What Protects Healthcare Workers From Exposure To Bloodborne Pathogens?

What Protects Healthcare Workers From Exposure To Bloodborne Pathogens
Comparing the universal precautions of OSHA’s Bloodborne Pathogens standard to the standard precautions and the transmission-based precautions used by healthcare practitioners for infection control – CDC/ Amanda Mills The Bloodborne Pathogens standard (29 CFR 1910.1030) and CDC’s recommended standard precautions both include personal protective equipment, such as gloves, gowns, masks, eye protection (e.g., goggles), and face shields, to protect workers from exposure to infectious diseases.

OSHA standards for bloodborne pathogens (BBP, 29 CFR 1910.1030 ) and personal protective equipment (PPE, 29 CFR 1910 Subpart I ) require employers to protect workers from occupational exposure to infectious agents.
The BBP standard applies when workers have occupational exposure to human blood or other potentially infectious materials (OPIM), as defined in paragraphs (a) and (b) of the BBP standard, and requires the use of universal precautions to prevent contact with these materials.1 Adhering to standard and transmission-based precautions in healthcare settings is recommended by Centers for Disease Control and Prevention (CDC), and protects workers from a wider range of infectious disease hazards than the BBP standard.

Employers and workers should be familiar with several key approaches to infection control, including universal precautions, standard precautions and transmission-based precautions.

Universal precautions (UP), originally recommended by the CDC in the 1980s, was introduced as an approach to infection control to protect workers from HIV, HBV, and other bloodborne pathogens in human blood and certain other body fluids, regardless of a patients’ infection status.2 UP is an approach to infection control in which all human blood and certain human body fluids are treated as if they are known to be infectious. Although the BBP standard incorporates UP, the infection control community no longer uses UP on its own.
Standard precautions (SP), introduced in 1996 in the CDC/Healthcare Infection Control and Prevention Advisory Committee’s “1996 Guideline for Isolation Precautions in Hospitals,” added additional infection prevention elements to UP in order to protect healthcare workers not only from pathogens in human blood and certain other body fluids, but also pathogens present in body fluids to which UP does not apply. SP includes hand hygiene; the use of certain types of PPE based on anticipated exposure; safe injection practices; and safe management of contaminated equipment and other items in the patient environment. SP is applied to all patients even when they are not known or suspected to be infectious.
Transmission-based precautions (TBP) for contact-, droplet-, and airborne-transmissible diseases augment SP with additional controls to interrupt the route(s) of transmission that may not be completely interrupted using SP alone.3 The different types of TBP are applied based on what is known or suspected about a patient’s infection.

The BBP standard requires the use of UP, and extends UP to protect workers against pathogens found in saliva during dental procedures and body fluids in situations where it is difficult or impossible to differentiate between body fluids (e.g., vomit mixed with blood).

During recent outbreaks of emerging infectious diseases, other body fluids to which UP and the BBP standard do not apply have been identified as potential sources of worker exposures and infections. For example, the CDC identified contact with urine, saliva, feces, vomit, and breast milk as potential sources of Ebola virus exposure.4, 5 Studies also found that urine of individuals with Zika can contain high concentrations of infectious virus that could persist in urine longer than it is detectable in serum, a component of blood.6, 7 (Note that exposure to urine has not been a recognized cause of Zika transmission.) By using SP in healthcare settings, additional protection is provided by expanding UP to protect workers where UP and the BBP standard do not apply.

For example, SP applies, without limitation, to urine, feces, nasal secretions, sputum, vomit, and other body fluids that may be potential sources of worker exposure to infectious agents. SP assumes that every person is potentially infected or colonized with an organism that could be transmitted in the healthcare setting.

Since SP was developed to integrate principles of UP and body substance isolation, 8 the infection prevention and control methods used under SP encompass what employers should already be implementing to protect workers against exposures under the BBP standard and its requirements for use of UP.
Other OSHA requirements, such as the PPE standards (see 29 CFR 1910 Subpart I ) and Section 5(a)(1), the General Duty Clause, of the Occupational Safety and Health Act, 29 USC 654, also may apply.9 The following tables highlight key distinctions among UP as originally written, the BBP standard (which incorporates UP), and SP.

Table 1 outlines the body fluids and other materials to which each applies. Table 1. Body fluids to which UP, the BBP standard, and SP apply

Exposure to	Covered by
UP (as originally defined)	BBP	SP
Blood
Semen 2
Vaginal secretions 2
Cerebrospinal fluid 2
Synovial fluid 2
Pleural fluid 2
Pericardial fluid 2
Peritoneal fluid 2
Amniotic fluid 2
Saliva in dental procedures 2
Any body fluid that is visibly contaminated with blood 2
All body fluids in situations where it is difficult or impossible to differentiate between body fluids 2		10
Urine 6, 11
Feces 11
Nasal secretion 11
Sputum 11
Vomit 11
Breast milk 11
Saliva, other than in dental procedures 11

Table 2 compares selected controls, actions and other measures for the protection of workers against exposure to blood and OPIM and for the protection of workers against exposure to material that is not blood or OPIM. Note that Table 2 discusses only selected provisions of the BBP standard, as well as only selected elements of SP and TBP, and is not intended to describe all provisions with which employers may need to comply.

