Exposure-Prone Procedures and Limitation Thresholds

Definition of an exposure-prone procedure

The SERTIH has retained Public Health Agency of Canada (2019) definition of an exposure-prone procedure:

“Exposure-prone procedures (EPPs) are invasive procedures where there is a risk that injury to the HCW may result in the exposure of the patient’s open tissues to the blood of the HCW. For transmission of a BBV from an infected HCW to patient to occur during an EPP, three conditions are necessary:

  1. HCW must sustain an injury or have a condition that allows for exposure
  2. HCW’s blood must come in contact with a patient’s wound, traumatized tissue, mucous membranes, or similar portal of entry
  3. HCW must be sufficiently viremic

EPPs with risk of transmission inlcude:

  1. ​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
  2. Repair of major traumatic injuries c. 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.

  3. 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 those carried out in cavities of the body where the hands of the professional are difficult to see and where there is the simultaneous presence of a needle or other sharp or pointed instrument or object.

Studies of virus transmissibility have shown that healthy skin is an effective barrier against most agents. Only blood contact on injured skin, on a mucosa (i.e. eye, mouth) or percutaneous exposures (which pass through the skin) have been associated with contamination and infection. As long as basic precautions appropriate for the procedure (such as wearing gloves) are rigorously applied, the patient’s risk of contact with the blood of the infected caregiver remains extremely low.

The SERTIH has written a reference guide (available in French only) which proposes a list of exposure-prone procedures for each profession and medical specialty targeted. The purpose of this publication is to guide recommendations for health care workers who are evaluated by the SERTIH. The guide should be used as a reference tool only and not to determine the nature or risk of an infected caregiver’s practice. These caregivers must always be evaluated by the SERTIH.

Limitation thresholds and recommendations for the assessment and follow-up of caregivers infected by HIV, HBV or HCV

Expert consensus recommendations specific to each pathogen (HIV, HBV and HCV) are available and regularly updated. These recommendations are based on scientific literature and global recommendations (available in French only).

1. Public Health Agency of Canada. Guideline on the Prevention of Transmission of Bloodborne Viruses from Infected Healthcare Workers in Healthcare Settings. 2019.