APPENDIX B*

PREVENTING HIV TRANSMISSION: RECOMMENDATIONS FOR HEALTH CARE WORKERS

Health care workers include, but are not limited to, nurses, physicians, dentists and dental workers, optometrists, podiatrists, chiropractors , laboratory and blood bank technologists and technicians, phlebotomists, dialysis personnel, paramedics, emergency medical technicians, medical examiners, morticians, housekeepers, laundry workers, and other whose work involves contact with patients, their blood or other body fluids, or corpses.

These recommendations, based on recommendations developed by the U.S. Public Health Service and Centers for Disease Control (3, 4), emphasize precautions appropriate to prevent transmission of bloodborne infectious organisms, including HIV and hepatitis B virus (HBV). These precautions should be routinely enforced, as should other standard infection-control precautions. The risk of transmission of HIV by parental exposure to a needle or other sharp instrument contaminated with the blood of an infected patient is l/200^th or 0.5% (5). Yet most of these incidents are preventable and more emphasis must be given to precautions targeted to prevent needle stick injuries in workers caring for any patient.

In addition to being informed of these precautions, all health care workers should be educated regarding the epidemiology, modes of transmission, and prevention of HIV infection.

The following precautions represent prudent practices that apply to preventing transmission of HIV and other bloodborne infections by healthcare workers in the workplace and should be used routinely, regardless of whether the workers or patients are known to be infected with HIV or HBV.

1. Sharp items (needles, scalpel blades, and other sharp instruments) should be considered as potentially infective and be handled with extraordinary care to prevent accidental injuries.

2. Disposable syringes and needles, scalpel blades and other sharp items should be placed in puncture-resistant containers located as close as practical to the area in which they are used. To prevent needle stick injuries, needles should not be recapped, purposely bent, broken, removed from disposable syringes, or otherwise manipulated by hand.

3. When the possibility of exposure to blood or other body fluids exists, routinely recommended precautions should be followed. The anticipated exposure may require gloves alone, as in handling items soiled with blood or equipment contaminated with blood or other body fluids, or may also require gowns, masks, and eye coverings when performing procedures involving more extensive contact with blood or potentially infective body fluids, as in some dental or endoscopic procedures or postmortem examinations. Hands should be washed thoroughly and immediately if they accidentally become contaminated with blood.

4. To minimize the need for emergency mouth-to-mouth resuscitation, mouth pieces, resuscitation bags, or other ventilation devices should be strategically located and available for use in areas where the need for resuscitation is predictable.

* Connecticut Department of health policy on blood borne pathogens. (1991)

Adopted: February 28, 1994