Control, action or other measure	To protect workers against exposure to.
Blood and OPIM 1	Material that is not blood or OPIM, including body fluids not covered under OPIM (e.g., urine 6 and feces)
Blood and body fluid precautions for all patients, regardless of infection status	BBP, SP	SP
Exposure control plan and required elements thereof 12	BBP
Patient isolation/placement	TBP	TBP
Hand hygiene	BBP, SP	SP
Safe injection practices	BBP, SP	SP
Safe sharps management/disposal	BBP, SP	SP
Prohibiting eating, drinking, smoking, or application of cosmetics or lip balm and handling of contact lenses in areas where there is a reasonable likelihood of occupational exposure 13	BBP
Separating food and drink from areas where blood and OPIM are present 13	BBP
Prohibiting mouth pipetting and suctioning of blood or OPIM 13	BBP
Safe specimen storage, packaging, shipment 13	BBP
PPE – Gloves, gowns, masks, eye protection (e.g., goggles), face shields	BBP, 14 SP, TBP	SP, TBP
PPE – Aprons and other protective body clothing	BBP, TBP	TBP
PPE – Surgical caps	BBP, TBP	TBP
PPE – Shoe/boot covers	BBP, TBP	TBP
PPE – N95 or higher respirators for aerosol-generating procedures on patients with suspected or proven infections transmitted by respiratory aerosols	SP, TBP	SP, TBP
PPE – Any additional appropriate equipment to prevent blood or other potentially infectious materials to pass through to or reach the employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used. See 29 CFR 1910.1030(d)(3)(i).	BBP
PPE – Any additional appropriate equipment (i.e., not specifically listed already) to protect workers against transmission of infectious agents	TBP	TBP
Housekeeping and environmental control procedures	BBP, SP	SP
Safe waste management 13	BBP
Safe laundry management	BBP, SP	SP
Soiled patient-care equipment management	BBP, SP	SP
Post exposure evaluation and follow-up after occupational exposure to a bloodborne pathogen(s) 15	BBP

How to safeguard against exposure to bloodborne pathogens in the healthcare setting?

How can you protect yourself? –

Get the hepatitis B vaccine. Read and understand your employer’s Exposure Control Plan. Dispose of used sharps promptly into an appropriate sharps disposal container. Use sharps devices with safety features whenever possible. Use personal protective equipment (PPE), such as gloves and face shields, every time there is a potential for exposure to blood or body fluids. Clean work surfaces with germicidal products.

How does bloodborne pathogens protect workers?

OSHA’S bloodborne pathogens standard protects employees who work in occupations where they are at risk of exposure to blood or other potentially infectious materials. OSHA’s hazard com- munication standard protects employees who may be exposed to hazardous chemicals.

Is a work practice control used to safeguard against exposure to bloodborne pathogens?

Other Work Practice Controls – The Bloodborne Pathogens Standard specifies other work practice controls:

Eating, drinking smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is reasonable likelihood of occupational exposure to body fluids. Some work places post signs where body fluids, used gloves, and specimens are not allowed, and permit eating and/or drinking in those areas.
Procedures involving blood or OPIM shall be performed in a manner to minimize splashing or generation of droplets. Mouth pipetting is specifically prohibited.

Test Your Knowledge When you use Standard Precautions you are in full compliance with OSHA’s requirement to use Universal Precautions.

True
False

Standard Precautions:

Do not cover all the requirements of the Bloodborne Pathogens Standard.
Consider all body fluids of all patients to be potentially infectious.
Require wearing of gloves for dry skin contact with all patients.
Are not feasible in settings such as correctional institutions.

Apply Your Knowledge Explain the difference between standard and universal precautions. How does your physical uniform, hair, nails, and equipment contribute or decrease your risk of pathogen contamination? Answers: A,B

Which of the following provides the best protection against bloodborne pathogens?

Bloodborne Pathogens: How To Protect Yourself One of the most effective ways to protect yourself from exposure is by following the principle of Standard Precautions also referred to as Universal Precautions. Standard Precautions assume that all human blood and all human body fluids are infectious and should be handled with appropriate protective measures.

Healthcare-Associated Infections (HAI) Guidelines and Recommendations are available at this site.
Included in the HAI guidelines are the use of personal protective equipment (PPE), work practices, and engineering controls to ensure safety in all situations where exposure to blood or body fluids is possible.
Personal Protective Equipment (PPE)

Always wear PPE (e.g. gloves, eye protection) when there is a potential for exposure to blood or body fluids. This is proven to be the single most effective precaution to avoid exposure. PPE should be readily accessible. If some PPE that you feel is necessary for your protection is not available to you, contact your supervisor.

Gloves as PPE Gloves may be made of latex, nitrile, rubber, or other impervious materials. If glove material is thin or flimsy, double gloving may provide additional protection. If you have cuts or sores on your hands, you should cover these with a bandage as additional protection before putting on gloves.

Inspect gloves before putting them on to check for tears or punctures and replace them at that point if they are damaged. Remove gloves carefully, trying not to touch the outside of the gloves with bare skin. The established method for removing gloves without contaminating hands is illustrated here: After removal, discard contaminated gloves in the medical waste box.

Always wash hands thoroughly as the final step. A Word about Latex Allergy Although latex gloves have proven effective in preventing transmission of infectious diseases, for some individuals, repeated exposures to latex may result in allergic reactions. These reactions result from exposure to certain proteins in the latex rubber.

