What Are Bloodborne Pathogens?
Bloodborne pathogens (BBPs) are infectious microorganisms found in human blood and certain other body fluids that can cause disease in humans. As firefighters and first responders, we face exposure risks on nearly every medical call, motor vehicle accident, and rescue situation.
The three bloodborne pathogens of primary concern are Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV). Each of these can cause serious, life-altering illness — but the good news is that exposure is preventable when we follow proper protocols.
- Hepatitis B (HBV) — Attacks the liver. Can survive outside the body on surfaces for up to 7 days. A vaccine is available and required for all first responders.
- Hepatitis C (HCV) — Also attacks the liver. The most common chronic bloodborne infection in the U.S. No vaccine currently exists; treatment is available.
- HIV — Attacks the immune system. Cannot survive long outside the body. Post-exposure prophylaxis (PEP) can greatly reduce infection risk if started within 72 hours.
How Exposure Happens
Understanding how bloodborne pathogens enter the body is critical to preventing exposure. Pathogens require a route of entry — they cannot penetrate intact, healthy skin on their own. However, the fireground and emergency scenes present many opportunities for that barrier to be compromised.
Needlestick / Sharps
Puncture wounds from contaminated needles, broken glass, jagged metal, or bone fragments
Mucous Membranes
Splash or spray of blood/body fluids to the eyes, nose, or mouth
Non-Intact Skin
Contact with cuts, abrasions, chapped skin, dermatitis, or hangnails
Parenteral Contact
Human bites that break the skin or contact with open wounds during patient care
Other potentially infectious materials (OPIM) include semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, and any body fluid visibly contaminated with blood. When in doubt, treat all body fluids as potentially infectious.
Personal Protective Equipment (PPE)
PPE is your primary defense against bloodborne pathogen exposure. The type and extent of PPE should be based on the anticipated level of exposure. You should always assess the scene and upgrade your protection level as the situation dictates. Never downgrade PPE during active patient contact.
| Scenario | Minimum Required PPE |
|---|---|
| Basic patient assessment (no visible blood) | Nitrile gloves |
| Wound care, bleeding control | Nitrile gloves + eye protection + gown |
| Airway management / suctioning | Nitrile gloves + face shield or mask with eye protection |
| Childbirth / major trauma | Nitrile gloves + gown + face shield + shoe covers |
| CPR / rescue breathing | Pocket mask or BVM + nitrile gloves + eye protection |
| Cleaning up blood / body fluid spill | Nitrile gloves + eye protection + gown (if splash risk) |
Never use latex gloves — they can cause severe allergic reactions. Mascoutah FD stocks nitrile gloves on all apparatus. Double-gloving is recommended for any situation involving heavy blood exposure or sharps handling. Always change gloves between patients.
Safe Work Practices & Engineering Controls
Beyond PPE, safe work practices and engineering controls form additional layers of protection. These are the habits and tools that reduce the likelihood of exposure even if PPE fails.
- Hand hygiene — Wash hands with soap and water (or use alcohol-based sanitizer) immediately after removing gloves and after any patient contact. This is the single most effective way to prevent infection transmission.
- Sharps handling — Never recap, bend, or break needles. Use one-handed scoop technique if recapping is absolutely necessary. Dispose of sharps immediately into a puncture-resistant container.
- No hand-to-face contact — Do not eat, drink, smoke, apply lip balm, or handle contact lenses in areas where there is potential for exposure.
- Decontamination — Clean and disinfect all equipment and surfaces after calls involving blood or OPIM using an EPA-registered tuberculocidal disinfectant or a freshly prepared 1:10 bleach solution.
- Bag it and tag it — Place all contaminated linens and waste in red biohazard bags. Contaminated sharps go in labeled puncture-resistant containers.
- Minimize splashing — Use caution when handling containers of blood or body fluids to minimize splashing, spraying, or aerosolizing.
Hepatitis B Vaccination
OSHA mandates that employers offer the Hepatitis B vaccine series to all employees with occupational exposure — at no cost to the employee. This vaccine is your best defense against HBV infection.
The vaccine is a three-dose series given over six months (0 months, 1 month, 6 months). After completing the series, a blood titer test confirms your immunity. Over 90% of healthy adults develop adequate antibody response after the full series.
If you have not completed the Hepatitis B vaccine series, or if you're unsure of your vaccination status, notify your officer immediately. You may decline the vaccine by signing a declination form, but you can change your mind and receive the vaccine at any time at no cost. There is no vaccine currently available for Hepatitis C or HIV.
Post-Exposure Procedures
If you experience an exposure incident — a specific eye, mouth, mucous membrane, non-intact skin, or parenteral contact with blood or OPIM — you must act immediately. Quick action can significantly reduce your risk of infection.
- Immediately cleanse the exposure site. For needle sticks and cuts, wash thoroughly with soap and running water. For mucous membranes (eyes, nose, mouth), flush with clean water for at least 15 minutes.
- Report the exposure to your officer immediately. Do not wait until end of shift or the next day. Time is critical.
- Document the incident. Complete an exposure report form including the date, time, route of exposure, type of fluid involved, and the circumstances of the incident.
- Seek medical evaluation promptly. Go to the designated healthcare provider or emergency department. Medical evaluation should occur within 2 hours whenever possible.
- Identify the source individual (if possible). The source individual's blood should be tested for HBV, HCV, and HIV (with their consent). If consent cannot be obtained, document the refusal.
- Baseline blood draw. Your blood will be collected and tested for HBV, HCV, and HIV to establish your baseline status at the time of exposure.
- Follow-up care. Follow your healthcare provider's guidance on post-exposure prophylaxis (PEP) and complete all recommended follow-up testing at 6 weeks, 3 months, and 6 months.
HIV post-exposure prophylaxis (PEP) must begin within 72 hours of exposure, but is most effective when started within 2 hours. Hepatitis B immunoglobulin (HBIG), if needed, should be administered within 24 hours. Do not delay reporting.
Decontamination & Waste Disposal
Proper decontamination and waste disposal are essential to protecting yourself, your crew, and the community after every call involving blood or body fluids.
- Apparatus surfaces — Wipe down stretcher, compartment floors, grab rails, and any contacted surfaces with EPA-registered disinfectant. Allow required wet contact time (usually 1–10 minutes depending on the product).
- Tools and equipment — Disinfect all reusable medical equipment (shears, stethoscopes, BP cuffs) per manufacturer guidelines.
- Turnout gear — If contaminated with blood, bag separately and launder per department protocol. Do not take contaminated gear home.
- Uniform contamination — Change out of contaminated clothing as soon as possible. Place in a biohazard bag for proper laundering.
- Biohazard waste — All items saturated or dripping with blood, and all sharps, go in labeled red biohazard bags or containers. These are disposed of through a licensed biomedical waste service.
A fresh 1:10 household bleach solution (1 part bleach to 9 parts water) is effective for surface decontamination. The solution must be prepared daily — it loses potency after 24 hours. Always ensure adequate ventilation when using bleach.
📝 Knowledge Check
Answer all 6 questions — 5 out of 6 required to pass