21 Universal Precautions* Universal Precautions for Prevention of Transmission of HIV and Other Blood-Borne Infections Universal precautions, as defined by the Centers for Disease Control and Prevention (CDC), are a set of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other blood- borne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV, and other blood-borne pathogens. However, implementing universal precautions does not eliminate the need for other isolation precautions, such as droplet precautions for influenza, airborne isolation for pulmonary tuberculosis, or contact isolation for methicillin- resistant Staphylococcus aureus (MRSA). Universal precautions apply to blood, other body fluids containing visible blood, semen, and vaginal secretions. Blood is the single most important source of exposure to blood-borne pathogens in the occupational setting. Uni- versal precautions also apply to tissues and to cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids. Universal precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomitus unless they contain visible blood. Human breast milk has been implicated in perinatal HIV transmission. Gloves should be worn by a worker if exposure to breast milk is frequent (e.g., in breast milk banking). Universal precautions do not apply to saliva except when visibly contaminated with blood. Universal precautions involve the use of protective barriers such as gloves, gowns, aprons, masks, or protective eye- wear, which can reduce the risk of exposure of the health care worker’s skin or mucous membranes to potentially infectious materials. In addition, under universal precautions, it is recommended that all health care workers take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices. The Needlestick Safety and Prevention Act requires that safer needle devices, such as self-sheathing needles, re- tractable needles, or devices that do not use needles (needleless systems), be used when available. Pregnant health care workers are not known to be at greater risk of contracting HIV infection than are health care workers who are not pregnant however, if a health care worker develops HIV infection during pregnancy, the infant is at risk of infection resulting from perinatal transmission. Because of this risk, pregnant health care workers should be especially familiar with, and strictly adhere to, precautions to minimize the risk of HIV transmission. The following procedures should be followed to prevent or minimize exposure to blood or other body fluids from any employee. Universal precautions supplement rather than replace routine infection control techniques (e.g., handwashing). 1. Wash hands and other skin surfaces immediately and thoroughly if contaminated with blood or other body fluids. Wash hands immediately after gloves are removed and between individual contacts. 2. Use appropriate barrier precautions routinely to prevent skin and mucous membrane exposure in anticipation of contact with blood or other body fluids from any individual. 3. Wear gloves for: present or anticipated contact with blood and body fluids, mucous membranes, or non-intact skin of all indi- viduals handling items or surfaces soiled with blood and body fluids to which universal precautions apply and performing venipunctures or other vascular access procedures. Gloves should be changed after contact with each individual. 4. Wear masks and protective eyewear during procedures (e.g., nail drilling, abdominal trauma) that are likely to generate droplets of blood or other body fluids to prevent exposure to mucous membranes of the mouth, nose, and eyes. 5. Wear gowns and aprons during procedures that are likely to generate splashes of blood or other body fluids.
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