In the dangerous world of law enforcement, a peace
officer's exposure to human bodily fluids and fluid-related infections is not
typically discussed as a topic of officer safety. Unlike the
obvious danger of being assaulted, the risks of blood-borne
infections are silent with virtually no recognizable warning signs. As potentially
life-threatening as any violent encounter, certain contagious
infections have significant adverse consequences, which
can extend to an individual’s family health, as well as the fitness
to continue a career in law enforcement. Peace officers dedicate the
majority of their time preparing for an immediate
violent threat. Firearms training, defensive tactics and the wearing of
body armor all play major roles in crisis preparation. In the presence of these
modern silent killers, it’s important to recognize the risks
associated with body-fluid exposure and to pursue the education, planning
and prevention of exposure and transmission of these diseases.
The Centers for Disease Control and Prevention (CDC)
estimates that more than one million people are infected with the
Human Immunodeficiency Virus (HIV) in the United States.1 It is
estimated that 1.2 million individuals are infected with the
Hepatitis B virus and 3.2 million are infected with the Hepatitis C
virus.2,3 All three of these viral infections will lead
to death. The majority of infected individuals do
not show outward signs of their disease and may be
unaware of their contagious risk. Regardless of the situation, age or
sex of an individual, the universal precaution protocol should be followed with
any contact in the field.4 The route of work-related transmission of
HIV, Hepatitis B and Hepatitis C to a peace officer is identical to any
other first responder or health care provider.5,6 Exposure to bodily
fluids, especially blood through an open wound, eye contact, needle sticks or a
human bite, are the most common pathways for infectious transmission.5,6
Research about the relative risk of law enforcement officers being infected
after an exposure is not well defined and minimal in comparison
to the amount of research directed toward health care workers
and their related risk.
The backbone of all law enforcement
operations entails planning and prevention on a daily basis. As
with U.S. health care protocol, the use of universal precautions
should be standard operating procedure within law enforcement.4
Although federal safety mandate requires every law enforcement agency to
supply gloves and eye protection in every patrol car, comprehensive officer
safety does not stop at federal law or OHSA requirements.7,8 Peace
officers should make every effort to follow a daily routine of precaution
and proactiveness. This should include covering all wounds or
scratches with a waterproof dressing prior to dressing in uniform.
Beginning each shift wiping down shared equipment with an
antiseptic wipe, as well as after every use, is also good practice.
Another one is making every attempt to wash both hands with an anti-bacterial
soap after removing protective gloves each time. All of these are good simple practices
that will help lower the risk of infectious transmission after an
exposure.
Despite the best precautions, bodily fluid
exposure will occur at some point during a career in law enforcement. Not all
bodily fluids have the same risk of infectious transmission.5,6 The
types of bodily fluid vary in risk of infectious transmission. Blood, semen and
vaginal fluid exposure carry the highest risk of infection.5,6 For
HIV and Hepatitis B, there are currently no documented cases of transmission
through urine, feces, sputum or vomitus.5,6 In the dynamic world of
law enforcement, determining what specific bodily fluid was included in an
exposure is almost impossible. For a peace officer, all bodily fluid contacts
should be treated the same. Post exposure, wash the affected area with an
antiseptic soap as soon as time allows and scrub it vigorously. Contact a
supervisor and inform them of the exposure. OSHA regulations require every
department to have a formal bodily fluid exposure policy and plan.7,8
Federal law requires that an employee be seen by a licensed physician within
one hour of exposure.7,8 Department supervisors should be able to
provide guidance in regard to departmental policy and adherence to OSHA
guidelines. Do not be embarrassed or reluctant to seek medical attention
immediately. Federal law requires that all law enforcement agencies keep this
information strictly confidential.7,8 Do not deny the significance
of a scratch or needle stick. Receiving care in hours — not days — can
make the difference in life or death. Not all medical providers will be up to
date on current CDC recommendations. Demand current CDC protocols be reviewed
by your medical provider and presented to you with the facts of your case
in mind.
It is important to consider both the bodily fluid
and the type of exposure. Not all exposures carry the same risk of infectious
transmission. The CDC classifies exposure into three categories: Category I
include all dirty needle sticks and contact of bodily fluids in the area of an
open cut or wound.5,6 For example, a human bite falls into Category
I.5,6 Category II includes exposure in the eyes, nose and mouth.5,6
Category III includes contact with a bodily fluid on skin that has no open
wounds or scratches.5,6 The chance of infection after a category III
exposure is virtually zero.4,5
HIV is responsible for the AIDS syndrome. Though
current treatment has made dramatic changes in how HIV is viewed, it has no
cure or vaccine, and without treatment it will lead to death. Current data
shows a transmission rate after an infected needle stick to be 0.3% and
exposure with infected fluid with a wound or scrape on your skin to be 0.1%.5,6
There are no current documented cases of transmission of HIV after exposure to
infected fluid with intact skin, i.e., blood on hands, skin or uniform with no
scrapes or cuts. The virus is considered to be very weak. It is typically
killed with hand soap, clothing detergent or any of the commercial antiseptic
lotions available.9 The virus dies very quickly when outside the body.9
If a category I or II exposure does occur, seek immediate medical attention. Do
not wait to complete an assignment or shift.
