Universal Precautions is an approach to infection control.
According to the concept of Universal Precautions, all human blood and certain human body
fluids are treated as if known to be infectious of HIV, HBV, and other bloodborne
pathogens.
Universal Precautions shall be used to prevent contact
with blood or other potentially infectious materials. Under circumstances in which
differentiation between body fluid types is difficult or impossible, all body fluids shall
be considered infectious materials.
All procedures involving blood or other body fluids shall
be performed in such a manner as to minimize splashing, spraying, splattering, and
generation of droplets of these substances.
Handwashing: The single most effective means
of preventing the spread of infections.
Handwashing facilities shall be available.
Hands and other skin surfaces shall be washed with soap and water.
Mucous membranes shall be flushed with water immediately.
When handwashing facilities are not immediately available, appropriate
antiseptic hand cleanser, in conjunction with clean cloth/paper towels or antiseptic
towelettes, shall be used. Hands shall be washed with soap and running water as soon as
possible.
Barrier Precautions:
Appropriate barrier precautions shall be routinely used to
prevent skin and mucous membrane exposure when contact with blood or other body fluids of
any patient is anticipated.
Latex gloves shall be worn when:
touching blood and body fluid, mucous membranes, or non-intact skin of all
patients;
handling items or surfaces soiled with blood or body fluids;
performing venipuncture and other vascular access procedures.
Disposable gloves must be of appropriate materials using intact latex or
intact vinyl, of appropriate quality for the procedure performed and of the appropriate
size for each employee rendering care.
Gloves shall be changed after each patient.
Disposable (single use) gloves, shall be replaced as soon as practicable if
they are torn, punctured, or when their ability to function as a barrier is compromised.
Disposable (single use) gloves shall not be washed or decontaminated for
re-use.
Utility gloves may be decontaminated for re-use if the integrity of the glove
is not compromised. However, they must be discarded if they are cracked, peeling, torn,
punctured, or exhibit other signs of deterioration or when their ability to function as a
barrier is compromised.
Masks, in combination with eye protection devices, such as goggles or glasses
with side shields or chin-length faceshields, shall be worn whenever splashes, spray,
splatter, or droplets of blood or other body fluids may be generated, and eye, nose or
mouth contamination can be reasonably anticipated.
Personal Protective Equipment:
Personal protective equipment will be considered
"appropriate" only if it does not permit blood or other potentially infectious
materials to pass through to or reach the employee's work clothes, street clothes,
undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use
and for the duration of time which the protective equipment will be used.
Required personal protective equipment (PPE):
must be readily accessible to employees in the appropriate sizes and provided
at no cost to the employee;
hypoallergenic gloves, glove liners, powderless gloves, or other similar
alternatives shall be readily accessible to those employees who are allergic to the gloves
normally provided;
shall be cleaned and laundered at no cost to the employee;
shall be repaired or replaced as needed to maintain its effectiveness, at no
cost to the employee. If a garment is penetrated by blood or other body fluids, the
garment shall be removed as soon as possible;
standard PPE for nursing staff and First Aid Providers shall be gowns,
aprons, and other protective body clothing. Appropriate protective clothing such as, but
not limited to, gowns, aprons, lab coats, clinic jackets, or similar outer garments shall
be worn in occupational exposure situations. The type and characteristics will depend upon
the task and degree of exposure anticipated [Cal/OSHA - GISO 5193 (d) (3) (K).] for daily
use.
Precautions shall be taken to prevent injuries caused by
needles and other sharp instruments or devices used during nursing procedures; when
cleaning used instruments; during disposal of used needles; and when handling sharp
instruments after procedures. First Aid practices for all others shall not involve the use
of needles or other sharp instruments. Precautions are as listed below.
To prevent needlestick injuries, needles shall not be recapped, purposely
bent or broken by hand, removed from disposable syringes, or otherwise manipulated by
hand. If recapping or needle removal is an absolute necessity due to a specific medical
procedure, it shall be accomplished through the use of a mechanical device or a one-handed
technique.
Shearing or breaking of contaminated needles is prohibited.
After use, disposable syringes and other sharp items shall immediately be
placed in puncture-resistant containers for disposal. The containers shall be located as
closely as practical to the use area, kept upright throughout use, replaced at least every
six months, and not be allowed to overfill.
Immediately, or as soon as possible after use, contaminated reusable sharps
shall be placed in appropriate containers until properly reprocessed. These containers
shall be:
puncture resistant;
labeled;
leak-proof on the sides and bottom;
so constructed to not allow employees to reach by hand into them.
When moving containers of contaminated sharps from the area of use, the
containers shall be:
closed immediately prior to removal or replacement to prevent spillage or
protrusion of;
contents during handling, storage, transport or shipping;
placed in a secondary container if leakage is possible.
The second container shall be:
closable;
constructed to contain all contents and prevent leakage during handling,
storage, transport, or shipping:
appropriately labeled and color coded
Reusable containers shall not be opened, emptied, or cleaned manually or in
any other manner which would expose employees to the risk of percutaneous injury.
CPR Precautions:
Although saliva has not been implicated in HIV
transmission, to minimize the need for emergency mouth-to-mouth resuscitation,
mouthpieces, resuscitation bags, pocket masks, or other ventilation devices shall be used.
Such equipment shall be stored in all District First Aid Stations and Kits.
Qualified Staff/First Aid Providers Precautions:
Qualified Staff/First Aid Providers who have exudative
lesions or weeping dermatitis shall be examined as soon as possible. These employees shall
refrain from all direct patient care and from handling patient-care equipment until such
examination occurs.
