Universal Precautions rev 9 2010

Staff Training

1. Universal Precautions

2. Objectives include:
•To be aware of what bloodborne infections are, how to prevent illness from
bloodborne pathogens and how to handle contaminated matter, and

3. Bloodborne Pathogens
•What is a bloodborne pathogen?
oA bloodborne pathogen is any organism that is present in human blood
that can cause disease. Some of the most common bloodborne
pathogens are HIV (Human Immunodeficiency Virus) that causes AIDS,
Hepatitis B Virus (HBV) that causes liver disease and Hepatitis C Virus
(HBC) that also causes liver disease.
•Why do you need to know about bloodborne
pathogens?
oYou need to know how to prevent yourself and others from acquiring
bloodborne illness, what diseases are spread through contact with
contaminated blood or other potentially infectious materials, and what
type of contact does and does not pose a threat of illness from a
bloodborne pathogen.

4. •What diseases are spread through bloodborne
pathogens?
oHBV (Hepatitis B Virus)
oHCV (Hepatitis C Virus)
oHIV (Human Immunodeficiency Virus)
oSyphilis
oMalaria
oMany Others
•For health care workers in the United States, the top
three are those of greatest concern.

5. Most common bloodborne
diseases
•Hepatitis B
oHepatitis B is a liver disease caused by a virus that can be a mild to severe
illness. It can be short-term or a serious long-term illness that can lead to liver
disease and liver cancer. The Hepatitis B vaccine can prevent you from
contracting Hepatitis B.
oHepatitis B can be acquired by contact with infected blood, semen and other
body fluids, having sex with an infected person, using contaminated needles, or
it can be passed from an infected mother to her newborn.
oThe Hepatitis B virus can survive outside of the body for at least 7 days and still
be capable of causing infection.
•Hepatitis C
oHepatitis C is a liver disease caused by the Hepatitis C virus. This can result in
an acute or chronic illness. Hepatitis C can lead to cirrhosis of the liver and liver
cancer.
oHepatitis can be acquired by contact with the blood of an infected person. This
occurs most often through use of contaminated needles.
oThere is no vaccine or cure for hepatitis C.

6. •HIV
oHIV (Human Immunodeficiency Virus) causes AIDS. HIV attacks the immune system and
destroys a type of white blood cell that the immune system needs to fight disease.
oHIV is most often acquired through sexual contact, by injection into a vein (injected drug
use), through mucous membranes, through contact of the virus into cuts and sores and
from infected mothers passing it to their child before or during birth or through breast-
feeding.
oHealthcare workers have become infected with HIV by being stuck with needles
contaminated with HIV-infected blood or by coming into contact with infected blood such
as being splashed with blood or a contaminated body fluid into an open cut or being
splashed in the eyes or nose. HIV is rarely contracted by health care workers through
work activities.
oThe HIV virus dies very quickly outside of the body. There is no vaccine for HIV.
oFollowing standard precautions (formerly called universal precautions) is the best way to
prevent contact with infected blood or other potentially infectious materials.

7. Symptoms of Disease
•Hepatitis B & C
Only blood tests can determine if you are infected. Symptoms may or may not be
present. Symptoms may include:
ofever
ojaundice (yellow skin/eyes)
ofatigue
oloss of appetite
onausea
ovomiting
odark urine
oclay-colored stools
ojoint pain
oabdominal discomfort or pain
•HIV
The only way to know if you are infected with HIV is to be tested. There may be no
symptoms for 10 years or more after exposure.

