Exposure-Prone Procedures and Limitation Thresholds
Definition of an exposure-prone procedure
The SERTIH has retained Health Canada’s (1998) definition of an exposure-prone procedure:
“They are procedures during which transmission of HBV, HCV or HIV from a health care worker [HCW] to patients is most likely to occur and includes the following:
- 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 health care worker’s fingers and a needle or other sharp instrument or object in a blind or highly confined anatomic site, e.g., during major abdominal, cardiothoracic, vaginal or orthopedic operations;
- the repair of major traumatic injuries;
- major cutting, or removal of any oral or perioral tissue, including tooth structures; during which blood from an injured health care worker may be exposed to the patient’s exposed tissues.”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).
- Recommandations concernant l’évaluation et le suivi des soignants infectés par le VIH (update in progress)
- Recommandations concernant l’évaluation et le suivi des soignants infectés par le VHB
- Recommandations concernant l'évaluation et le suivi des soignants infectés par le VHC
- Complément au document « Recommandations concernant l’évaluation et le suivi des soignants infectés par le virus de l’hépatite C (VHC) » – Soignants sous traitement sans interféron composé de médicaments antiviraux à action directe (upcoming publication)
1. Health Canada. Proceedings of the Consensus Conference on Infected Health Care Workers: Risk for Transmission of Blood-borne Pathogens. CCDR, 1998; 24S4.