Universal Precautions

The following are the standard recommended precautions for anyone working in a healthcare setting who may come in contact with blood or other fluids that may contain the viruses that cause HIV and/or HCV, among other bloodborne diseases. Syringe exchanges should develop their own protocols for biohazard handling and disposal. To the extent possible, participants should be responsible for their own returned syringes, needles and/or injection supplies, including depositing any loose syringes and/or injection supplies in biohazard containers on premises. If necessary, exchange workers should use tongs to deposit used syringes or other supplies in biohazard containers. Please visit the CDC’s resource, Human Immunodeficiency Virus (HIV) in Healthcare Settings, for more information.

Recommendations for Prevention of HIV Transmission in Health-Care Settings

The CDC’s Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis (PEP) can be found here. The updated provisions are:

  • PEP is recommended when occupational exposures to HIV occur.
  • Determine the HIV status of the exposure source patient to guide need for HIV PEP, if possible.
  • Start PEP medication regimens as soon as possible after occupational exposure to HIV and continue them for a four-week duration.
  • New Recommendation: PEP medication regimens should contain three (or more) antiretroviral drugs (listed in appendix A) for all occupational exposures to HIV.
  • Expert consultation is recommended for any occupational exposures to HIV and at a minimum for situations described in Box 1.
  • Provide close follow-up for exposed personnel (Box 2) that includes counseling, baseline and follow-up HIV testing and monitoring for drug toxicity.  Follow-up appointments should begin within 72 hours of an HIV exposure.
  • New Recommendation: If a newer, fourth generation combination HIV p24 antigen-HIV antibody test is utilized for follow-up HIV testing of exposed HCP, HIV testing may be concluded at four months after exposure (Box 2). If a newer testing platform is not available, follow-up HIV testing is typically concluded at six months after an HIV exposure

Centers for Disease Control. Recommendations for prevention of HIV transmission in health-care settings. MMWR 1987; 36 (suppl no. 2S)

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. This approach, previously recommended by CDC , and referred to as "universal blood and body-fluid precautions" or "universal precautions," should be used in the care of ALL patients, especially including those in emergency-care settings in which the risk of blood exposure is increased and the infection status of the patient is usually unknown.

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.

Hands should be cleansed (with soap and water or alcohol-based cleanser) immediately and thoroughly, regardless of signs of obvious contamination. Soap and water must be used if there are any signs of contamination. For more information, consult the CDC Guideline for Hand Hygiene in Health-Care Settings here.

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; the puncture-resistant containers should be located as close as practical to the use area. Large-bore reusable needles should be placed in a puncture-resistant container for transport to the reprocessing area.

4. Although saliva has not been implicated in HIV transmission, to minimize the need for emergency mouth-to-mouth resuscitation, mouth-pieces, 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 until the condition resolves.

6. Pregnant health care workers are not known to be at greater risk of contracting HIV infection than health-care workers who are not pregnant; however, if a health care worker develops HIV infection during pregnancy, the infant is at risk of infection resulting from perinatal transmission. Because of this risk, pregnant health care workers should be especially familiar with and strictly adhere to precautions to minimize the risk of HIV transmission. Implementation of universal blood and body-fluid precautions for ALL patients eliminates the need for use of the isolation category of "Blood and Body Fluid Precautions" previously recommended by CDC for patients known or suspected to be infected with blood-borne pathogens. Isolation precautions (e.g., enteric, "AFB") should be used as necessary if associated conditions, such as infectious diarrhea or tuberculosis, are diagnosed or suspected.