Symptoms may include flushing, skin rashes, hives, runny nose, sneezing, itchy eyes, scratchy throat and wheezing. Rarely and over time, with repeated exposures, symptoms may escalate to anaphylactic shock. However, the response would unlikely be the first indication of a person’s adverse reaction to latex.

Use non-latex gloves for activities involving contact with infectious materials.
When using latex gloves, use powder-free gloves with reduced protein content.
When wearing latex gloves, do not use oil-based creams or lotions.
After removing latex gloves, wash hands with mild soap and dry thoroughly.
Frequently clean areas and equipment contaminated with latex-containing dust.

Other PPE that may be needed:
Goggles
Because bloodborne pathogens can be transmitted through the mucous membranes of the eyes, it is very important to protect them by using chemical splash goggles if there is a potential for splash or spray to occur in the course of your work.
Face shields
Face shields may also be worn in addition to goggles to provide additional face protection against splashes to the mouth and nose.
Gowns or Lab Coats
Wear gowns or lab coats to protect clothing and to keep blood or OPIM from soaking through to the skin.
Contaminated Clothing

Personal clothing that becomes contaminated with blood should be removed as soon as possible to avoid fluids from seeping through and coming in contact with skin. Contaminated laundry should be handled as little as possible and placed in a red biohazard bag until it is decontaminated, disposed of, or laundered.

Always wear PPE in potential exposure situations
Remove and replace PPE that is torn, punctured, or otherwise no longer acting as a barrier to infectious materials.
Remove PPE before leaving the work area.
Dispose of PPE in the proper biohazard waste receptacle.

: Bloodborne Pathogens: How To Protect Yourself

What are the three important precautions to preventing a bloodborne pathogen?

How to Protect Yourself – It is important to understand what the hazards of bloodborne pathogens are, and what preventative measures you can take to protect yourself from exposure. The three main areas of protection include Attitude, Personal Protective Equipment and Housekeeping.

What are the 5 major tactics for protection against bloodborne pathogens?

Standard precautions include maintaining personal hygiene and using personal protective equipment (PPE), engineering controls, work practice controls, and proper equipment cleaning and spill cleanup procedures.

What are the 4 main universal precautions?

Hand hygiene. Use of personal protective equipment (e.g., gloves, masks, eyewear). Respiratory hygiene / cough etiquette. Sharps safety (engineering and work practice controls).

Which standard prescribes safeguards to protect workers against bloodborne pathogens?

OSHA’s Bloodborne Pathogens standard (29 CFR 1910.1030) as amended pursuant to the Needlestick Safety and Prevention Act of 2000, prescribes safeguards to protect workers against the health hazards caused by bloodborne pathogens.

What methods to minimize exposure to blood or bodily fluids involve?

Blood and body fluid precautions involve the use of protective barriers such as gloves, gowns, masks, and eye protection. These reduce the risk of exposing the skin or mucous membranes to potentially infectious fluids.

Who regulates exposure and prevention of bloodborne pathogens?

Infection control principles and practices for local health agencies – Bloodborne pathogens are microorganisms that cause disease and are present in human blood. They include but are not limited to human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV).

OSHA issued the Bloodborne Pathogens Standard 29 CFR Part 1910.1030 to protect health care workers and others who come in contact with blood and other potentially infectious material ( OPIM ) during their occupational duties.
The purpose of the standard is to prevent occupational exposure to bloodborne pathogens and to reduce the chances of infection when exposure does occur.

This standard requires employers to write and implement an exposure control plan for employees with occupational exposure to blood and OPIM, using administrative, engineering, and work practice controls to prevent or minimize employee exposure. The exposure control plan must contain at least the following elements:

Cleaning/disinfection of contaminated equipment and surfaces Exposure determination – a list of all job classifications in which all employees in those classifications have occupational exposure (example: all employees classified as phlebotomists), or a list of job classifications in which some employees have occupational exposure, or a list of all tasks and procedures in which occupational exposure occurs (example: administering immunizations, doing finger sticks). Most local public health agencies will probably not have entire job classifications in which all persons have occupational exposure, but may have certain personnel with assigned duties that involve occupational exposure. Handling laundry Hazard communication Hepatitis B vaccination Maintenance of sharps injury log Post-exposure follow-up Provision for hand hygiene practices Safe management and disposal of sharps Standard precautions – set of practices used with ALL clients to prevent contact with blood and OPIM Use of personal protective equipment; Use of sharps with safety devices Needlestick Safety and Prevention Act Waste management Work practices that reduce or eliminate exposure to blood and OPIM (example: no eating, drinking in potentially contaminated areas, using leak-proof containers for specimen storage)

Frequently Asked Questions

What is the first line of defense against bloodborne pathogens?

PPE is an employee’s first line of defense against bloodborne pathogens. Because of this, provides (at no cost to employees) the PPE they need to protect themselves against exposures. for ensuring all work sites have appropriate PPE available to employees.

What type of protection is best for handling bloody material?

Hand Protection – What Protects Healthcare Workers From Exposure To Bloodborne Pathogens Gloves should be worn every single time you plan on coming into contact with blood. Gloves designed to protect you from bloodborne pathogens should be single-use, disposable gloves made of latex, rubber, nitrile, or some other waterproof material. Always inspect gloves before each use to make sure there are no tears or punctures.

