cavities where you can't see your hands or fingers well and when a needle or other sharp or pointed instrument is being used.
Studies of virus transmissibility have shown that healthy skin provides an effective barrier against most agents. Only blood contacts with injured skin (e.g. cut skin) or mucous membranes (e.g. eye, mouth) or by percutaneous exposure (through the skin) have been associated with contamination and infection. As long as the basic precautions appropriate to the procedure (e.g. wearing gloves) are rigorously applied, the risk of a patient coming into contact with your blood remains extremely low.
SERTIH has published a reference guide (in French only) that presents a list of exposure-prone procedures for each profession and medical specialty covered by SERTIH. The aim of this publication is to guide the recommendations made to caregivers who contact SERTIH.
The guide should be used as a reference tool only, and not to determine the nature or risk of the practice of the caregiver whose file is being assessed. The caregiver’s file must always be assessed by SERTIH.
Limitation thresholds and recommendations for the assessment and follow-up of caregivers who are blood-borne infection carriers
The expert consensus recommendations for each pathogen (HIV, HBV, and HCV) are updated regularly. These recommendations are based on the scientific literature and relevant global recommendations on the subject (in French only).