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INTRODUCTION

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The U.S. Occupational Safety and Health Administration defines occupational exposure as a "reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of the employee's duties."1 Blood is defined as "human blood, blood products, or blood components."1 Other potentially infectious materials are defined as "human body fluids, such as saliva, semen, and vaginal secretions; cerebrospinal, synovial, pleural, pericardial, peritoneal, and amniotic fluids; any body fluids visibly contaminated with blood; unfixed human tissue or organs; HIV [human immunodeficiency virus] or HBV [hepatitis B virus] containing cell or tissue cultures, culture mediums, or other solutions; and all body fluids where it is difficult or impossible to differentiate between body fluids."1 Healthcare workers should treat all bodily secretions, fluids, and tissues as potentially infectious.

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The Hospital Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention lists select infections and conditions that may be encountered in the ED, along with recommended occupational exposure precautions.2,3,4 The concept of standard precautions is built on the premise that healthcare workers cannot readily identify patients who are infected or at risk for infection. This is why using infection control practices and personal protective equipment during all patient care activities is key.

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U.S. Occupational Safety and Health Administration federal regulations prescribe safeguards to protect workers and reduce risk of exposure to blood and body fluids.5 Updated and detailed standards (known as the Bloodborne Pathogens Standard) are in Title 29 of the Code of Federal Regulations and amended by the Needlestick Safety and Prevention Act.6,7 The standards require healthcare facilities (1) to develop a written exposure control plan, (2) to use engineering controls to reduce risk by removing the hazard or isolating the worker from exposure, (3) to use work practice controls to standardize and maximize the safety with which work tasks are performed, (4) to identify mechanisms for compliance with Title 29 standards, and (5) to communicate workplace hazards to those with potential for bloodborne disease exposures. The Centers for Disease Control and Prevention and U.S. Occupational Safety and Health Administration Web sites provide the most up to date information regarding current regulations and standards.

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PORTALS FOR EXPOSURE

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Portals for infectious disease entry are percutaneous, mucous membrane (oral, ocular, nasal, vaginal, or rectal), respiratory, and dermal. The risk of infection in an exposed healthcare provider depends on (1) the route (portal) of exposure, (2) the concentration (number of organisms) of the pathogen in the infectious material, (3) the infectious characteristics (virility) of the pathogen, (4) the volume (dose) of infectious material, and (5) the immunocompetence (susceptibility) of the exposed individual.

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Percutaneous exposures pose the highest risk of transmission for bloodborne disease. Needle sticks and lacerations by sharp objects account for the majority of percutaneous injuries. Phlebotomy, initiation ...

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