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Copyright (c) 2025 Ahmed Jardi Ali Majmi, Khalil Mohammed Khalil Aldhuwaymir, Abdullah Ali Nasser Alshehri, Monirah Salem Alharbi, Hanan Faris Ahmed Muswadi, Basmah Abdulelah Abdullah Madkhali, Yara Abduh Ali Sultan, Nemat Nour Allah Qari, Abdulaziz Salman Almukhalfa, Jawaher Mohammed Abkar Zailai, Fatimah Ibrahim Ali Sharwani, Wejdan Abdullah Ahmed Ali, Afnan Obeid Saeed Alanzi

This work is licensed under a Creative Commons Attribution 4.0 International License.
Occupational Exposure to Bloodborne Pathogens Among Nurses, Dental Staff, and Health Security Workers-An Updated Review
Corresponding Author(s) : Ahmed Jardi Ali Majmi
Saudi Journal of Medicine and Public Health, Vol. 2 No. 2 (2025)
Abstract
Background: Occupational exposure to bloodborne pathogens remains a significant hazard for healthcare workers despite the implementation of global safety standards such as the OSHA Bloodborne Pathogens Standard. Nurses, dental staff, and health security workers are particularly vulnerable due to frequent contact with blood and body fluids, increasing the risk of transmission of HIV, HBV, and HCV.
Aim: This review aims to synthesize updated evidence on occupational exposure risks, regulatory frameworks, preventive strategies, and ongoing challenges among nurses, dental personnel, and health security workers.
Methods: A narrative updated review approach was used, analyzing regulatory guidelines, epidemiological data, and recent literature on occupational exposure, infection control practices, and preventive interventions in healthcare settings.
Results: Findings indicate that needlestick injuries and sharps-related incidents remain the primary route of exposure. HBV, HCV, and HIV continue to represent the most clinically significant pathogens. Despite vaccination programs, engineering controls, and training initiatives, compliance gaps, underreporting, inconsistent PPE use, and suboptimal adherence to standard precautions persist. Economic burden and psychological distress among exposed workers remain substantial.
Conclusion: Occupational exposure to bloodborne pathogens continues to pose a multidimensional challenge requiring strengthened compliance, improved training, and system-wide safety culture. Interprofessional collaboration and strict adherence to OSHA standards are essential for reducing risk.
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- Occupational exposure to bloodborne pathogens--OSHA. Final rule. Fed Regist. 1991 Dec 06;56(235):64004-182.
- Wicker S, Stirn AV, Rabenau HF, von Gierke L, Wutzler S, Stephan C. Needlestick injuries: causes, preventability and psychological impact. Infection. 2014 Jun;42(3):549-52.
- Abdo Almoliky M, Elzilal HA, Alzahrani E, Abo-Dief HM, Saleh KA, Alkubati SA, Saad MS, Sultan MA. Prevalence and associated factors of needle stick and sharp injuries among nurses: A cross-sectional study. SAGE Open Med. 2024;12:20503121231221445.
- Collins CH, Kennedy DA. Microbiological hazards of occupational needlestick and 'sharps' injuries. J Appl Bacteriol. 1987 May;62(5):385-402.
- Guilbert JJ. The world health report 2002 - reducing risks, promoting healthy life. Educ Health (Abingdon). 2003 Jul;16(2):230.
- Mironova M, Ghany MG. Hepatitis B Vaccine: Four Decades on. Vaccines (Basel). 2024 Apr 18;12(4)
- Schillie S, Vellozzi C, Reingold A, Harris A, Haber P, Ward JW, Nelson NP. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018 Jan 12;67(1):1-31.
- Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.
- Lin CL, Kao JH. Global strategies and actions to eliminate hepatitis B virus infection. Clin Mol Hepatol. 2025 Oct;31(4):1197-1212.
- Karimi SM, Poursafargholi S, Bayan Mohamed Y, Zarei H, Moghadami M, Rose M, Goldsby M, Fu W, Little BB. The association of direct-acting antiviral therapy with health care utilization and costs in patients with chronic hepatitis C virus infection: A systematic review of real-world studies in the United States. J Manag Care Spec Pharm. 2025 Nov;31(11):1189-1200.