What are the most common barrier against bloodborne pathogens?

Unbroken skin forms the best barrier against blood borne pathogens. However, infected blood can enter your system through: open sores, cuts, abrasions, acne or any damaged or broken skin such as sunburn or blisters.

What is standard precautions in healthcare?

– PPE includes items such as gloves, gowns, masks, respirators, and eyewear used to create barriers that protect skin, clothing, mucous membranes, and the respiratory tract from infectious agents. PPE is used as a last resort when work practices and engineering controls alone cannot eliminate worker exposure.

The items selected for use depend on the type of interaction a public health worker will have with a client and the likely modes of disease transmission.
Wear gloves when touching blood, body fluids, non-intact skin, mucous membranes, and contaminated items.
Gloves must always be worn during activities involving vascular access, such as performing phlebotomies.

Wear a surgical mask and goggles or face shield if there is a reasonable chance that a splash or spray of blood or body fluids may occur to the eyes, mouth, or nose. Wear a gown if skin or clothing is likely to be exposed to blood or body fluids. Remove PPE immediately after use and wash hands.

It is important to remove PPE in the proper order to prevent contamination of skin or clothing.
The CDC has suggested steps for correctly Donning and Removing PPE,
If PPE or other disposable items are saturated with blood or body fluids such that fluid may be poured, squeezed, or dripped from the item, discard into a biohazard bag.

PPE that is not saturated may be placed directly in the trash. Saturated waste generated from the home should be placed in sealable leak-proof plastic bags before placing in regular trash bags for disposal. The OSHA PPE Standards 1910.132 and 1910.133 require employers to provide PPE for employees with hazard exposure in the workplace, train employees on the proper use of PPE, and properly maintain, store, and dispose of PPE.

How do you prevent bloodborne infections?

–

Wear appropriate PPE for tasks and procedures in which occupational exposure may occur. Use and activate safety devices when handling needles and lancets. Dispose of infectious waste properly. Notify their supervisors immediately after they experience an exposure. Complete the required initial and annual training. Comply with all other aspects of the BBP exposure control plan.

Do gloves protect from bloodborne pathogens?

Bloodborne Pathogen standard as it applies to gloves used as personal protective equipment. | Occupational Safety and Health Administration OSHA requirements are set by statute, standards and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations.

This letter constitutes OSHA’s interpretation of the requirements discussed.
Note that our enforcement guidance may be affected by changes to OSHA rules.
Also, from time to time we update our guidance in response to new information.
To keep apprised of such developments, you can consult OSHA’s website at,

May 18, 1992 Ms. Rebecca L. Burke White, Verville, Fulton & Saner Attorneys At Law Suite 1100 1156 Fifteenth Street, N.W. Washington, D.C.20005 Dear Ms. Burke: This is in further response to your letter of March 30, in which you requested clarification concerning the use of gloves in allergy testing and treatment procedures under the Occupational Safety and Health Administration (OSHA) regulation, 29 CFR 1910.1030, “Occupational Exposure to Bloodborne Pathogens”.

As you are aware, the personal protective equipment requirements of the standard are performance oriented. That is, it is the employer’s responsibility to evaluate the task and the type of exposure expected and, based on the determination, select the “appropriate” personal protective equipment in accordance with paragraph (d)(3)(i) of the standard.

At a minimum, gloves must be used where there is reasonable anticipation of employee hand contact with blood, other potentially infectious material, mucous membranes, or non-intact skin; when performing vascular access procedures; or when handling or touching contaminated surfaces or items.

In general, OSHA agrees with you that gloves are not necessary when giving allergy immunotherapy injections or when performing allergy skin testing as long as hand contact with blood or other potentially infectious material is not anticipated.
You state in your letter that, following the immunotherapy injections, “there may be a drop of blood which is dabbed with cotton and a band-aid placed over it.” If bleeding is anticipated and the employee is required to clean the site following injection, then gloves must be worn when doing so.

As an alternative, the patient can be instructed to put pressure on the injection site with an alcohol wipe or cotton ball which the patient would then discard. Such a procedure prevents employee hand contact with blood. Lastly, as you state in your letter, if the patient’s skin is abraded, gloves would be required.

What are 3 ways pathogens can be reduced?

Pathogens are disease-causing viruses, bacteria, fungi or protists, which can infect animals and plants. Humans have an immune system, which can defend them from pathogens.

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The transmission of pathogens can be prevented or reduced in a number of ways. A number of important methods of doing this are shown in the table below.


Method	Example	How it works
Sterilising water	Cholera	Chemicals or UV light kill pathogens in unclean water.
Suitable hygiene – food	Salmonella	Cooking foods thoroughly and preparing them in hygienic conditions kills pathogens.
Suitable hygiene – personal	Athlete’s foot	Washing surfaces with disinfectants kills pathogens. Treating existing cases of infection kills pathogens.
Vaccination	Measles	Vaccinations introduce a small or weakened version of a pathogen into your body, and the immune system learns how to defend itself.
Contraception	HIV/AIDs	Using barrier contraception, like condoms, stops the transfer of bodily fluids and sexually transmitted diseases.

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What are OSHA’s three lines of defense against bloodborne pathogens?

