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DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and Prevention

National Institute for Occupational Safety and Health

Summary

Patient care puts paramedics atrisk o exposure to blood. Theseexposures carry the risk o inec-tion rom bloodborne pathogenssuch as hepatitis B virus (HBV),hepatitis C virus (HCV), andhuman immunodeciency virus(HIV), which causes AIDS.

A national survey o 2,664 para-medics contributed new inor-mation about their risk o expo-

sure to blood and identied op-portunities to control exposuresand prevent inections.

Preventing Exposures to BloodbornePathogens among Paramedics

Description of

ExposureParamedics, the most highly trainedemergency medical technicians(EMTs), can be exposed to bloodbecause they treat trauma victims

and perorm advanced lie supportprocedures using needles and othersharp instruments.

Paramedics oten work under unpre-dictable, adverse conditions where

patients may be experiencing un-

controlled bleeding or disorienta-

tion.

Exposure to blood can occur rom a

sharps injury, such as a needlestick

ater use on a patient or a cut rom a

contaminated sharp object.

Exposure can also occur rom a

splash to the eyes, nose, or mouth;

contact on non-intact (broken or

cracked) skin; or a human bite.

National Survey of

ParamedicsConstella Group and NIOSH conduct-ed a national survey o paramedics be-tween 20022003 to measure the in-cidence o exposure to blood among

paramedics [Leiss et al. 2006, 2009;Boal et al. 2008, 2010; Mathews etal. 2008].

We analyzed the results or Calior-nia paramedics separately because

Paramedics attend to a patient.Photo courtesy of 911imaging.

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Caliornia had a needlestick prevention law several yearsbeore there was a similar national law.

Survey Findings

Exposure ratesTwenty-two percent o all the paramedics surveyed had atleast one exposure to blood in the previous year. Caliorniaparamedics had one-quarter the national rate o needlesticksand hal the national rate o all exposures to blood. The na-tional sharps injury rate or paramedics was also high com-pared with most hospital workers. Also, exposure o brokenskin to blood was extremely high among paramedics.

Use of safety devices

Saety devices have engineered sharps injury protections;

non-saety devices do not.Eighty percent o needlesticks involved non-saety devices.The use o saety devices was much higher among Caliorniaparamedics compared with paramedics nationally.

The main predictor or use o saety devices was wheth-er employers provided them. Many paramedics said theyneeded more training in the use o saety devices.

Use of personal protective

equipment (PPE)

Major actors or eye and nose exposures to blood in-cluded: the patient vomited, spit, or coughed; the pa-tient was uncooperative, combative, or being resuscitat-ed; or the blood/body fuid splashed.

Although more than 80% o paramedics said their em-ployers provided saety goggles and ace/surgical masks,most splashes to the eye or nose occurred when protec-tion was not used.

Most exposures to broken skin were on the hand, butone-third were on the arm.

One-th o paramedics said they needed more training inhow to use PPE, and one-ourth said they needed better-designed PPE or additional PPE to protect themselves.

Special situations

Forty percent o exposures to broken skin happenedwhen a patient was being extricated. Uncooperative orcombative patients were a major actor or exposures tothe eye, nose, and broken skin.

Safety proceduresParamedics had signicantly ewer exposures to bloodi their supervisors emphasized ollowing Universal/Standard Precautions and i paramedics were evaluatedon ollowing saety procedures.

Reporting exposures to managementOur survey ound exposures were underreported. Only72% o needlesticks, 29% o exposures to broken skin, and49% o exposures overall were reported to employers.

The most common reason paramedics gave or not re-porting an exposure was that they did not consider it asignicant exposure.

In particular, they did not seem to think contact o theirbroken skin with patients blood was serious enough towarrant reporting.

Survey results suggested paramedics were less likely toreport needlesticks i they thought the exposure wastheir own ault.

The Importance of ReportingImmediate reporting to management o all potential ex-posures is important or the ollowing reasons:

Exposures should be medically evaluated immediately(some treatments, such as or HIV exposure, should bestarted as soon as possible, preerably within hours).

Inected workers who remain undiagnosed could placeothers, especially sexual partners, at risk o inection.

HIV, HBV, and HCV have all been transmittedthrough broken skin; thus, these exposures have an in-ection risk and should be reported.

Workers who develop occupational inections may notbe eligible or workers compensation i the exposurehas not been documented.

Employers need to know about exposures so they canimplement eective prevention strategies, such aschanging work practices, buying dierent saety de-

vices or PPE, or improving employee training.

Recommendations

Employers

Show employees that saety is a core value in your or-ganization. Require workers to ollow all saety proce-dures and include this in their job perormance evalu-ations.

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ConclusionsNationally, paramedics have high rates o occupational

exposure to blood. Lower exposure rates among Calior-

nia paramedics and among most hospital workers suggest

that practical steps can be taken to eectively reduce ex-

posures. This includes always providing and using appro-priate saety devices and PPE and promoting adherence

to saety procedures.

These steps will help protect the health o paramedics,

their co-workers and amily members, and the general

public.

