This page is intended to provide tips/ advice for clinicians managing a patient at risk of exposure to a blood borne virus (BBV). There is no expectation that community clinicians are risk assessing, undertaking investigations or providing treatment (post-exposure prophylaxis, or PEP).
If any blood tests or treatment is needed either in-hours or OOH then patients should be referred to secondary care (ED usually). We encourage you to call the ED advice lines for support if you are unsure whether ED involvement is or is not required.
Some background information about BBV exposures
- The majority of needle stick and sexual exposure cases don’t require HIV PEP.
- The combined UHBW and NBT guideline includes the detail about HIV risk assessment and PEP.
- As mentioned before, there is no expectation that a community clinician will undertake this risk assessment. However, the tool may be useful if it enables you to confidently determine that PEP is not required (potentially with support/ advice from the ED consultant line or virology), and this could in turn avoid referral to ED.
- If there is uncertainty, or bloods or PEP are required, please refer to ED.
- If a decision is made to prescribe HIV PEP then ED prescribe this for 3-4 days and then a 28 day full-course is prescribed following assessment by the HIV team. ED will refer all patients initiated on HIV PEP to the HIV team at NBT.
- For Hepatitis B exposure, most patients need a baseline blood test and to start a Hepatitis B immunisation course. Hepatitis B immunoglobulin would be indicated if the donor patient was known to have Hepatitis B or it was a high-risk exposure. Contact ED or virology for advice. The Green book has a useful guideline to help stratify risk following potential Hepatitis B exposure in the Hepatitis B chapter.
NHS healthcare staff and 'exposure injuries'
- UHBW have a guideline, covering management of a staff member subject to an ‘exposure injury’ (needlestick/injury from clinical instruments or splash of bodily fluids to eye/mouth/mucous membrane) during the OOH period.
- These are often managed in ED in the OOH period, and followed up by Occupational Health.
Spiking incidents (both drink and injection spiking)
- Please see here for the NBT spiking guideline.
- If a patient is asymptomatic following possible/ confirmed drink spiking, they are unlikely to require any medical investigation/intervention. Advice can be sought from ED. Safeguarding needs to be considered and the individual should be encouraged/ advised to report all incidents to the police.
- Suspected needle-spiking incidents are often managed in ED. A risk assessment can be undertaken in the community, with advice sought from ED/virology if needed (as outlined above).
- The Clinical Toolkit has a page covering needle spiking specifically.
Please note, the NBT/UBHW guidelines we have referenced are written and owned by the acute trusts. We have made a note of the review dates for these documents. Please be aware we can not provide a live link to the intranet of the acutes trusts and are thus hosting these documents on our toolkit.
Review date for this page – August 2025