8. How are bloodborne
pathogens spread?
•Bloodborne pathogens are spread through contact with bodily fluids that
have been contaminated with infected blood. These are considered to be
Potentially Infectious Materials (PIMs). Bloodborne pathogens are most
commonly spread through:
oContact with bodily fluids that have potential to transmit disease including:
Blood
Semen
Vaginal secretions
Amniotic fluid
Any body fluid contaminated with blood
Other internal human body fluids
Cerebrospinal fluid (brain)
Synovial fluid (joints)
Pleural fluid (lungs)
Pericardial fluid (heart)
Peritoneal fluid (abdomen)
oSexual contact
oCuts or punctures of the skin with a contaminated sharp object
oContact of infected fluids with open cuts or mucous membranes (eyes, nose, mouth, etc.)
oContact of infected fluids, materials or equipment with inflamed skin, acne or skin abrasions

9. •Materials that are Not potentially infectious include:
oTears
oSweat
oSaliva (except during dental procedures when blood is commonly present in the
saliva)
oVomit
oFeces
oUrine
oNose fluids
oIntact human skin
•How are bloodborne pathogens NOT spread?
oBy bloodborne pathogens touching intact skin
oCasual contact such as handshakes, hugging, sneezing, touching doorknobs,
using swimming pools, sitting on toilet seats

10. How do I prevent myself and others
from contracting a bloodborne
illness?
•The three most important
things you can do to prevent
illness from bloodborne
pathogens are:
oGet vaccinated for Hepatitis B
oUse safe work practices
including Standard Precautions
oUse good hygiene practices
•Each of these will be
discussed.

11. Hepatitis B Vaccination
•OSHA regulations require that employers must offer the Hepatitis B vaccine at no
cost to any employee who is exposed to blood or other potentially infectious
materials as part of their job duties. An employee may decline to be vaccinated, but
must sign a form provided by the employer noting the declination.
•Three doses are generally required to complete the hepatitis B vaccine series,
although there is an accelerated two-dose series for adolescents. The typical
schedule is as follows:
oFirst Injection - At any given time
oSecond Injection - At least one month after the first dose
oThird Injection - Six months after the first dose
•Your doctor may recommend testing your blood 1-6 months after the vaccines have
been administered to determine if the vaccine has successfully helped you to
develop the antibodies needed to protect you from hepatitis B. If the ‘titer’ is below
10 mIU/mL 1 to 6 months after the initial vaccination series is completed, you are
not considered immune and you may need an additional dose(s) of the vaccine. If
the titer level is still too low after the additional dose(s), no further doses are typically
administered, even if the titer status remains ‘non-immune’.

12. Safe Work Practices
•The first line of defense against bloodborne illness is prevention. The CDC
(Center for Disease Control) has published standard precautions to be
used in environments where exposure to blood or other PIMs is likely.
oStandard precautions are “a set of precautions designed to prevent transmission of
human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne
pathogens when providing first aid or health care. Under standard precautions, blood and
certain body fluids of all patients are considered potentially infectious for HIV, HBV and
other bloodborne pathogens.“
•Standard Precautions include:
oProper Hand Washing
oPrecautions to prevent injury by needles and other sharp objects
oTreating all human blood and other PIMs as if they are contaminated
oUse of Personal Protective Equipment
Gloves
Gowns
Masks
Other Protective Barriers

13. •Per the CDC:
“Universal precautions apply to blood, other body fluids containing visible blood, semen, and
vaginal secretions. Universal precautions also apply to tissues and to the following fluids:
cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids. Universal
precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomitus
unless they contain visible blood. Universal precautions do not apply to saliva except when
visibly contaminated with blood or in the dental setting where blood contamination of saliva is
predictable.
Universal precautions involve the use of protective barriers such as gloves, gowns, aprons,
masks, or protective eyewear, which can reduce the risk of exposure of the health care
worker's skin or mucous membranes to potentially infective materials. In addition, under
universal precautions, it is recommended that all health care workers take precautions to
prevent injuries caused by needles, scalpels, and other sharp instruments or devices.”
Although not specifically noted in standard precautions, disposable CPR masks are another
item that can help prevent the spread of bloodborne pathogens. A disposable CPR mask
should contain a flexible mouth barrier that prevents physical contact with the victim's face
while performing CPR, a breathing tube that facilitates an open airway during mouth-to-mouth
resuscitation and an anti-flux valve to prevent backflow of the victim's breath or bodily fluids
into the mouth or other mucous membrane of the person performing CPR.

