Wednesday, 20 August 2014

Summary of Universal Precautions and Laboratory Safety Procedures

Universal Precautions 
Since medical history and examination cannot reliably identify all patients infected with HIV or other blood borne pathogens, blood and body-fluid precautions should be consistently used for all patients.
 
1. All health-care workers should routinely use appropriate barrier precautions to prevent skin and mucous-membrane exposure when contact with blood or other body fluids of any patient is anticipated. Gloves should be worn for touching blood and body fluids, mucous membranes, or non-intact skin of all patients, for handling items or surfaces soiled with blood or body fluids, and for performing venipuncture and other vascular access procedures. Gloves should be changed after contact with each patient. Masks and protective eyewear or face shields should be worn during procedures that are likely to generate  droplets of blood or other body fluids to prevent exposure of mucous membranes of the mouth, nose, and eyes. Gowns or aprons should be worn during procedures that are likely to generate splashes of blood or other body fluids.

2. Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with
blood or other body fluids. Hands should be washed immediately after gloves are removed.
 
3. All health-care workers should take precautions to prevent injuries caused by needles, scalpels, and
other sharp instruments or devices during procedures; when cleaning used instruments; during disposal of used needles; and when handling sharp instruments after procedures. To prevent needle stick injuries, needles should not be recapped, purposely bent or broken by hand, removed from disposable syringes, or otherwise manipulated by hand. After they are used, disposable syringes and needles, scalpel blades, and other sharp items should be placed in puncture-resistant containers for disposal.
 
4. Although saliva has not been implicated in HIV transmission, to minimize the need for emergency
mouth-to-mouth resuscitation, mouthpieces, resuscitation bags, or other ventilation devices should be available for use in areas in which the need for resuscitation is predictable.
 
5. Health-care workers who have exudative lesions or weeping dermatitis should refrain from all direct patient care and from handling patient-care equipment.
 
6. The following procedure should be used to clean up spills of blood or blood-containing fluids: 
(1) Put on gloves and any other necessary barriers. 
(2) Wipe up excess material with disposable towels and place the towels in a container for sterilization.
(3) Disinfect the area with either a commercial EPA-approved germicide or household bleach (sodium hypochlorite). The latter should be diluted from 1:100 (smooth surfaces) to 1:10 (porous or
dirty surfaces); the dilution should be no more than 24 hours old. When dealing with large spills or those containing sharp objects such as broken glass,  first cover the spill with disposable toweling. Then saturate the toweling with commercial germicide or a 1:10 bleach solution and allow it to stand for at least 10 minutes. Finally clean as described above.

Precautions for Laboratories 
Blood and other body fluids from all patients should be considered infective.
 
1. All specimens of blood and body fluids should be put in a well-constructed container with a secure
lid to prevent leaking during transport. Care should be taken when collecting each specimen to avoid contaminating the outside of the container and of the laboratory form accompanying the specimen.
 
2. All persons processing blood and body-fluid specimens should wear gloves. Masks and protective eyewear should be worn if mucous membrane contact with blood or body fluids is anticipated. Gloves should be changed and hands washed after completion of specimen processing.
 
3. For routine procedures, such as histologic and pathologic studies or microbiologic culturing, a biological safety cabinet is not necessary. However, biological safety cabinets should be used whenever procedures are conducted that have a high potential for generating droplets. These include activities such as blending, sonicating, and vigorous mixing.
 
4. Mechanical pipetting devices should be used for manipulating all liquids in the laboratory. Mouth
pipetting must not be done,
 
5. Use of needles and syringes should be limited to situations in which there is no alternative, and the
recommendations for preventing injuries with needles outlined under universal precautions should be followed.
 
6. Laboratory work surfaces should be decontaminated with an appropriate chemical germicide after a spill of blood or other body fluids and when work activities are completed.
 
7. Contaminated materials used in laboratory tests should be decontaminated before reprocessing or be placed in bags and disposed of in accordance with institutional policies for disposal of infective waste.
 
8. Scientific equipment that has been contaminated with blood or other body fluids should be decontaminated and cleaned before being repaired in the laboratory or transported to the manufacturer.
 
9. All persons should wash their hands after completing laboratory activities and should remove protective clothing before leaving the laboratory.
 
10. There should be no eating, drinking, or smoking in the work area.

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