- Premkumar M, Dhiman RK. Direct-Acting Antiviral Agents for HCV Infection. J Clin Exp Hepatol. 2018 Mar;8(1):1-2.
- Kerkar N, Hartjes K. Hepatitis C Virus-Pediatric and Adult Perspectives in the Current Decade. Pathogens. 2024 Dec 29;14(1)
- Bhattacharya D, Aronsohn A, Price J, Lo Re V., AASLD-IDSA HCV Guidance Panel. Hepatitis C Guidance 2023 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Clin Infect Dis. 2023 May 25;
- Peters RPH, Grinsztejn B, Celum C, Mayer KH, Molina JM, Delany-Moretlwe S, Ngure K, Torres-Rueda S, Guy RJ, Reiss P, Ferrand RA, Kittiyaowamarn R, Bekker LG. Innovations in the biomedical prevention, diagnosis, and service delivery of HIV and other sexually transmitted infections. Lancet. 2025 Nov 01;406(10515):2133-2151.
- Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2020 Apr 15;4(4):CD011621.
- Boyce JM, Pittet D., Healthcare Infection Control Practices Advisory Committee. HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002 Oct 25;51(RR-16):1-45, quiz CE1-4.
- Boyce JM. Update on hand hygiene. Am J Infect Control. 2013 May;41(5 Suppl):S94-6.
- Lotfinejad N, Peters A, Tartari E, Fankhauser-Rodriguez C, Pires D, Pittet D. Hand hygiene in health care: 20 years of ongoing advances and perspectives. Lancet Infect Dis. 2021 Aug;21(8):e209-e221.
- Kuhar DT, Henderson DK, Struble KA, Heneine W, Thomas V, Cheever LW, Gomaa A, Panlilio AL., US Public Health Service Working Group. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):875-92.
- Tatelbaum MF. Needlestick safety and prevention act. Pain Physician. 2001 Apr;4(2):193-5.
- Tuma S, Sepkowitz KA. Efficacy of safety-engineered device implementation in the prevention of percutaneous injuries: a review of published studies. Clin Infect Dis. 2006 Apr 15;42(8):1159-70.
- Phillips EK, Conaway MR, Jagger JC. Percutaneous injuries before and after the Needlestick Safety and Prevention Act. N Engl J Med. 2012 Feb 16;366(7):670-1.
- Beekmann SE, Henderson DK. Protection of healthcare workers from bloodborne pathogens. Curr Opin Infect Dis. 2005 Aug;18(4):331-6.
- Kilinc Balci FS. Isolation gowns in health care settings: Laboratory studies, regulations and standards, and potential barriers of gown selection and use. Am J Infect Control. 2016 Jan 01;44(1):104-11.
- Howsepian AA. Post-traumatic stress disorder following needle-stick contaminated with suspected HIV-positive blood. Gen Hosp Psychiatry. 1998 Mar;20(2):123-4.
- Mannocci A, De Carli G, Di Bari V, Saulle R, Unim B, Nicolotti N, Carbonari L, Puro V, La Torre G. How Much do Needlestick Injuries Cost? A Systematic Review of the Economic Evaluations of Needlestick and Sharps Injuries Among Healthcare Personnel. Infect Control Hosp Epidemiol. 2016 Jun;37(6):635-46.
- Cooke CE, Stephens JM. Clinical, economic, and humanistic burden of needlestick injuries in healthcare workers. Med Devices (Auckl). 2017;10:225-235.
- Kunishima H, Yoshida E, Caputo J, Mikamo H. Estimating the national cost burden of in-hospital needlestick injuries among healthcare workers in Japan. PLoS One. 2019;14(11):e0224142.
- Oh HS, Yoon Chang SW, Choi JS, Park ES, Jin HY. Costs of postexposure management of occupational sharps injuries in health care workers in the Republic of Korea. Am J Infect Control. 2013 Jan;41(1):61-5.