If you’re in the health and safety field, you have undoubtedly seen the figure below illustrating OSHA’s three lines of defense against workplace hazards. Source: OSHA In this article, we’ll review the three lines of defense — engineering controls, administrative and work practice controls, and personal protective equipment (PPE) — and discuss how housekeeping fits into the picture.

What are the standard precautions preventing transmission of bloodborne diseases?

Standard Precautions What Protects Healthcare Workers From Exposure To Bloodborne Pathogens Standard Precautions are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect DHCP and prevent DHCP from spreading infections among patients.

Standard Precautions include — Each element of Standard Precautions is described in the following sections. Education and training are critical elements of Standard Precautions, because they help DHCP make appropriate decisions and comply with recommended practices. When Standard Precautions alone cannot prevent transmission, they are supplemented with Transmission-Based Precautions.

This second tier of infection prevention is used when patients have diseases that can spread through contact, droplet or airborne routes (e.g., skin contact, sneezing, coughing) and are always used in addition to Standard Precautions. Dental settings are not typically designed to carry out all of the Transmission-Based Precautions (e.g., Airborne Precautions for patients with suspected tuberculosis, measles, or chickenpox) that are recommended for hospital and other ambulatory care settings.

Patients, however, do not usually seek routine dental outpatient care when acutely ill with diseases requiring Transmission-Based Precautions.
Nonetheless, DHCP should develop and carry out systems for early detection and management of potentially infectious patients at initial points of entry to the dental setting.

To the extent possible, this includes rescheduling non-urgent dental care until the patient is no longer infectious or referral to a dental setting with appropriate infection prevention precautions when urgent dental treatment is needed. Hand hygiene is the most important measure to prevent the spread of infections among patients and DHCP.

Education and training programs should thoroughly address indications and techniques for hand hygiene practices before performing routine and oral surgical procedures. For routine dental examinations and nonsurgical procedures, use water and plain soap (hand washing) or antimicrobial soap (hand antisepsis) specific for health care settings or use an alcohol-based hand rub.

Although alcohol-based hand rubs are effective for hand hygiene in health care settings, soap and water should be used when hands are visibly soiled (e.g., dirt, blood, body fluids). For surgical procedures, 1 perform a surgical hand scrub before putting on sterile surgeon’s gloves.

For all types of hand hygiene products, follow the product manufacturer’s label for instructions.
Complete guidance on how and when hand hygiene should be performed, including recommendations regarding surgical hand antisepsis and artificial nails can be found in the,a.
When hands are visibly soiled.b.

After barehanded touching of instruments, equipment, materials, and other objects likely to be contaminated by blood, saliva, or respiratory secretions.c. Before and after treating each patient.d. Before putting on gloves and again immediately after removing gloves.

Use soap and water when hands are visibly soiled (e.g., blood, body fluids); otherwise, an alcohol-based hand rub may be used.

Footnote 1 Definition from 2003 CDC Dental Guidelines—Oral surgical procedures involve the incision, excision, or reflection of tissue that exposes the normally sterile areas of the oral cavity. Examples include biopsy, periodontal surgery, apical surgery, implant surgery, and surgical extractions of teeth (e.g., removal of erupted or nonerupted tooth requiring elevation of mucoperiosteal flap, removal of bone or section of tooth, and suturing if needed).

Personal protective equipment (PPE) refers to wearable equipment that is designed to protect DHCP from exposure to or contact with infectious agents.
PPE that is appropriate for various types of patient interactions and effectively covers personal clothing and skin likely to be soiled with blood, saliva, or other potentially infectious materials (OPIM) should be available.

These include gloves, face masks, protective eye wear, face shields, and protective clothing (e.g., reusable or disposable gown, jacket, laboratory coat). Examples of appropriate use of PPE for adherence to Standard Precautions include—

Use of gloves in situations involving possible contact with blood or body fluids, mucous membranes, non-intact skin (e.g., exposed skin that is chapped, abraded, or with dermatitis) or OPIM.
Use of protective clothing to protect skin and clothing during procedures or activities where contact with blood or body fluids is anticipated.
Use of mouth, nose, and eye protection during procedures that are likely to generate splashes or sprays of blood or other body fluids.

DHCP should be trained to select and put on appropriate PPE and remove PPE so that the chance for skin or clothing contamination is reduced. Hand hygiene is always the final step after removing and disposing of PPE. Training should also stress preventing further spread of contamination while wearing PPE by:

Keeping hands away from face.
Limiting surfaces touched.
Removing PPE when leaving work areas.
Performing hand hygiene.

The application of Standard Precautions and guidance on appropriate selection and an example of putting on and removal of personal protective equipment is described in detail in the,

Provide sufficient and appropriate PPE and ensure it is accessible to DHCP.
Educate all DHCP on proper selection and use of PPE.
Wear gloves whenever there is potential for contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment.

a. Do not wear the same pair of gloves for the care of more than one patient.b. Do not wash gloves. Gloves cannot be reused.c. Perform hand hygiene immediately after removing gloves.

Wear protective clothing that covers skin and personal clothing during procedures or activities where contact with blood, saliva, or OPIM is anticipated.
Wear mouth, nose, and eye protection during procedures that are likely to generate splashes or spattering of blood or other body fluids.
Remove PPE before leaving the work area.