Work Area Precautions
Eating, drinking, applying cosmetics or lip balm, and handling contact lenses
are prohibited in areas where occupational exposure may be expected.
Food and drink shall not be kept in refrigerators, freezers, shelves
cabinets, or on countertops or benchtops where blood or other body fluids are present.
Mouth pipetting/suctioning of blood or other potentially infectious materials
is prohibited.
Cleaning and Decontamination of Blood or other Body Fluids.
Blood and other body fluids which are spilled will be
cleaned up as follows:
Blood and other body fluids which are spilled can easily
be cleaned up with the use of an absorbent/disinfectant product such as Premisorb or
Liquid Treatment Systems (LTS).
Alternative clean-up methods should include use of paper
towels. After this initial clean-up, surfaces shall be wiped with one of the following
disinfectants:
chemical germicides that are approved for use as hospital disinfectants and
are tuberculocidal when used at recommended dilutions;
products registered by the Environmental Protection Agency (EPA) as being
effective against HIV with an accepted (HIV "Aids Virus") label; or
solution
of 5.25% sodium hypochlorite (household bleach) diluted 1 to 10 with
water.
Housekeeping:
All equipment and working surfaces shall be cleaned and
decontaminated after contact with blood or other potentially infectious materials.
Contaminated work surfaces shall be decontaminated with an appropriate disinfectant after
completion of procedures; immediately or as soon as feasible when surfaces are overtly
contaminated or after any spill of blood or other potentially infectious materials; and at
the end of the work shift if the surface may have become contaminated since the last
cleaning.
All bins, pails, cans, and similar receptacles intended for reuse which
have a reasonable likelihood for becoming contaminated with blood or other
potentially infectious materials shall be inspected and decontaminated at
the end of each work shift.
Cleaning and decontamination shall be done immediately, or as soon as
feasible upon visible contamination, but no later than the end of the work
shift.
Broken glassware which may be contaminated shall not be
picked up directly with the hands. Mechanical means shall be used, such as a brush and
dust pan, tongs, or forceps.
Environmental surfaces such as walls, floors, and other
surfaces are not associated with transmission of infections to patients or healthcare
workers. Therefore, extraordinary attempts to disinfect or sterilize these environmental
surfaces are not necessary, unless directly contaminated with blood or body fluids.
General housekeeping support for environmental surfaces,
including cabinets and shelves, and non-infectious trans containers within nursing and
first aid areas shall continue to be provided by District custodial staff.
Waste:
Contaminated items should be separated into regulated or
non-regulated waste containers and handled as described below.
Regulated Waste, Medical Waste, and Bio
Hazardous Waste
If an outside vendor is used to pick up the regulated waste, the individual
plastic red bags should be prepared for pick-up according to the vendor's instructions.
The person responsible for the waste pick up must send a copy of the purchase
order and invoice to the Risk Manager.
If an outside vendor is not used, regulated waste shall be placed in
containers which are:
closable;
constructed to contain all contents and prevent leakage of fluids during
handling, storage, transport or shipping;
appropriately labeled or color-coded;
closed prior to removal to prevent spillage or protrusion of contents during
handling,storage, transport or shipping
If outside contamination of the regulated waste container occurs, if shall be
placed in a second regulated waste container.
If the contaminated item contains dried blood or has been rinsed into a drain
connected to a sanitary sewer and followed with a small amount of bleach, it may be
disposed of as regular trash. The trash should be kept in a closed container in a locked
area until it is collected and transported for disposal in a sanitary landfill.
Bulk blood, suctioned fluids, excretions, and secretions may be carefully
poured down a drain connected to a sanitary sewer followed with a small amount of bleach.
Laundry
Universal Precautions shall be observed with all used
laundry. Each laundry hamper shall be labeled with a red "Biohazard" sticker or
a laundry bag labeled as "Biohazard." Used laundry shall be stored in a
"leak resistant" container such as a plastic bag, and the bag shall be labeled
with a red "Biohazard" sticker. Contaminated laundry shall be handled as little
as possible with a minimum of agitation. Contaminated laundry shall not be sorted or
rinsed in the use location.
Laundry support shall be provided by outside vendors
utilizing bloodborne pathogen exposure control guidelines as outlined by Cal-OSHA.
Sterilization and Disinfection
Standard sterilization and disinfection procedures for
patient-care and laboratory equipment currently recommended for use in a variety of
healthcare settings are adequate to sterilize or disinfect instruments, devices, or other
items contaminated with blood or other body fluids from persons infected with bloodborne
pathogens including HBV and HIV.
Medical devices or instruments that require sterilization
or disinfection shall be thoroughly cleaned before being exposed to germicide, and the
manufacturer's instructions for use of the germicide shall be followed.
Designated Emergency First Aid Responders
Universal Precautions shall be followed as discussed
(Section IV. A.). Latex gloves shall be worn when touching blood and body fluids, mucous
membranes, or non-intact skin of all patients, and for handling items or surfaces soiled
with blood or body fluids. Designated employees shall wear gloves on all emergencies.
Masks in combination with eye protection devices, such as goggles or glasses with side
shields, or chin-length face shields, shall be worn whenever splashes, spray, splatter, or
droplets of blood or other body fluids may be reasonably anticipated.
During the cleanup of an accident site, PPE, such as
gloves, coveralls, and boots, must be used. All blood and body fluids/materials shall be
disposed of as "medical waste."
and
Safety