14. Proper Hand Washing and
Other Hygiene & Safety
Practices
•Hand washing is one of the most effective ways to
prevent the spread of illness and infection. It is
important to wash hands frequently and correctly.
•The CDC has created an information sheet on the
correct procedures for hand washing.

15. Wet your hands with clean running water and apply soap. Use warm water if it is
Hand washing is a simple thing and it's the best way to prevent infection and
illness.
Clean hands prevent infections. Keeping hands clean prevents illness at home, at
school, and at work. Hand hygiene practices are key prevention
tools in healthcare settings, in daycare facilities, in schools and public institutions,
and for the safety of our food.
In healthcare settings, hand washing can prevent potentially fatal infections from
spreading from patient to patient and from patient to healthcare worker and vice-
versa. The basic rule in the hospital is to cleanse hands before and after each
patient contact by either washing hands or using an alcohol-based hand rub.
At home, hand washing can prevent infection and illness from spreading from
family member to family member and, sometimes, throughout a community. In the
home, the basic rule is to wash hands before preparing food and after handling
uncooked meat and poultry, before eating, after changing diapers, after coughing,
sneezing, or blowing one's nose into a tissue, and after using the
bathroom.
Wash Your Hands: The Right Way

16. When washing hands with soap and water:
•Wet your hands with clean running water and apply soap. Use warm water if it is
available.
•Rub hands together to make a lather and scrub all surfaces.
•Continue rubbing hands for 15-20 seconds.
•Need a timer? Imagine singing "Happy Birthday" twice through to a friend.
•Rinse hands well under running water.
•Dry your hands using a paper towel or air dryer. If possible, use your paper towel to
turn off the faucet.
•Always use soap and water if your hands are visibly dirty.
•Apply product to the palm of one hand.
•Rub hands together.
•Rub the product over all surfaces of hands and fingers until hands are dry.
If soap and clean water are not available, use an alcohol-based hand rub to clean your
hands. Alcohol-based hand rubs significantly reduce the number of germs on skin and are
fast-acting. When using an alcohol-based hand sanitizer:
•Apply product to the palm of one hand.
•Rub hands together.
•Rub the product over all surfaces of hands and fingers until hands are dry.
Wash Your Hands: The Right Way

17. •Other Hygiene & Safety Practices
oNever eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses in an area of likely exposure
oNever store food or drinks near PIMs
oMinimize splashing, spraying, or splattering when handling PIMs
oAlways dispose of lancets, insulin syringes and other sharps in a sharps container
oWhen emptying trash, never use your hands to compact the trash
oCarry trash bags away from your body
•When working with human blood or other PIMs:
oMinimize splashing or spraying of human blood or other PIMs
oMouth pipetting/suctioning of blood or other potentially infectious materials is prohibited
oPlace specimens of blood or other potentially infectious materials in a leak-proof, non-breakable container for
collection, handling, processing, storage, transport, or shipping
oCorrectly color-code and/or label with the biohazard symbol any container for storage, transport, or shipping of
blood or other PIMs
oIf outside contamination of the primary container occurs, the primary container is to be placed within a second
container which prevents leakage during handling, processing, storage, transport, or shipping and appropriately
label or color-code this container
oAffix biohazard symbols to containers of regulated waste, refrigerators, and freezers
oKeep waste containers near the area where work with human blood or other PIMs is being performed
oNever overfill waste containers
oWash hands frequently, even if gloves have been worn

18. •In an work area where blood or other PIMs will be handled or stored, hand
and skin washing and eye washing facilities are to be provided in a location
that is readily accessible to staff.
•If facilities are not feasible, then either an appropriate antiseptic hand
cleanser and clean cloth/paper towels or antiseptic towelettes are to be
provided.
•After use of the antiseptic cleansers or towelettes, hands and contaminated
skin need to be washed with soap and running water as soon as possible.