- Tabah A, Ramanan M, Laupland KB, Buetti N, Cortegiani A, Mellinghoff J, Conway Morris A, Camporota L, Zappella N, Elhadi M, Povoa P, Amrein K, Vidal G, Derde L, Bassetti M, Francois G, Ssi Yan Kai N, De Waele JJ., PPE-SAFE contributors. Personal protective equipment and intensive care unit healthcare worker safety in the COVID-19 era (PPE-SAFE): An international survey. J Crit Care. 2020 Oct;59:70-75.
- Hessels AJ, Genovese-Schek V, Agarwal M, Wurmser T, Larson EL. Relationship between patient safety climate and adherence to standard precautions. Am J Infect Control. 2016 Oct 01;44(10):1128-1132.
- Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC, van Beeck EF. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol. 2010 Mar;31(3):283-94.
- Glowicz JB, Landon E, Sickbert-Bennett EE, Aiello AE, deKay K, Hoffmann KK, Maragakis L, Olmsted RN, Polgreen PM, Trexler PA, VanAmringe MA, Wood AR, Yokoe D, Ellingson KD. SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol. 2023 Mar;44(3):355-376.
- Weaver MG. Using active learning strategies to present bloodborne pathogen programs. J Sch Nurs. 2003 Jun;19(3):181-4.
- Zhang Z, Yamamoto T, Wu XN, Moji K, Cai GX, Kuroiwa C. Educational intervention for preventing bloodborne infection among medical students in China. J Hosp Infect. 2010 May;75(1):47-51.
- Dogra S, Mahajan R, Jad B, Mahajan B. Educational interventions to improve knowledge and skills of interns towards prevention and control of hospital-associated infections. Int J Appl Basic Med Res. 2015 Aug;5(Suppl 1):S54-7.
- Agerton TB, Mahoney FJ, Polish LB, Shapiro CN. Impact of the bloodborne pathogens standard on vaccination of healthcare workers with hepatitis B vaccine. Infect Control Hosp Epidemiol. 1995 May;16(5):287-91.
- Strelow B, Roxas EG, Perkins KM, Frick SJ, Wagner EL, Petersen EE, Alimire M, Olson R, Wingo M, O'Laughlin D. Boosting Hepatitis B Vaccination Rates Among Healthcare Workers in the State of Minnesota. J Community Health. 2025 Dec;50(6):1144-1149.
- Vaid N, Langan KM, Maude RJ. Post-exposure prophylaxis in resource-poor settings: review and recommendations for pre-departure risk assessment and planning for expatriate healthcare workers. Trop Med Int Health. 2013 May;18(5):588-95.
- Bekele T, Gebremariam A, Kaso M, Ahmed K. Attitude, reporting behavour and management practice of occupational needle stick and sharps injuries among hospital healthcare workers in Bale zone, Southeast Ethiopia: a cross-sectional study. J Occup Med Toxicol. 2015;10:42.
- Bush C, Schmid K, Rupp ME, Watanabe-Galloway S, Wolford B, Sandkovsky U. Bloodborne pathogen exposures: Difference in reporting rates and individual predictors among health care personnel. Am J Infect Control. 2017 Apr 01;45(4):372-376.
References
Occupational exposure to bloodborne pathogens--OSHA. Final rule. Fed Regist. 1991 Dec 06;56(235):64004-182.
Wicker S, Stirn AV, Rabenau HF, von Gierke L, Wutzler S, Stephan C. Needlestick injuries: causes, preventability and psychological impact. Infection. 2014 Jun;42(3):549-52.
Abdo Almoliky M, Elzilal HA, Alzahrani E, Abo-Dief HM, Saleh KA, Alkubati SA, Saad MS, Sultan MA. Prevalence and associated factors of needle stick and sharp injuries among nurses: A cross-sectional study. SAGE Open Med. 2024;12:20503121231221445.
Collins CH, Kennedy DA. Microbiological hazards of occupational needlestick and 'sharps' injuries. J Appl Bacteriol. 1987 May;62(5):385-402.