AcknowledgmentsThe principal contributors to this document were

Winired L. Boal, National Institute or Occupational

Saety and Health, and Jack K. Leiss, Cedar Grove In-stitute or Sustainable Communities. NIOSH also ac-

knowledges the valuable assistance o Celia Fishman,

National Association o Emergency Medical Technicians;

and Joe Grat, National Association o Emergency Med-

ical Services Educators.

ReferencesBoal WL, Leiss JK, Sousa S, Lyden JT, Li J, Jagger J [2008].

The national study to prevent blood exposure in paramed-

ics: exposure reporting. Am J Ind Med 51(3):213222.Boal WL, Leiss JK, Ratclie JM, Sousa S, Lyden JT, Li J,

Jagger J [2010]. The national study to prevent blood ex-

posure in paramedics: rates o exposure to blood. Int Arch

Occup Environ Health 83:191199.

CFR. Code o Federal regulations. Washington, DC: U.S.

Government Printing Oce, Oce o the Federal Reg-

ister.

Leiss JK, Ratclie JM, Lyden JT, Sousa S, Orelien JG, Boal

WL, Jagger J [2006]. Blood exposure among paramedics:

incidence rates rom the national study to prevent blood

exposure in paramedics. Ann Epidemiol 16(9):720725.

Leiss JK, Sousa S, Boal WL [2009]. Circumstances sur-rounding occupational blood exposure events in the na-

tional study to prevent blood exposure in paramedics. In-

dustrial Health 47(2):139144.

Mathews R, Leiss JK, Lyden JT, Sousa S, Ratclie JM, Jag-

ger J [2008]. Provision and use o personal protective

equipment and saety devices in the national study to pre-

vent blood exposure in paramedics. Am J Inect Control

36(10):743749.

Train employees about bloodborne pathogens, saework practices, the proper use o saety devices andPPE, and other topics required by the BloodbornePathogens standard [29 CFR* 1910.1030]. Includethe opportunity or questions and answers with thetrainer.

Have a written Exposure Control Plan and update itannually.

Provide eective medical saety devices and involverontline workers in their selection.

Provide appropriate PPE and encourage its use. PPEincludes gloves; impermeable clothing; ace shieldsor surgical ace masks and eye protection; and mouth-pieces, resuscitation bags, pocket masks, or other ven-tilation devices.

Develop eective techniques or extricating patientsrom enclosed places, handling combative or uncoop-erative patients, and avoiding vomitus.

Encourage workers to report all blood or body fuidexposures. Identiy and address any barriers or atti-tudes that discourage reporting.

Review exposures to identiy patterns and opportuni-ties or prevention. Inorm workers o the ndings.

Implement a procedure or post-exposure evaluationand ollow-up.

Oer ree hepatitis B virus vaccinations, and encour-age workers to get vaccinated.

Paramedics

Follow Universal/Standard Precautions and other saetyprocedures (see www.cdc.gov/ncidod/dhqp/bp_universal_precautions.html).

Attend bloodborne pathogens and other saety training.

Use appropriate saety devices provided by your em-ployer.

Dispose o sharps properly.

Use appropriate PPE provided by your employer.

Avoid skin contact with blood, including on the arms.

Wash skin visibly soiled with body fuids with soap and

water. Ater skin contact with body fuids, even i skin is notvisibly soiled, use antimicrobial soap and water oralcohol-based sanitizer.

Report all exposures to blood and other potentially in-ectious materials to management.

Get vaccinated against hepatitis B virus.

*Code of Federal Regulations. See CFR in Reerences.

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers or Disease Control and PreventionNational Institute or Occupational Saety and Health

4676 Columbia ParkwayCincinnati, OH 452261998

Ofcial BusinessPenalty or Private Use $300

More inormation about bloodborne pathogens is available onthe NIOSH Web site at www.cdc.gov/niosh/topics/bbp and

on the OSHA Web site at www.osha.gov/SLTC/bloodborne-

pathogens/index.html.

More inormation or healthcare workers is available on the

NIOSH Web site at www.cdc.gov/niosh/topics/healthcare/.

To receive inormation about other occupational saety and

health topics, contact NIOSH at

Telephone: 1800CDCINFO (18002324636)

TTY: 18882326348 E-mail: cdcino@cdc.gov

or visit the NIOSH Web site at www.cdc.gov/niosh.

For a monthly update on news at NIOSH, subscribe toNIOSH

eNews by visiting www.cdc.gov/niosh/eNews.

Mention o any company or product does not constitute en-

dorsement by NIOSH. In addition, citations to Web sites ex-

ternal to NIOSH do not constitute NIOSH endorsement o the

sponsoring organizations or their programs or products. Further-

more, NIOSH is not responsible or the content o these Web

sites.

This document is in the public domain and may be

freely copied or reprinted. NIOSH encourages all

readers of the Workplace Solutions to make them

available to all interested employers and workers.

As part o the Centers or Disease Control and Prevention,NIOSH is the Federal agency responsible or conducting re-search and making recommendations to prevent work-relat-ed illnesses and injuries. All Workplace Solutions are based onresearch studies that show how worker exposures to hazard-ous agents or activities can be signicantly reduced.

Preventing Exposures to Bloodborne Pathogens

among Paramedics

DHHS (NIOSH) Publication No. 2010139

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safer healthier people April 2010