Respiratory hygiene/cough etiquette infection prevention measures are designed to limit the transmission of respiratory pathogens spread by droplet or airborne routes. The strategies target primarily patients and individuals accompanying patients to the dental setting who might have undiagnosed transmissible respiratory infections, but also apply to anyone (including DHCP) with signs of illness including cough, congestion, runny nose, or increased production of respiratory secretions.

Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and continuing throughout the visit.

a. Post signs at entrances with instructions to patients with symptoms of respiratory infection to— i. Cover their mouths/noses when coughing or sneezing. ii. Use and dispose of tissues. iii. Perform hand hygiene after hands have been in contact with respiratory secretions.b.

Provide tissues and no-touch receptacles for disposal of tissues.c. Provide resources for performing hand hygiene in or near waiting areas.d. Offer masks to coughing patients and other symptomatic persons when they enter the dental setting.e. Provide space and encourage persons with symptoms of respiratory infections to sit as far away from others as possible.

If available, facilities may wish to place these patients in a separate area while waiting for care.

Educate DHCP on the importance of infection prevention measures to contain respiratory secretions to prevent the spread of respiratory pathogens when examining and caring for patients with signs and symptoms of a respiratory infection.

Most percutaneous injuries (e.g., needlestick, cut with a sharp object) among DHCP involve burs, needles, and other sharp instruments. Implementation of the OSHA Bloodborne Pathogens Standard has helped to protect DHCP from blood exposure and sharps injuries.

However, sharps injuries continue to occur and pose the risk of bloodborne pathogen transmission to DHCP and patients.
Most exposures in dentistry are preventable; therefore, each dental practice should have policies and procedures available addressing sharps safety.
DHCP should be aware of the risk of injury whenever sharps are exposed.

When using or working around sharp devices, DHCP should take precautions while using sharps, during cleanup, and during disposal. Engineering and work-practice controls are the primary methods to reduce exposures to blood and OPIM from sharp instruments and needles.

Whenever possible, engineering controls should be used as the primary method to reduce exposures to bloodborne pathogens. Engineering controls remove or isolate a hazard in the workplace and are frequently technology-based (e.g., self-sheathing anesthetic needles, safety scalpels, and needleless IV ports).

Employers should involve those DHCP who are directly responsible for patient care (e.g., dentists, hygienists, dental assistants) in identifying, evaluating and selecting devices with engineered safety features at least annually and as they become available.

Other examples of engineering controls include sharps containers and needle recapping devices.
When engineering controls are not available or appropriate, work-practice controls should be used.
Work-practice controls are behavior-based and are intended to reduce the risk of blood exposure by changing the way DHCP perform tasks, such as using a one-handed scoop technique for recapping needles between uses and before disposal.

Other work-practice controls include not bending or breaking needles before disposal, not passing a syringe with an unsheathed needle by hand, removing burs before disassembling the handpiece from the dental unit, and using instruments in place of fingers for tissue retraction or palpation during suturing and administration of anesthesia.

Consider sharp items (e.g., needles, scalers, burs, lab knives, and wires) that are contaminated with patient blood and saliva as potentially infective and establish engineering controls and work practices to prevent injuries.
Do not recap used needles by using both hands or any other technique that involves directing the point of a needle toward any part of the body.
Use either a one-handed scoop technique or a mechanical device designed for holding the needle cap when recapping needles (e.g., between multiple injections and before removing from a non-disposable aspirating syringe).
Place used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers located as close as possible to the area where the items are used.

Safe injection practices are intended to prevent transmission of infectious diseases between one patient and another, or between a patient and DHCP during preparation and administration of parenteral (e.g., intravenous or intramuscular injection) medications.

Safe injection practices are a set of measures DHCP should follow to perform injections in the safest possible manner for the protection of patients. DHCP most frequently handle parenteral medications when administering local anesthesia, during which needles and cartridges containing local anesthetics are used for one patient only and the dental cartridge syringe is cleaned and heat sterilized between patients.

Other safe practices described here primarily apply to use of parenteral medications combined with fluid infusion systems, such as for patients undergoing conscious sedation. Unsafe practices that have led to patient harm include 1) use of a single syringe — with or without the same needle — to administer medication to multiple patients, 2) reinsertion of a used syringe — with or without the same needle — into a medication vial or solution container (e.g., saline bag) to obtain additional medication for a single patient and thenusing that vial or solution container for subsequent patients, and 3) preparation of medications in close proximity to contaminated supplies or equipment.

Safe injection practices were covered in the Special Considerations section (Aseptic Technique for Parenteral Medications) of the 2003 CDC dental guidelines. However, because of reports of transmission of infectious diseases by inappropriate handling of injectable medications, CDC now considers safe injection practices to be a formal element of Standard Precautions.

Complete guidance on safe injection practices can be found in the, Additional materials, including a list of, are also available. The One & Only Campaign is a public health effort to eliminate unsafe medical injections. The campaign is led by CDC and the Safe Injection Practices Coalition (SIPC).

Prepare injections using aseptic technique2 in a clean area.
Disinfect the rubber septum on a medication vial with alcohol before piercing.
Do not use needles or syringes* for more than one patient (this includes manufactured prefilled syringes and other devices such as insulin pens).
Medication containers (single and multidose vials, ampules, and bags) are entered with a new needle and new syringe, even when obtaining additional doses for the same patient.
Use single-dose vials for parenteral medications when possible.
Do not use single-dose (single-use) medication vials, ampules, and bags or bottles of intravenous solution for more than one patient.
Do not combine the leftover contents of single-use vials for later use.
The following apply if multidose vials are used—

a. Dedicate multidose vials to a single patient whenever possible.b. If multidose vials will be used for more than one patient, they should be restricted to a centralized medication area and should not enter the immediate patient treatment area (e.g., dental operatory) to prevent inadvertent contamination.c.

