History is key in helping to access the risk of disease transmission in bodily fluid exposure. Healthcare workers should be asked about previous immunizations. A thorough investigation into their social history, including tattoos, body piercings, and other body modifications, is recommended. The history-taker needs to ask about sexual, travel, and drug use history. Travel history is especially important as recent pandemics have highlighted the ease of imported infections in the age of across the globe travel.[9] A previous history of blood transfusions and hemodialysis should also be explored. The source patients need to be interviewed as well. A comprehensive history-taking is advised as this affects treatment. All of these factors play into risk stratification for patients exposed to bodily fluids.

On physical exam, patients need to be examined at the site of the percutaneous exposure or the site of exposure. The area needs to be examined for foreign bodies, bleeding, or signs of localized infection. If splashed into an eye, the eye should be examined for any obvious foreign bodies, debris, or signs of trauma. An exam of the heart, lungs, abdomen, and lymph nodes should be done as a baseline for possible infection later on. Most exposures will not exhibit clinical signs until later.[10]

A thorough history and physical is usually the only evaluation necessary in patients presenting with bodily fluid exposure. Management will depend on the type of exposure and the source of exposure. All percutaneous injuries should be assessed for foreign bodies. Some cases may require some form of radiographic imaging. Modality would be dependent on the location of the exposure and clinical suspicion of a foreign body. Labwork consisting of testing for HIV, Hepatitis B, and Hepatitis C is standard. Additional testing may be needed according to local hospital guidelines and regional incidence of other blood-borne pathogens.[10][11]

Management and treatment can vary greatly from institution to institution. Almost all protocols recommend getting a sample of the affected healthcare worker's blood and as well as recommend getting a sample of blood from the source. Even though healthcare workers are aware of the need for testing, a majority will forego testing and start prophylactic treatment. Most find little value with regard to formal risk assessment and feel it adds little value in primary outcomes. Similar attitudes have been found in African counties as well.[5] As for management, if the source patient is known to be HIV positive, the post-exposure prophylaxis (PEP) regimen is started. If the source patient is HCV-positive, additional testing is carried out for up to 6 months depending on the scenario. HBV-positive source patients require testing of the healthcare worker's hepatitis B immunization status. In the United States, this follow-up is usually performed by the health care facility's occupational health department.[12] One of the biggest concerns among those exposed is great anxiety that they have contracted a serious blood-borne pathogen while testing is completed.[4]

In general, the differential diagnosis of bodily fluid exposure depends on the fluid the healthcare worker was exposed to, as well as the pathogens potentially present in those fluids. Testing for HBV, HCV, and HIV is standard.[13] Other considerations include emerging infections affecting a region that may have been brought in by travelers.[9]

With early recognition of bodily fluid exposure, along with proper follow-up testing, the prognosis is good for healthcare workers following a body fluid exposure. The incidence of transmission of HBV, HCV, and HIV after a needle-stick is declining in industrial nations. However, the emergence of “rare” pathogens in developing countries requires continued vigilance in the healthcare community.[14]

Complications of bodily fluid exposures include the transmission of various types of pathogens. Also, a localized site infection can occur due to exposure. Nerve damage from a needle-stick can occur along with the potential of the needle breaking off in the skin. Significant anxiety and depression can occur after an event and should be considered.[4]

Continued education of the use of protective equipment and safe practices in handling bodily fluids is crucial in reducing risk. Multiple training sessions regarding the use of personal protective equipment are recommended for healthcare workers. The key factor in personal protective equipment is having adequate supplies readily available for healthcare staff.[2] Those who are exposed must not be afraid to report their exposure. Timely testing will lessen anxiety as well as lead to better outcomes if some form of pathogen transmission has occurred. Surveillance of pathogens found in bodily fluids will guide health care providers in treatment following exposure to bodily fluids.[15]

In recent years, Ebola virus disease and severe acute respiratory syndrome have led to renewed research regarding personal protective equipment (PPE).[16] In 2020, the novel coronavirus COVID-19 became a worldwide pandemic that has highlighted the need for proper personal protective equipment.[17] Hospital protocols involving interdisciplinary teams have been revised over the years as novel outbreaks of disease have occurred. These events have been studied, and work on improving personal protective equipment continues today. However, work remains to be done in developing countries as a higher transmission risk of pathogens exist with bodily fluid exposure.[6] Continued training of healthcare workers, along with good team leadership, has been proved to decrease exposures to body fluids.[18] Interprofessional communication is key to preventing and addressing body fluid exposures.