Preventing HIV infection is a universal goal, and within healthcare facilities prevention is an important component of any infection control program. Environmental control factors, engineering and work practice controls, as well as training and education of healthcare workers are all part of a comprehensive infection prevention program.
Universal Precautions was a system designed to prevent transmission of bloodborne pathogens in healthcare and other settings. Under Universal Precautions, blood/OPIM of all patients would always be considered potentially infectious for HIV and other pathogens. Standard Precautions is the preferred, newer system because it considers all body fluids except sweat to be potentially infectious.
Standard Precautions (and Universal Precautions) involve the use of protective barriers—defined in the following section—to reduce the risk of exposure of the employee’s skin or mucous membranes to OPIM. It is also recommended that all healthcare workers take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices. Both Standard and Universal Precautions apply to blood and OPIM.
Hand hygiene is the single most important procedure for preventing the spread of infections, and strict adherence protects both patients and workers. Despite its simplicity and effectiveness in preventing the spread of infectious disease, hand hygiene adherence remains unacceptably low throughout the world. Adherence varies among professional categories of healthcare workers and between hospital departments but is usually estimated as less than 50% (Pittet, 2001).
Hand hygiene should be done when you first come on duty, before you touch any clean equipment, and before and after every patient contact, including after touching intact skin. Hand hygiene should be performed after contact with body fluids, including your own—for example, after coughing, sneezing, or blowing your nose. In addition, perform hand hygiene:
- Before any clean or invasive procedure.
- Before contact with any portal of entry, your patient’s or your own.
- Before putting on sterile gloves.
- Before and after eating.
- Each time you remove your gloves.
- When leaving an isolation room.
- When going from a dirtier to a cleaner part of the patient’s body.
- When your hands feel or look dirty.
- After contact with contaminated things or environments, such as charts.
- After handling used equipment or linen.
- After using the bathroom.
If you can see dirt on your hands—whether from blood, body fluid, or something else—wash your hands with soap and water. Washing with soap and water physically removes the dirt from your hands but does not kill germs.
Alcohol products kill most germs—including viruses—but they do not remove dirt and debris from your hands. If you use alcohol choose a product that contains alcohol as part of its overall formulary—plain alcohol should not be used because it evaporates too quickly to provide enough contact time to kill germs. It is also advisable to keep fingernails short and to wear a minimum of jewelry (CDC, 2002).
Personal Protective Equipment
The Occupational Safety and Health Administration (OSHA) defines personal protective equipment (PPE) as “specialized clothing or equipment worn by an employee for protection against infectious materials.”
Gloves, masks, protective eyewear, and chin-length plastic face shields are examples of personal protective equipment (PPE). PPE shall be provided and worn by employees in all instances where they may come into contact with blood or OPIM. This includes but is not limited to dentistry, phlebotomy, or processing of any bodily fluid specimen, as well as postmortem (after death) procedures.
Traditionally, latex gloves have been advised for use when dealing with blood or OPIM. However, some people are allergic to latex. In most circumstances, nitrile, vinyl, and other glove alternatives meet the definition of “appropriate” gloves and may be used in place of latex gloves. Employers are required to provide non-latex alternatives to employees with latex and other sensitivities. Reusable PPE must be cleaned and decontaminated, or laundered, by the employer.
Lab coats and scrubs are generally considered to be worn as uniforms or personal clothing. When contamination is reasonably likely, protective gowns should be worn. If lab coats or scrubs are worn as PPE, they must be removed as soon as practical and laundered by the employer.
Percutaneous exposure incidents (needlestick, sharp injuries, as well as splashes leading to exposure of the skin or mucosa to blood) are a potential mode of exposure to—and transmission of—bloodborne infectious diseases among healthcare workers. According to the CDC, approximately 600,000 healthcare workers in the United States experience exposures to blood each year. These can occur in any department and may be related to faulty needle insertion techniques, needle recapping, or incautious disposal of contaminated needles and sharps. Needlestick and sharp injuries may be combined with failure to use appropriate barrier garments (for example, hand gloves of proper size) (Falagas et al., 2007).
Because injuries from needles and other sharps have been associated with transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV, the prevention of sharps injuries is an essential goal of Standard (and Universal) Precautions. Needles and other sharp devices should be handled in a manner that will prevent injury to the user and to others who may encounter the device during or after routine patient care. For additional information about these exposures, their prevention, and treatment consult the CDC’s Bloodborne Infectious Diseases website here.
Needles are not to be recapped, purposely bent or broken, removed, or otherwise manipulated by hand. After they are used, disposable syringes and needles, scalpel blades, and other sharp items are to be immediately placed in puncture-resistant, labeled containers for disposal.
Phlebotomy needles must not be removed from holders unless required by a medical procedure. The intact phlebotomy needle/holder must be placed directly into an appropriate sharps container.
Tags and Labels
Tags or labels must be used to protect employees from exposure to potentially hazardous biologic agents. Tags must contain a signal word (BIOHAZARD) or the biohazard symbol and a major message. The major message must indicate the specific hazardous condition or the instruction to the employee. The signal word must be readable at a minimum of five feet or such greater distance as warranted by the hazard.
The tag’s major message must be presented in either pictographs, written text, or both. The signal word and the major message must be understandable to all employees who may be exposed to the identified hazard. All employees will be informed as to the meaning of the various tags used throughout the workplace and what special precautions are necessary.
Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas that carry occupational exposure. Food and drink must not be stored in refrigerators, freezers, or cabinets where blood or OPIM are stored, or in other areas.