Healthcare workers are at risk of acquiring blood‐borne infections such as human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS), hepatitis B and hepatitis C. While the risk is small, there were 4830 significant occupational exposures to a blood‐borne virus reported among healthcare workers between 2004 and 2013. Of these, half were exposed to hepatitis C, a third to HIV and a tenth to hepatitis B. Of these exposures, 71% involved a percutaneous needle stick injury (the majority were sharps injuries involving a hollow‐bore needle) and 65% occurred in wards, theatres or A&E (PHE [94]; Woode Owusu et al. [131]). An understanding of the risk of infection and the preventive measures to be taken is essential in promoting a safer work environment (DH [19]).

Blood‐borne viruses are present in the blood and in other high‐risk fluids, which should be handled with the same precautions as blood. High‐risk fluids include:

Body fluids that do not need to be regarded as high risk, unless they are blood stained, are:

The most likely route of infection for healthcare workers is through the percutaneous inoculation of infected blood via a sharps injury (often called a needle stick injury) or by blood or other high‐risk fluid splashing onto broken skin or a mucous membrane in the mouth, nose or eyes. These incidents are collectively known as ‘inoculation injuries’. An EU directive incorporated into UK law requires healthcare organizations to use safe devices and systems of work to minimize the risk of inoculation injury (HSE [59]). Blood or another high‐risk fluid coming into contact with intact skin is not regarded as an inoculation injury. It carries little or no risk due to the impervious nature of intact skin. The guidance in Box 4.4 has been shown to reduce the risk of sharps injuries.