Occupational Exposure to Blood and Body Fluids, Biosafety Practices, and Post-Exposure Prophylaxis Utilization among Emergency Nurses: A Systematic Review

Abstract

Background: Emergency nurses are routinely exposed to blood and body fluids due to the high-intensity, unpredictable nature of emergency care, placing them at increased risk of blood-borne infections such as HIV, hepatitis B, and hepatitis C. Despite established biosafety guidelines and post-exposure prophylaxis (PEP) protocols, occupational exposure and inadequate preventive practices remain significant concerns globally. Objective: This systematic review aimed to synthesize existing evidence on the prevalence of occupational exposure to blood and body fluids, adherence to biosafety practices, and utilization of post-exposure prophylaxis among emergency nurses. Methods: A comprehensive literature search was conducted across PubMed/MEDLINE, Scopus, CINAHL, Web of Science, and Google Scholar for studies published in English between January 2000 and December 2024. Eligible studies included quantitative, qualitative, and mixed-methods research focusing on emergency nurses. Study selection followed PRISMA guidelines. Data were extracted using a standardized form, and methodological quality was assessed using appropriate critical appraisal tools. Due to heterogeneity among studies, a narrative synthesis approach was adopted. Results: Thirty-five studies met the inclusion criteria. The prevalence of occupational exposure among emergency nurses ranged from approximately 30% to over 80% across studies, with needle stick and sharps injuries being the most common exposure types. Adherence to biosafety practices varied widely, with consistent glove use but suboptimal compliance with other personal protective equipment and safe sharps handling. Reporting of exposure incidents and utilization of PEP were generally low, with delayed initiation and incomplete adherence frequently reported. Key barriers included high workload, insufficient training, limited access to protective equipment, and lack of institutional support. Conclusion: Occupational exposure to blood and body fluids remains a substantial risk for emergency nurses. Strengthening biosafety practices, improving reporting systems, and ensuring timely access to PEP are essential to enhance occupational safety and protect this vulnerable workforce.