Do not use fluid infusion or administration sets (e.g., IV bags, tubings, connections) for more than one patient.

Footnotes 2 A technique that prevents or reduces the spread of microorganisms from one site to another, such as from patient to DHCP, from patient to operatory surfaces, or from one operatory surface to another. * A Note about Administering Local Dental Anesthesia: When using a dental cartridge syringe to administer local anesthesia, do not use the needle or anesthetic cartridge for more than one patient.

Ensure that the dental cartridge syringe is appropriately cleaned and heat sterilized before use on another patient.
Instrument processing requires multiple steps using specialized equipment.
Each dental practice should have policies and procedures in place for containing, transporting, and handling instruments and equipment that may be contaminated with blood or body fluids.

Manufacturer’s instructions for reprocessing reusable dental instruments and equipment should be readily available—ideally in or near the reprocessing area. Most single-use devices are labeled by the manufacturer for only a single use and do not have reprocessing instructions.

Use single-use devices for one patient only and dispose of appropriately.
Cleaning, disinfection and sterilization of dental equipment should be assigned to DHCP with training in the required reprocessing steps to ensure reprocessing results in a device that can be safely used for patient care.
Training should also include the appropriate use of PPE necessary for safe handling of contaminated equipment.

Patient-care items (e.g., dental instruments, devices, and equipment) are categorized as critical, semicritical, or noncritical, depending on the potential risk for infection associated with their intended use.

Critical items, such as surgical instruments and periodontal scalers, are those used to penetrate soft tissue or bone. They have the greatest risk of transmitting infection and should always be sterilized using heat.
Semicritical items (e.g., mouth mirrors, amalgam condensers, reusable dental impression trays) are those that come in contact with mucous membranes or non-intact skin (e.g., exposed skin that is chapped, abraded, or has dermatitis). These items have a lower risk of transmission. Because the majority of semicritical items in dentistry are heat-tolerant, they should also be sterilized using heat. If a semicritical item is heat-sensitive, DHCP should replace it with a heat-tolerant or disposable alternative. If none are available, it should, at a minimum, be processed using high-level disinfection.

Note: Dental handpieces and associated attachments, including low-speed motors and reusable prophylaxis angles, should always be heat sterilized between patients and not high-level or surface disinfected. Although these devices are considered semicritical, studies have shown that their internal surfaces can become contaminated with patient materials during use.

If these devices are not properly cleaned and heat sterilized, the next patient may be exposed to potentially infectious materials.
Digital radiography sensors are also considered semicritical and should be protected with a Food and Drug Administration (FDA)-cleared barrier to reduce contamination during use, followed by cleaning and heat-sterilization or high-level disinfection between patients.

If the item cannot tolerate these procedures then, at a minimum, protect with an FDA-cleared barrier. In addition, clean and disinfect with an Environmental Protection Agency (EPA)-registered hospital disinfectant with intermediate-level (i.e., tuberculocidal claim) activity between patients.

Noncritical patient-care items (e.g., radiograph head/cone, blood pressure cuff, facebow) are those that only contact intact skin. These items pose the least risk of transmission of infection. In the majority of cases, cleaning, or if visibly soiled, cleaning followed by disinfection with an EPA-registered hospital disinfectant is adequate. Protecting these surfaces with disposable barriers might be a preferred alternative.

Cleaning to remove debris and organic contamination from instruments should always occur before disinfection or sterilization. If blood, saliva, and other contamination are not removed, these materials can shield microorganisms and potentially compromise the disinfection or sterilization process.

Automated cleaning equipment (e.g., ultrasonic cleaner, washer-disinfector) should be used to remove debris to improve cleaning effectiveness and decrease worker exposure to blood.
After cleaning, dried instruments should be inspected, wrapped, packaged, or placed into container systems before heat sterilization.

Packages should be labeled to show the sterilizer used, the cycle or load number, the date of sterilization, and, if applicable, the expiration date. This information can help in retrieving processed items in the event of an instrument processing/sterilization failure.

The ability of a sterilizer to reach conditions necessary to achieve sterilization should be monitored using a combination of biological, mechanical, and chemical indicators. Biological indicators, or spore tests, are the most accepted method for monitoring the sterilization process because they assess the sterilization process directly by killing known highly resistant microorganisms (e.g., Geobacillus or Bacillus species).

A spore test should be used at least weekly to monitor sterilizers. However, because spore tests are only performed periodically (e.g., once a week, once a day) and the results are usually not obtained immediately, mechanical and chemical monitoring should also be performed.

Mechanical and chemical indicators do not guarantee sterilization; however, they help detect procedural errors and equipment malfunctions.
Mechanical monitoring involves checking the sterilizer gauges, computer displays, or printouts; and documenting the sterilization pressure, temperature, and exposure time in your sterilization records.

Since these parameters can be observed during the sterilization cycle, this might be the first indication of a problem. Chemical monitoring uses sensitive chemicals that change color when exposed to high temperatures or combinations of time and temperature.