19. Sharps Safety
•Employees working with children and adults with disabilities may come into
contact with ‘sharps’ – most commonly needles and lancets. Needlesticks
or cuts with contaminated objects can cause infection from a bloodborne
pathogen. Proper handling and disposal of sharps is essential to prevent
exposure to such bloodborne pathogens as HIV, HBV and HCV.
The Needlestick Safety and Prevention Act changes the bloodborne
pathogen standard to include terminology requiring ‘safer medical devices,
such as sharps with engineered sharps injury protections and needleless
systems’ be used.
There are many products and needles available that promote safe use and
disposal of needles, lancets and other sharps after use. Safer products
include needles that retract, sheathe or blunt immediately after use.

20. •Needles, lancets used to obtain a drop of blood for blood glucose testing
for persons with diabetes and other sharps must be discarded in leak-proof,
puncture-resistant containers that are red, have a lid, are maintained in an
upright position to prevent leaks and are appropriately marked. The lid is
required on this container to ensure safe transporting of the container. Be
sure the container is not overfilled, since it is important that the lid close
tightly. Having sharps disposal containers properly marked and located
also can help prevent accidents.
Safety conscious organizations work to eliminate hazards, use engineering
controls (such as needles that retract) use administrative controls (such as
policies and procedures for staff to follow to reduce exposure to hazards),
use of work practice controls (such as having and using the means to
safely use and dispose of sharps, and use of Personal Protective
Equipment (PPE) when appropriate.
There are many good resources to help you protect yourself and others
when handling needles and other sharp objects. Below are three resources
that are required reading for this section.

21. •Although disposal of sharps in an individual’s home is
not regulated by OSHA, proper disposal of needles,
lancets and other sharps at home is still important. In
order to protect anyone who may handle household
waste, individuals in the home should be aware of ways
to safely dispose of sharps. When an individual with a
disability lives in their own home, staff may have the
opportunity to teach acceptable disposal options for
sharps in the home.
•The Ohio EPA offers tips for disposal of such items.

22. Required Reading
•Required reading
oTips for Disposal of
Household
Generated Sharps

23. Use of Personal Protective
Equipment (PPE)
•Personal protective equipment includes specialized clothing worn to protect against a hazard.
This includes such items as gloves, masks, face shields and gowns.
Employers are required to provide necessary personal protective equipment. The type of
personal protective equipment provided and used must be suitable and “the level of protection
must fit the expected exposure.” For example, someone who is unlikely to be splashed but
may need to handle blood or other PIM, might only need to wear gloves. They would not be
expected to use more extensive protection such as a mask or gown.
It is essential that employees:
oKnow where PPEs are located
oKnow when to use a PPE
oKnow what PPE is correct for the situation
oKnow the proper way to remove and dispose of the PPE
oChange gloves after use on each person
oWash hands after removing a PPE
•Gloves are the most common PPE used in healthcare settings. For proper removal of gloves
and additional information on PPEs, please click the links below.

24. Engineering Controls
•Engineering controls include such safety controls as sharps disposal containers, self-
sheathing needles, safer medical devices, such as sharps with engineered sharps injury
protections and needleless systems that isolate or remove the bloodborne pathogens hazard
from the workplace. Engineering controls are used to maintain a safe environment for
employees and individuals who the facility serves.
•Proper labeling and signage for potential biohazards
•The Bloodborne Pathogens Standard clearly states the requirements for labeling. They are as
follows:
oLabels
Warning labels shall be affixed to containers of regulated waste, refrigerators and freezers
containing blood or other potentially infectious material; and other containers used to
store, transport or ship blood or other potentially infectious materials.
These labels shall be fluorescent orange or orange-red or predominantly so, with lettering
and symbols in a contrasting color.
oLabels shall be affixed as close as feasible to the container by string, wire, adhesive, or
other method that prevents their loss or unintentional removal.
oThe safety procedures that have been discussed in this section typically fall into a
hierarchy of controls. Following the hierarchy normally leads to the implementation of
inherently safer
systems, ones where the risk of illness or injury has been substantially reduced. Below is
one example of this hierarchy to keep you and those you work with safe.

