Prevention of Transmission of Human Immunodeficiency Virus and Other Blood-Borne Pathogens in Health Care Settings

Only blood, semen, vaginal secretions, and possibly breast milk have been implicated in transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other blood-borne pathogens.

Blood is the single most important source of transmission of blood-borne pathogens in health care settings. Infection control efforts must focus on preventing exposures to blood.

Although the risk is unknown, universal precautions also apply to tissues and to cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, and amniotic fluid.

Universal precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomitus unless they contain visible blood. Although universal precautions do not apply to these body substances, the wise nurse wears gloves for protection from other infections.

Precautions are used for all patients. (Reason: It is impossible to know which patients are infected with such conditions as HIV, HBV, or other infectious agents.)

Gloves are worn whenever the health care worker may come in contact with blood, body fluids containing blood, and other body fluids to which universal precautions apply. (Reason: Diseases can be carried in the body substances.)

Wear gloves at all times if you have any break in the skin of your hands. If you have an exudative condition, such as weeping dermatitis, you must be evaluated before working with patients and patient care equipment. (Reason: You may be at great risk of contracting a disease; you might also spread disease.)

Change gloves after each contact with a client. (Reason: The gloves may be contaminated.)

Wash your hands and skin surfaces immediately and thoroughly if they are contaminated with blood or body fluids. (Reason: Proper washing will help to stop the spread of infection.)

Wear a gown or apron when clothing could become soiled. (Reason: To prevent spread of infection to yourself or others.)

Wear a mask and eye protection if splashing is possible. Hospital protocol will determine what type of eye protection is required for each specific case. (Reason: Infection could enter your body through the mucous membranes of your mouth or nose or through your eyes.)

Dispose of sharp objects carefully. Do not recap or break needles. Needles and sharp objects are placed in a special container after use. (Reason: There is a possibility of accidental finger stick. It is important to protect yourself and housekeeping personnel.)

If you have an on-the-job accident that causes a break in the skin, notify your nursing supervisor immediately. (Reason: Immediate precautions must be taken to protect you.)

Special care is taken of a deceased patient’s body. (Reason: To prevent leakage of body substances. It is safer to assume that all patients are infectious.)

All health care workers who perform or assist in vaginal or cesarean delivery 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. Gloves should be worn until after postdelivery care of the umbilical cord.

Pregnant health care workers are not known to be at greater risk of contracting HIV infection than health care workers who are not pregnant; however, if a health care worker develops HIV infection during pregnancy, the infant is at risk. 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.

(Adapted from Centers for Disease Control: Recommendations for prevention of HIV transmission in health care settings. MMWR 36: Suppl. 25: 1987. Centers for Disease Control: Update: Universal precautions for prevention or transmission of human immunodeficiency virus, hepatitis B virus, and other blood-borne pathogens in health-care settings. MMWR 37: 24, 1988)