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INTRODUCTION

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 covers “human blood, blood products, or blood components.”1 Other potentially infectious materials are “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.

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.2-4 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. Using infection control practices and personal protective equipment during all patient care activities is key.

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 The Centers for Disease Control and Prevention and U.S. Occupational Safety and Health Administration websites provide the most up-to-date information regarding current regulations and standards.

PORTALS FOR EXPOSURE

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.

Percutaneous exposures pose the highest risk of transmission for bloodborne disease. Needle sticks and lacerations by sharp objects account for most percutaneous injuries. Phlebotomy, initiation of IV access, manipulation of access devices, suturing, and medication injection all put workers at risk.

Mucous membrane exposures result from splatters, splashes, and sprays of blood and body fluids. Tasks associated with risk of mucous membrane exposure include wound management (hemorrhage control, exploration, irrigation, debridement), airway suctioning, nasogastric or orogastric tube placement, intubation, and specimen handling.

Respiratory exposures occur through inhalation of airborne or droplet particulate materials. Exposure risk grows when an individual is confined with an expectorating, coughing, or sneezing patient for prolonged periods or in a poorly ventilated environment.

Dermal exposure involves skin contact with patients, environmental surfaces, or objects contaminated with infectious material. The risk of infection increases ...

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