In 2008, with never-reported details, previously
sealed New York state court documents disclosed the medical retirements of four
New York City police officers who were infected with HIV on the job. Court
documents indicated one officer was cut with a contaminated razor blade,
another one was bitten in the hand by a HIV positive criminal and the third
sustained a cut to the hand while searching a prisoner.10 The route
of infection for the fourth officer is not known. None of the infected officers
completed exposure reports at the time of the incidents, making it impossible
to prove their exposures were work related.9 At the time of the
court hearings, one HIV infected female officer was also claiming duty-related
exposure from her sexual relationship with one of the four infected male
officers.10,11,12 Brooklyn federal court records indicate that the
NYPD Pension Board reviewed the claims of a total of 12 HIV infected officers
from November 1999 and August 2007.10
The present antiviral drugs have been shown to be
very successful in preventing viral transmission but must be started
immediately if the exposure was high risk. Because not all people will tell you
they are either HIV or Hepatitis positive or even know their status, knowing
state law in regard to forced testing is important. The Fourth Amendment has
jurisdiction over forced testing. Voluntary consent to test an individual’s
blood is the best method to achieve results. While still in the field, try to
get as much information about the person’s medical past. A history of IV drug
use, incarcerations, sexual orientation and previous blood transfusions are
important pieces of information in determining relative risk. While on scene,
don’t be concerned about saving the needle or fluid-contaminated object
involved in the exposure. Testing the fluid on the needle has shown to be very
inaccurate and not worthwhile.6 Further, trying to transport the
needle only increases the risk of being injured again. The information gathered
from a suspect or victim will be very helpful to physicians when it is not
clear cut if antiviral drugs will be recommended. The drugs have very serious
side effects that need to be discussed prior to initiation of treatment.
Because of this risk of these drugs, it is recommended that only certain
exposures be treated.5,6 If your exposure is not category I or II,
no treatment is recommended.5,6 If your exposure is a category I or
II and the HIV status is not immediately known, your physician will discuss
with you the options and risks. This is where finding out information on the
subject or victim is so important. Female officers who could possibly be
pregnant should have an immediate pregnancy test prior to starting any
treatment.
Hepatitis B is one of the scariest of the “silent
killers” out there. It can remain alive and infectious seven days outside the
body.6 Like with HIV, there appears to be no known risk of
transmission when Hepatitis B-infected blood makes contact with clothes or skin
that has no wounds or scrapes.5,6 Unlike HIV, the risk of
transmission of Hepatitis B after a human bite is real.2 Depending
on the viral count in the infected blood, the chance of becoming infected can
reach as high as 30% after a bite.2 On July 24, 1991, Front Royal
Police Lieutenant William Farrell died from complications of Hepatitis B. He
contracted the virus during an on-duty fight where he was scratched and bitten.13
The Hepatitis B vaccine, a three-shot series, is very effective in prevention
of this virus, but must be received prior to exposure. Becoming Hepatitis B
positive will eventually lead to liver failure and death. After infection,
there is no treatment at this time. By law, the Hepatitis B vaccine must be
provided free of charge by your agency.7,8 To be effective, the
vaccination series should occur at the start of a career. Every 5-7 years, the
effectiveness of the vaccine should be checked with a simple blood test. If you
have had the vaccine and testing shows that it’s effective, there is no
recommended treatment for a Hepatitis B exposure, regardless if the status of
the subject is positive or not.6
Hepatitis C, like Hepatitis B infections, will
ultimately lead to liver failure and death if a liver transplant is not
available. The risk of infection after a dirty needle exposure is 1.8%.3 Risk
after fluid exposure to your eyes or mouth is 0.9%.3 Though the risk
of acquiring Hepatitis C from a human bite is much lower than Hepatitis B, the
risk is estimated to be approximately 2% depending on the viral count of the
infected person.14 There is no treatment currently for exposure to
Hepatitis C infected fluid.5 During the ensuing fight and arrest of
a drunk man 24 years ago, a Blue Mound Police Officer was bitten in the arm.
After two years of unexplained fatigue, the officer was diagnosed with
Hepatitis C. In 2010, the retired 57-year-old man was fighting liver cancer and
cirrhosis and desperately waiting for a liver transplant to save his life.15
Unlike Hepatitis B, there is no vaccine to prevent the infection.5
It too can live outside the body for a long period of time, living up to four
days at room temperature.4,5 It is a very strong virus that is hard
to kill and washing your hands may not be enough. Some recommend washing your
exposed skin with diluted bleach, but this may not be practical. Because both
forms of Hepatitis can survive outside the body for so long, cleaning all
shared and restraint equipment is important.
How long these silent killers can live outside the
body is important information to know and consider when thinking about possible
treatments.
HIV
Considered a very weak virus.
Usually killed with hand soap.
Dies very quickly outside the body.
HEPATITIS B
One of the scariest of the silent killers.
Washing hands helps decrease risk of infection.
Can remain alive up to seven days
outside the body.
HEPATITIS C
Very strong virus that is hard to kill.
Washing hands may not be enough.
Can live up to four days outside the
body.
Like all aspects in law enforcement, planning ahead
and developing a routine is key to decreasing the risk of infectious fluid
exposure. Wearing of gloves and eye protection should be part of every
pre-shift checklist. Checking for any skin wounds and covering them with a
waterproof barrier should occur before a uniform goes on. Spending a few
moments cleaning the shared equipment should occur daily. Washing the area
vigorously with anti-bacterial soap or the equivalent as soon as possible after
exposure could be a life saving practice. Remembering to interview your subject
or victim in regard to high-risk behavior will greatly help in defining the
risk of an exposure and in evaluating treatment options. Their cooperation and
voluntary consent will go a long way in expediting your need for immediate care
and treatment. Don’t deny the danger of a silent killer.