Guilbert JJ. The world health report 2002 - reducing risks, promoting healthy life. Educ Health (Abingdon). 2003 Jul;16(2):230.
Mironova M, Ghany MG. Hepatitis B Vaccine: Four Decades on. Vaccines (Basel). 2024 Apr 18;12(4)
Schillie S, Vellozzi C, Reingold A, Harris A, Haber P, Ward JW, Nelson NP. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018 Jan 12;67(1):1-31.
Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.
Lin CL, Kao JH. Global strategies and actions to eliminate hepatitis B virus infection. Clin Mol Hepatol. 2025 Oct;31(4):1197-1212.
Karimi SM, Poursafargholi S, Bayan Mohamed Y, Zarei H, Moghadami M, Rose M, Goldsby M, Fu W, Little BB. The association of direct-acting antiviral therapy with health care utilization and costs in patients with chronic hepatitis C virus infection: A systematic review of real-world studies in the United States. J Manag Care Spec Pharm. 2025 Nov;31(11):1189-1200.
Premkumar M, Dhiman RK. Direct-Acting Antiviral Agents for HCV Infection. J Clin Exp Hepatol. 2018 Mar;8(1):1-2.
Kerkar N, Hartjes K. Hepatitis C Virus-Pediatric and Adult Perspectives in the Current Decade. Pathogens. 2024 Dec 29;14(1)
Bhattacharya D, Aronsohn A, Price J, Lo Re V., AASLD-IDSA HCV Guidance Panel. Hepatitis C Guidance 2023 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Clin Infect Dis. 2023 May 25;
Peters RPH, Grinsztejn B, Celum C, Mayer KH, Molina JM, Delany-Moretlwe S, Ngure K, Torres-Rueda S, Guy RJ, Reiss P, Ferrand RA, Kittiyaowamarn R, Bekker LG. Innovations in the biomedical prevention, diagnosis, and service delivery of HIV and other sexually transmitted infections. Lancet. 2025 Nov 01;406(10515):2133-2151.
Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2020 Apr 15;4(4):CD011621.
Boyce JM, Pittet D., Healthcare Infection Control Practices Advisory Committee. HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002 Oct 25;51(RR-16):1-45, quiz CE1-4.
Boyce JM. Update on hand hygiene. Am J Infect Control. 2013 May;41(5 Suppl):S94-6.
Lotfinejad N, Peters A, Tartari E, Fankhauser-Rodriguez C, Pires D, Pittet D. Hand hygiene in health care: 20 years of ongoing advances and perspectives. Lancet Infect Dis. 2021 Aug;21(8):e209-e221.
Kuhar DT, Henderson DK, Struble KA, Heneine W, Thomas V, Cheever LW, Gomaa A, Panlilio AL., US Public Health Service Working Group. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):875-92.
Tatelbaum MF. Needlestick safety and prevention act. Pain Physician. 2001 Apr;4(2):193-5.
Tuma S, Sepkowitz KA. Efficacy of safety-engineered device implementation in the prevention of percutaneous injuries: a review of published studies. Clin Infect Dis. 2006 Apr 15;42(8):1159-70.
Phillips EK, Conaway MR, Jagger JC. Percutaneous injuries before and after the Needlestick Safety and Prevention Act. N Engl J Med. 2012 Feb 16;366(7):670-1.
Beekmann SE, Henderson DK. Protection of healthcare workers from bloodborne pathogens. Curr Opin Infect Dis. 2005 Aug;18(4):331-6.
Kilinc Balci FS. Isolation gowns in health care settings: Laboratory studies, regulations and standards, and potential barriers of gown selection and use. Am J Infect Control. 2016 Jan 01;44(1):104-11.
Howsepian AA. Post-traumatic stress disorder following needle-stick contaminated with suspected HIV-positive blood. Gen Hosp Psychiatry. 1998 Mar;20(2):123-4.