Examples include chemical indicator tapes, strips or tabs, and special markings on packaging materials. Chemical monitoring results are obtained immediately following the sterilization cycle and therefore can provide more timely information about the sterilization cycle than a spore test. A chemical indicator should be used inside every package to verify that the sterilizing agent (e.g., steam) has penetrated the package and reached the instruments inside.

If the internal chemical indicator is not visible from the outside of the package, an external indicator should also be used. External indicators can be inspected immediately when removing packages from the sterilizer. If the appropriate color change did not occur, do not use the instruments.

Chemical indicators also help to differentiate between processed and unprocessed items, eliminating the possibility of using instruments that have not been sterilized. Note: A single-parameter internal chemical indicator provides information regarding only one sterilization parameter (e.g., time or temperature).

Multiparameter internal chemical indicators are designed to react to ≥ 2 parameters (e.g., time and temperature; or time, temperature, and the presence of steam) and can provide a more reliable indication that sterilization conditions have been met. Sterilization monitoring (e.g., biological, mechanical, chemical monitoring) and equipment maintenance records are an important component of a dental infection prevention program.

Maintaining accurate records ensures cycle parameters have been met and establishes accountability.
In addition, if there is a problem with a sterilizer (e.g., unchanged chemical indicator, positive spore test), documentation helps to determine if an instrument recall is necessary.
Ideally, sterile instruments and supplies should be stored in covered or closed cabinets.

Wrapped packages of sterilized instruments should be inspected before opening and use to ensure the packaging material has not been compromised (e.g., wet, torn, punctured) during storage. The contents of any compromised packs should be reprocessed (i.e., cleaned, packaged, and heat-sterilized again) before use on a patient.

Clean and reprocess (disinfect or sterilize) reusable dental equipment appropriately before use on another patient.
Clean and reprocess reusable dental equipment according to manufacturer instructions. If the manufacturer does not provide such instructions, the device may not be suitable for multi-patient use.

a. Have manufacturer instructions for reprocessing reusable dental instruments/equipment readily available, ideally in or near the reprocessing area.

Assign responsibilities for reprocessing of dental equipment to DHCP with appropriate training.
Wear appropriate PPE when handling and reprocessing contaminated patient equipment.
Use mechanical, chemical, and biological monitors according to manufacturer instructions to ensure the effectiveness of the sterilization process. Maintain sterilization records in accordance with state and local regulations.

Policies and procedures for routine cleaning and disinfection of environmental surfaces should be included as part of the infection prevention plan. Cleaning removes large numbers of microorganisms from surfaces and should always precede disinfection.

Disinfection is generally a less lethal process of microbial inactivation (compared with sterilization) that eliminates virtually all recognized pathogenic microorganisms but not necessarily all microbial forms (e.g., bacterial spores).
Emphasis for cleaning and disinfection should be placed on surfaces that are most likely to become contaminated with pathogens, including clinical contact surfaces (e.g., frequently touched surfaces such as light handles, bracket trays, switches on dental units, computer equipment) in the patient-care area.

When these surfaces are touched, microorganisms can be transferred to other surfaces, instruments or to the nose, mouth, or eyes of DHCP or patients. Although hand hygiene is the key to minimizing the spread of microorganisms, clinical contact surfaces should be barrier protected or cleaned and disinfected between patients.

EPA-registered hospital disinfectants or detergents / disinfectants with label claims for use in health care settings should be used for disinfection.
Disinfectant products should not be used as cleaners unless the label indicates the product is suitable for such use.
DHCP should follow manufacturer recommendations for use of products selected for cleaning and disinfection (e.g., amount, dilution, contact time, safe use, and disposal).

Facility policies and procedures should also address prompt and appropriate cleaning and decontamination of spills of blood or other potentially infectious materials. Housekeeping surfaces, (e.g., floors, walls, sinks) carry less risk of disease transmission than clinical contact surfaces and can be cleaned with soap and water or cleaned and disinfected if visibly contaminated with blood.

Establish policies and procedures for routine cleaning and disinfection of environmental surfaces in dental health care settings.

a. Use surface barriers to protect clinical contact surfaces, particularly those that are difficult to clean (e.g., switches on dental chairs, computer equipment) and change surface barriers between patients.b. Clean and disinfect clinical contact surfaces that are not barrier-protected with an EPA-registered hospital disinfectant after each patient.

Select EPA-registered disinfectants or detergents / disinfectants with label claims for use in health care settings.
Follow manufacturer instructions for use of cleaners and EPA-registered disinfectants (e.g., amount, dilution, contact time, safe use, disposal).

: Standard Precautions

What is the first line of defense against bloodborne pathogens?

What is standard precautions in healthcare?

The items selected for use depend on the type of interaction a public health worker will have with a client and the likely modes of disease transmission.
Wear gloves when touching blood, body fluids, non-intact skin, mucous membranes, and contaminated items.
Gloves must always be worn during activities involving vascular access, such as performing phlebotomies.

It is important to remove PPE in the proper order to prevent contamination of skin or clothing. The CDC has suggested steps for correctly Donning and Removing PPE, If PPE or other disposable items are saturated with blood or body fluids such that fluid may be poured, squeezed, or dripped from the item, discard into a biohazard bag.