Biosafety in the Laboratory Prudent Practices for Handling and Disposal of Infectious Materials (1989) / Chapter Skim
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Appendix C: Recommendations for Prevention of HIV Transmission in Health-Care Settings
Appendix C: Recommendations for Prevention of HIV Transmission in Health-Care Settings
Pages 155-174
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From page 155... ...
Introduction 156 Definition of Health-Care Workers 156 Health-Care Workers with AIDS 157 Risk to Health-Care Workers of Acquiring REV in Health-Care Settings 157 Precautions to Prevent Transmission of HIV 158 Universal~cautions 158 Precautions for Invasive Procedures 159 159 Precautions for Dentistry.............. Precautions for AUtDDRi~R or Morticinn.~' Environmental Considerations for H]
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From page 156... ...
and precautions for health-care workers and allied professionals (2~; recommendations for preventing HIV transmission in the workplace (3) and during invasive procedures (4~; recommendations for preventing possible transmission of HIV from tears (5~; and recommendations for providing dialysis meaunent for HIV-infected patients (63.
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From page 157... ...
Two other prospective studies to assess the risk of nosocomial acquisition of HIV infection for healthcare workers are ongoing in the United States. As of April 30, 1987, 332 health-care workers with a total of 453 needlestick or mucous-membrane exposures to the blood or other body fluids of HIV-infected patients were tested for HIV antibody at the National Institutes of Health (103.
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From page 158... ...
PRECAU IRONS TO PREVENT TRANSMISSION OF HIV Universal Precautions Since medical history and examination cannot reliably identify all patients infected with HIV or other blood-borne pathogens, blood and body-fluid precautions should be consistently used for all patients. This approach, previously recommended by CDC (3,4)
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From page 159... ...
Gowns or aprons made of materials that provide an effective barrier should be worn during 159 invasive procedures that are likely to result in the splashing of blood or other body fluids. All healthcare workers who perform or assist in vaginal or cesarean deliveries should wear gloves and gowns when handling the placenta or the infant until blood and amniotic fluid have been removed from the infant's skin and should wear gloves during post-delivery care of the umbilical cord.
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From page 160... ...
Precautions for Dialysis Patients with end-stage renal disease who are undergoing maintenance dialysis and who have HIV infection can be dialyzed in hospital-based or freestanding dialysis units using conventional infectioncontrol precautions (21~. Universal blood and bodyfluid precautions should be used when dialyzing all patients.
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From page 161... ...
Implementation of universal blood and body fluid precautions for all patients eliminates the need for warning labels on specimens since blood and other body fluids from all patients should be consid ered infective. ENVIRONMENTAL CONSIDERATIONS FOR HIV TRANSMISSION No environmentally mediated mode of HIV trans mission has been documented.
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From page 162... ...
When considered in the context of environmental conditions in health-care facilities, these results do not require any changes in currently recommended sterilization, disinfection, or housekeeping strategies. When medical devices are contaminated with blood or other body fluids, existing recommendations include the cleaning of these instruments, followed by disinfection or sterilization, depending on the type of medical device.
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From page 163... ...
SEROLOGIC TESTING FOR HIV INFECTION Background A person is identified as infected with HIV when a sequence of tests, starting with repeated enzyme immunoassays (EIAs) and including a Western blot or similar, more Specific assay, are repeatedly reactive.
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From page 164... ...
In addition, more recent recommendations have stated that hospitals, in conjunction with state and local health departments, should periodically determine the prevalence of HIV infection among patients from age groups at highest risk of infection (32~. Adherence to universal blood and body-fluid precautions recommended for the care of all patients will minimize the risk of transmission of HIV and other blood-borne pathogens from patients to healthcare workers.
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From page 165... ...
Such transmission has occurred in situations (e.g., oral and gynecologic surgery in which health-care workers, when tested, had very high concentrations of BV in their blood (at least 100 million infectious virus particles per milliliter, a concentration much higher than occurs with HIV infection) , and the health-care workers sustained a puncture wound while performing invasive procedures or had exudative or weeping lesions or microlacerations that allowed virus to contaminate instruments or open wounds of patients (33,34~.
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From page 166... ...
or mucous-membrane (e.g., splash to the eye or mouth) exposure to blood or other body fluids or has a cutaneous exposure involving large amounts of blood or prolonged contact with blood especially when the exposed skin is chapped, abraded, or afflicted with dermatit~the source patient should be informed of the incident and tested for serologic evidence of HIV infection after consent is obtained.
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From page 167... ...
CDC. Update: Human immunodeficiency virus infections in health-care workers exposed to blood of infected patients.
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From page 168... ...
II. UPDATE: UNIVERSAL PRECAUTIONS FOR PREVENTION OF TRANSMISSION OF HUMAN IMMUNODEFICIENCY VIRUS, HEPATITIS B VIRUS, AND OTHER BLOODBORNE PATHOGENS IN HEALTH CARE SETTINGS INTRODUCTION The purpose of this report is to clarify and supplement the CDC publication entitled '`Recommendations for Prevention of HIV Transmission in HealthCare Setiings" (1~.*
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From page 169... ...
Whereas aseptic procedures used to obtain these fluids for diagnostic or therapeutic purposes protect health-care workers from skin exposures, they cannot prevent penetrating injuries due to contaminated needles or other sharp instruments. BODY FLUIDS TO WHICH UNIVERSAL PRECAUTIONS DO NOT APPLY Universal precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomitus unless they contain visible blood.
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From page 170... ...
USE OF PROTECTIVE BARRIERS Protective barriers reduce the risk of exposure of the health-care worker's niacin or mucous membranes to potentially infective materials. For universal precautions, protective barriers reduce the risk of exposure to blood, body fluids containing visible blood, and other fluids to which universal precautions apply.
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From page 171... ...
2. Use protective barriers to prevent exposure to blood, body fluids containing visible blood, and other fluids to which universal precautions apply.
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From page 172... ...
MMWR EDITORIAL NOTE Implementation of universal precautions does not eliminate the need for other category- or diseasespecific isolation precautions, such as enteric precautions for infectious diarrhea orisol~on for pulmonary tuberculosis (1,2~. In addition to universal precautions, detailed precautions have been developed for the following procedures and/or settings in which prolonged or intensive exposures to blood occur invasive procedures, dentistry, autopsies or morticians' services, dialysis, and the clinical laboratory.
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From page 173... ...
Update: Acquired immunodeficiency syndrome and human immunodeficiency virus infection among healthcare workers.
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From page 174... ...
Low occupational risk of human immunodeficiency virus infection among dental professionals.
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