25. A Hierarchy of Controls

26. •Treating all human blood
and other PIMs as if they
are contaminated
•When handling any bodily
fluids or other materials that
you are unsure whether they
are contaminated with blood
or other infectious materials,
always treat and handle them
as if they are contaminated.
This includes any of the
precautions noted in this
section as deemed
appropriate.

27. Proper Disposal of
Contaminated or Potentially
Contaminated Materials
•Worksites are to be maintained in a clean and sanitary condition.
Schedules for cleaning and method of decontamination are to be based on
the location within the facility, type of surface to be cleaned, type of soil
present, and tasks or procedures being performed in the area. All
equipment and environmental and working surfaces need to be cleaned
and decontaminated after contact with blood or other potentially infectious
materials.
•Contaminated work surfaces are to 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.
•Protective coverings, such as plastic wrap, aluminum foil, or imperviously-
backed absorbent paper used to cover equipment and environmental
surfaces, are to be removed and replaced as soon as possible when they
become overtly contaminated or at the end of the work shift if they may
have become contaminated during the shift.

28. •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 on a
regularly scheduled basis and cleaned and decontaminated immediately or
as soon as feasible upon visible contamination.
•Broken glassware which may be contaminated is not to be picked up
directly with the hands. It is to be cleaned up using mechanical means,
such as a brush and dust pan, tongs, or forceps.
•Reusable sharps that are contaminated with blood or other potentially
infectious materials shall not be stored or processed in a manner that
requires employees to reach by hand into the containers where these
sharps have been placed. See the sharps section of this course for more
information on handling sharps.

29. •Regulated Waste
Reusable containers shall not be opened, emptied, or cleaned manually or in any
other manner which would expose employees to the risk of injury.
oRegulated 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; labeled or color-coded in
accordance with the bloodborne pathogens standard; and closed prior to removal to prevent spillage
or protrusion of contents during handling, storage, transport, or shipping.
oIf outside contamination of the regulated waste container occurs, it shall be placed in a second
container. The second container is to be closable; constructed to contain all contents and prevent
leakage of fluids during handling, storage, transport or shipping; labeled or color-coded in accordance
with the bloodborne pathogens standard; and closed prior to removal to prevent spillage or protrusion
of contents during handling, storage, transport, or shipping.
oDisposal of all regulated waste shall be in accordance with applicable regulations of the United States,
States and Territories, and political subdivisions of States and Territories.

30. •Laundry
oContaminated laundry is to be handled as little as possible with a minimum of agitation.
oContaminated laundry is to be bagged or containerized at the location where it was used and is not to
be sorted or rinsed in the location of use. Contaminated laundry is to be placed and transported in
bags or containers labeled or color-coded in accordance with the Bloodborne Pathogens Standard.
When a facility utilizes Universal/Standard Precautions in the handling of all soiled laundry, alternative
labeling or color-coding is sufficient if it permits all employees to recognize the containers as requiring
compliance with these precautions.
oWhenever contaminated laundry is wet and presents a reasonable likelihood of soak-through of or
leakage from the bag or container, the laundry is to be placed and transported in bags or containers
which prevent soak-through and/or leakage of fluids to the exterior.
The employer is to ensure that employees who have contact with contaminated laundry wear
protective gloves and other appropriate personal protective equipment.
When a facility ships contaminated laundry off-site to a second facility which does not utilize Universal
Precautions in the handling of all laundry, the facility generating the contaminated laundry must place
such laundry in bags or containers which are labeled or color-coded in accordance with the
Bloodborne Pathogens Standard.

