Immediate Eye Irrigation for Body Fluid Splash Exposure
If body fluids are splashed into the eye, immediately irrigate the eyes with clean water, saline, or sterile irrigants for at least 15 minutes, then report the incident to your supervisor and seek immediate medical evaluation. 1
Immediate First-Line Action
- Begin irrigation immediately at the site of exposure - do not delay to find "ideal" solutions, as immediate decontamination is critical to minimize tissue damage and infection risk 1, 2
- Flush the involved eye with water for a minimum of 15 minutes - this applies whether the exposure is from potentially infectious body fluids or chemical irritants 1, 2
- Use clean water, normal saline, or sterile irrigants - tap water is readily available, safe, and effective as the preferred initial irrigation fluid 1, 3
- Ensure thorough irrigation of the entire eye surface and fornices - some patients may need assistance keeping their eyelids open during the procedure 1, 4
Optimal Irrigation Technique
- Use copious amounts of fluid delivered as a continuous stream - for healthcare settings, attach a 1-liter bag of normal saline to IV tubing with a 16-gauge Teflon catheter at the distal end for controlled, continuous irrigation 4
- Warmed lactated Ringer's solution is theoretically preferable to normal saline because it has more physiologic pH and osmolarity, though any aqueous solution is acceptable initially 3
- Avoid contaminating the unaffected eye during irrigation - direct the stream from inner to outer canthus on the affected side 2
Critical Post-Exposure Steps
After completing irrigation, immediately:
- Report the incident to your supervisor 1
- Seek immediate medical evaluation - arrange for prompt ophthalmology consultation for all but the most trivial exposures 1, 3
- Document the exposure thoroughly including the type of body fluid involved, source patient identification (if possible), and extent of exposure 1
Bloodborne Pathogen Risk Assessment
The following body fluids are considered potentially infectious for HIV, hepatitis B, and hepatitis C when splashed into mucous membranes: 1
- Blood or any fluid with visible blood contamination
- Semen and vaginal secretions
- Cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids
The following fluids are NOT considered high-risk unless visibly contaminated with blood: 1
- Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus
Post-Exposure Prophylaxis Protocol
After irrigation and initial evaluation, the physician must: 1
- Determine the serologic status of the source patient for hepatitis B virus, hepatitis C virus, and HIV (obtain permission consistent with local statutes; FDA-approved rapid HIV testing is available) 1
- Determine the immunity status of the exposed person - specifically hepatitis B vaccination history and anti-HBsAg antibody levels 1
- Administer hepatitis B immune globulin (HBIG) if indicated - for unvaccinated persons exposed to HBsAg-positive source, give 0.06 mL/kg IM as soon as possible after exposure and within 24 hours if possible 1, 5
- Initiate or complete hepatitis B vaccine series as appropriate based on vaccination status 1, 5
Common Pitfalls to Avoid
- Do not delay irrigation to search for "better" solutions - immediate tap water irrigation is far superior to delayed irrigation with any other fluid 2, 3
- Do not stop irrigation prematurely - continue for the full 15 minutes minimum, extending to 30 minutes or even 2 hours for massive chemical exposures 3
- Do not assume low-risk fluids are safe - even saliva or tears can transmit infection if blood-contaminated, and visual inspection may miss microscopic blood 1
- Do not skip ophthalmology referral - mucous membrane exposures carry significant infection risk, with studies showing 45% of surgical procedures result in blood/body fluid splashes to protective eyewear 6