Mannocci A, De Carli G, Di Bari V, Saulle R, Unim B, Nicolotti N, Carbonari L, Puro V, La Torre G. How Much do Needlestick Injuries Cost? A Systematic Review of the Economic Evaluations of Needlestick and Sharps Injuries Among Healthcare Personnel. Infect Control Hosp Epidemiol. 2016 Jun;37(6):635-46.
Cooke CE, Stephens JM. Clinical, economic, and humanistic burden of needlestick injuries in healthcare workers. Med Devices (Auckl). 2017;10:225-235.
Kunishima H, Yoshida E, Caputo J, Mikamo H. Estimating the national cost burden of in-hospital needlestick injuries among healthcare workers in Japan. PLoS One. 2019;14(11):e0224142.
Oh HS, Yoon Chang SW, Choi JS, Park ES, Jin HY. Costs of postexposure management of occupational sharps injuries in health care workers in the Republic of Korea. Am J Infect Control. 2013 Jan;41(1):61-5.
Tabah A, Ramanan M, Laupland KB, Buetti N, Cortegiani A, Mellinghoff J, Conway Morris A, Camporota L, Zappella N, Elhadi M, Povoa P, Amrein K, Vidal G, Derde L, Bassetti M, Francois G, Ssi Yan Kai N, De Waele JJ., PPE-SAFE contributors. Personal protective equipment and intensive care unit healthcare worker safety in the COVID-19 era (PPE-SAFE): An international survey. J Crit Care. 2020 Oct;59:70-75.
Hessels AJ, Genovese-Schek V, Agarwal M, Wurmser T, Larson EL. Relationship between patient safety climate and adherence to standard precautions. Am J Infect Control. 2016 Oct 01;44(10):1128-1132.
Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC, van Beeck EF. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol. 2010 Mar;31(3):283-94.
Glowicz JB, Landon E, Sickbert-Bennett EE, Aiello AE, deKay K, Hoffmann KK, Maragakis L, Olmsted RN, Polgreen PM, Trexler PA, VanAmringe MA, Wood AR, Yokoe D, Ellingson KD. SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol. 2023 Mar;44(3):355-376.
Weaver MG. Using active learning strategies to present bloodborne pathogen programs. J Sch Nurs. 2003 Jun;19(3):181-4.
Zhang Z, Yamamoto T, Wu XN, Moji K, Cai GX, Kuroiwa C. Educational intervention for preventing bloodborne infection among medical students in China. J Hosp Infect. 2010 May;75(1):47-51.
Dogra S, Mahajan R, Jad B, Mahajan B. Educational interventions to improve knowledge and skills of interns towards prevention and control of hospital-associated infections. Int J Appl Basic Med Res. 2015 Aug;5(Suppl 1):S54-7.
Agerton TB, Mahoney FJ, Polish LB, Shapiro CN. Impact of the bloodborne pathogens standard on vaccination of healthcare workers with hepatitis B vaccine. Infect Control Hosp Epidemiol. 1995 May;16(5):287-91.
Strelow B, Roxas EG, Perkins KM, Frick SJ, Wagner EL, Petersen EE, Alimire M, Olson R, Wingo M, O'Laughlin D. Boosting Hepatitis B Vaccination Rates Among Healthcare Workers in the State of Minnesota. J Community Health. 2025 Dec;50(6):1144-1149.
Vaid N, Langan KM, Maude RJ. Post-exposure prophylaxis in resource-poor settings: review and recommendations for pre-departure risk assessment and planning for expatriate healthcare workers. Trop Med Int Health. 2013 May;18(5):588-95.
Bekele T, Gebremariam A, Kaso M, Ahmed K. Attitude, reporting behavour and management practice of occupational needle stick and sharps injuries among hospital healthcare workers in Bale zone, Southeast Ethiopia: a cross-sectional study. J Occup Med Toxicol. 2015;10:42.
Bush C, Schmid K, Rupp ME, Watanabe-Galloway S, Wolford B, Sandkovsky U. Bloodborne pathogen exposures: Difference in reporting rates and individual predictors among health care personnel. Am J Infect Control. 2017 Apr 01;45(4):372-376.