31. •Decontamination and Sterilization
All surfaces, tools, equipment and other objects that come in contact with blood or
potentially infectious materials must be decontaminated and sterilized as soon as
possible. Equipment and tools must be cleaned and decontaminated before servicing or
being put back to use.
Decontamination means the use of physical or chemical products to remove, inactivate,
or destroy bloodborne pathogens on a surface or item to the point where they are no
longer capable of transmitting infectious particles and the surface or item is rendered
safe for handling, use, or disposal. Use cleaning products or solutions approved by your
employer and meet EPA (Environmental Protection Agency) requirements for this use.
Under 29 CFR 1910.1030, the Occupational Exposure to Bloodborne Pathogens
standard, the Occupational Safety and Health Administration (OSHA) requires that
contaminated items and surfaces be decontaminated with an appropriate disinfectant.
EPA-registered tuberculocidal disinfectants and solutions of 5.25 sodium hypochlorite
(household bleach) diluted between 1:10 and 1:100 with water are considered
appropriate for this purpose.

32. •Current listings of the EPA’s registered sterilizer, antimicrobial,
tuberculocide, products effective against certain blood borne/body fluid
pathogens, Mycobacteria tuberculosis (tubercle bacteria), human HIV-1
virus, Hepatitis B, Hepatitis C viruses, as well as products classified as
sterilizers can be located at
http://www.epa.gov/oppad001/chemregindex.htm. The use of EPA
registered products effective against human blood borne pathogens listed
on this web site are in compliance with OSHA’s (Occupational Safety and
Health Administration) Occupational Exposure to blood borne Pathogens
(29 CFR 1910).
•Chemical germicides that are EPA-approved for use as "hospital
disinfectants" and that are tuberculocidal/virucidal when used at
recommended dilutions and contact times can be used to decontaminate
spills of blood or other body fluids that contain blood.

33. •If you are cleaning up a spill of blood, you can carefully cover the spill with
paper towels or rags, then gently pour the approved solution of bleach over
the towels or rags, and leave it for the amount of time recommended by the
product manufacturer. This will help ensure that any bloodborne pathogens
are killed before you actually begin cleaning or wiping the material up. By
covering the spill with paper towels or rags, you decrease the chances of
causing a splash when you pour the bleach on it.
If you are decontaminating equipment or other objects you should leave the
disinfectant in place for the amount of time recommended by the product
manufacturer before continuing the cleaning process.
Any materials you use to clean up a spill of blood or potentially infectious
materials such as mops, sponges, re-usable gloves, buckets, pails, etc.
also need to be decontaminated with approved cleaners.

34. What do I do if I am exposed to
blood or other a potentially
infectious material?
Exposure means that a mucous membrane, broken skin (from cuts, scrapes,
abrasions, acne, etc.) or a skin puncture has come into contact with blood or a
potentially infectious material. If you have experienced an exposure, clean the
area as described below or per your employer’s policies, report the incident and
get medical care.
•First Aid
oIf you or someone you work with is splashed or in other ways contacted with blood or
other PIMs, the first step is to thoroughly wash the exposed skin with soap and running
water. If the contact is with a mucous membrane, immediately flush the involved mucous
membrane with water for at least 15 minutes.
oAs soon as this is completed, report the incident to your supervisor or other appropriate
staff at your place of employment. Follow reporting procedures established by your
employer.
oContact your doctor or other appropriate medical professional as soon as possible for
follow-up treatment.

35. •Reporting Exposure Incidents
oReporting exposure incidents encourages immediate medical attention and
follow-up. It can help the affected individual as well as assuring that if the
person becomes infected from the incident, they do not infect other
persons. It also helps assure the affected person receives necessary,
ongoing medical care.
oReporting incidents also helps the employer evaluate why the incident
occurred and work toward preventing future exposure incidents.
oYour employer should have in place procedures for reporting exposure
incidents.

36. Universal Precaution Quiz
.
Instructions: Print your name and date at the top of a sheet of paper.
Answer the following questions:
•What is a bloodbourne pathogen?
•What methods will you utilize to avoid contamination from a potential
bloodbourne pathogen?
•What is the proper way to wash your hands?