In the summer of 1987 the Centers for Disease Control and Prevention (CDC) in Atlanta proposed a new concept for isolation precautions called "Universal Precautions," originally designed to protect health care workers (HCWs) from exposure to bloodborne pathogens. Universal Precautions (i.e., using certain work practices and barrier equipment when exposure to any blood or other potentially infectious materials is likely) should minimize the risk of transmission of bloodborne infections.
In May 1989, the Occupational Safety and Health Administration (OSHA) of the Department of Labor issued its own advisory notice calling for the timely implementation of Universal Precautions. The final OSHA standard, 29 CFR 1910.1030, was issued in December 1991. This standard is Federal law. In January 1996, the CDC recommended that Universal Precautions be renamed Standard Precautions. Standard Precautions combines the major features of Universal Precautions and Body Substance Isolation (designed to reduce the risk of transmission of pathogens from moist body substances).
Standard Precautions apply to the following: 1) blood; 2) all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain visible blood; 3) nonintact skin; 4) mucous membranes; 5) any unfixed tissue or organ (other than intact skin) from a human (living or dead); 6) HIV-containing cell or tissue cultures, organ cultures, or HIV- or HBV- containing culture medium or other solutions; and 7) blood, organs, or other tissues from experimental animals infected with HIV or HBV.
Risks to Employees
The following brief review of the risks to employees from three important bloodborne pathogens, hepatitis B virus (HBV), human immunodeficiency virus (HIV), and hepatitis C virus (HCV), will underscore the necessity for Standard Precautions. HBV can be transmitted parenterally, sexually, and perinatally. Although percutaneous inoculation is the most common mechanism for occupational infection, HCWs are also at risk when blood or other potentially infectious materials contaminate mucous membranes or nonintact skin. Even microscopic breaks in the skin may permit infection with HBV. Initial symptoms of hepatitis B infection range from none (asymptomatic) to nausea, malaise, and jaundice, with the development of acute or chronic hepatitis.
For more information on Hepatitis B, check out the DOC Hepatitis web page.
Another bloodborne infection that represents an occupational risk is HIV. This virus is also transmitted parenterally, sexually, and perinatally. HIV adversely affects the immune system, with several stages of disease progression. Within a month after exposure, an individual may experience an acute retroviral syndrome (a mononucleosis-like syndrome), with signs and symptoms that can include fever, lymphadenopathy, myalgia, arthralgia, diarrhea, fatigue, and rash. Individuals may be asymptomatic for months to years after infection, although they can transmit the virus to others. Most HIV-infected persons will eventually develop acquired immunodeficiency syndrome (AIDS), which can result in fatal opportunistic infections or neoplastic processes.
Occupational infection with HIV may occur after an adverse exposure to blood or other potentially infectious materials (contaminated with blood) from a individual infected with this virus. The risk of infection following an adverse exposure is very low when compared with HBV and is estimated to be about three HIV infections per 1000 exposures. Hepatitis C virus (HCV) is another bloodborne infection that represents an occupational risk. HCV accounts for the majority of hepatitis formerly called non-A, non-B hepatitis. Like HBV, this virus is transmitted parenterally but less efficiently.
Recognizing Occupational Exposures
Occupational exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials. "Other potentially infectious materials" include the following human body fluids: semen, vaginal secretions, amniotic fluid, peritoneal fluid, pericardial fluid, pleural fluid, sputum, dental procedures, cerebrospinal fluid, synovial fluid, any body fluid that is visibly contaminated with blood.
HANDS SHOULD BE WASHED PROMPTLY AND THOROUGHLY as soon as possible after contact with blood or other potentially infectious materials and equipment or articles contaminated by them. Handwashing is necessary because gloves may have inconspicuous holes and because microbial growth may occur due to the moist environment inside gloves.
Protective Barrier Equipment
Where potential occupational exposure remains after institution of engineering and work-practice controls, personal protective equipment shall also be used. To minimize occupational exposure, Standard Precautions employ barrier equipment such as gloves, face shields or masks, eye protection, pocket masks, etc. Barrier equipment is considered appropriate only if it does not permit blood and other potentially infectious materials to pass through to or reach the employee´s clothes, skin, eyes, mouth, or other mucous membranes under normal conditions of use.
When to Use Barriers
Protective barriers should be used in situations in which blood and other potentially infectious fluids are likely to contact a employee´s exposed skin or mucous membranes. The appropriate types of barriers used will depend upon the circumstances.
Gloves shall be worn to provide a protective barrier to prevent gross contamination of the hands when touching blood or other potentially infectious materials, mucous membranes, nonintact skin, and contaminated items. Wear gloves whenever you can reasonably anticipate having contact with blood or other potentially infectious materials, and contaminated items, or when handling or touching contaminated items or surfaces. Disposable (single-use) gloves should never be washed and reused. Remove gloves promptly after use, before touching noncontaminated items and environmental surfaces such as doorknobs, telephones, computers, equipment, etc.
Wash hands promptly and thoroughly after removal of gloves to avoid transfer of microorganisms to other environments. Wearing gloves does not replace the need for handwashing, because gloves may have small, inapparent defects or may be torn during use, and hands can become contaminated during removal of gloves.
Eye-protection devices, such as plastic glasses with solid side shields, goggles, masks with clear visors, and chin-length face shields, shall be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated toward the eyes, nose, or mouth. In these situations, wear either: (1) mask and eye protection or (2) a chin-length face shield. Personal eyewear is not recommended as barrier equipment unless side panels are present.
What to Do With Spills of Blood and Body Fluids (Cleanup Procedures)
Employees should wear gloves, and if indicated, other personal protective equipment, before cleaning spills of blood or other potentially infectious material. To clean a spill carefully remove visible material with paper towels or some other absorbent paper; apply a disinfectant, or a diluted solution of bleach (no older than 24 hours) mixed as follows: 1 part bleach to 9 parts water. The area should remain wet with disinfectant or the bleach solution for 10 minutes.
What to Do If Exposed to Blood or Other Potentially Infectious Materials
Wounds and skin sites that have been in contact with blood or body fluids should be washed with soap and water; mucous membranes should be flushed with water. No evidence exists that using antiseptics for wound care or expressing fluid by squeezing the wound further reduces the risk of bloodborne pathogen transmission; however, the use of antiseptics is not contraindicated. The application of caustic agents (e.g., bleach) or the injection of antiseptics or disinfectants into the wound is not recommended. In all cases of an exposure, medical attention is advised.
All exposures should be immediately reported to supervisors and then quickly reported to the safety manager at your location. Prompt reporting of exposures is important as the timing of initiating postexposure treatment may be critical. Follow DOC Policy 20.6.7 - Blood Borne Pathogens. For more information regarding On-The-Job-Injuries, read DOC Policy 20.5.17 - Management of Injured Workers.
Standard/Universal Precautions are designed to provide protection to the employee by use of a combination of work practices, procedures, and equipment. Employees should be familiar with and use these precautions for their own personal safety.