Bloodborne Pathogens & Aerosols

Occupational exposures can occur through needlesticks or cuts from other sharp instruments contaminated with an infected patient's blood (including blood contaminated saliva) or through contact of the eye, nose, mouth, or skin with a patient's blood. Health care personnel are at risk for occupational exposure to bloodborne pathogens — pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV).  Following a specific exposure, the risk of infection varies depending on factors such as:

• The pathogen involved.
• The type and severity of exposure.
• The amount of blood involved in the exposure.
• The amount of pathogen in the patient's blood at the time of exposure.

Although most exposures do not result in infection, the exposed person should be evaluated immediately by a qualified health care professional¹ in case treatment is needed.

If you experienced a needlestick, cut yourself with a sharp instrument, or were exposed to the blood or another body fluid of a patient, immediately follow these steps:

• Wash the site of the needlestick or cut with soap and water.
• Flush splashes to the nose, mouth, or skin with water.
• Irrigate eyes with clean water, saline, or sterile irrigants.
• Report the incident to your supervisor or the person in your practice responsible for managing exposures.
• Immediately seek medical evaluation from a qualified health care professional¹ because, in some cases, postexposure treatment may be recommended and should be started as soon as possible.

Health care professionals who evaluate the exposures of dental health care personnel (DHCP) should be:

• Selected before DHCP are placed at risk of exposure.
• Experienced in providing antiretroviral therapy.
• Familiar with the unique nature of dental injuries so they can provide appropriate guidance on the need for antiretroviral prophylaxis.
• Because not all exposure assessors are experienced in antiretroviral therapy, it may be necessary to identify more than one health care professional to perform these tasks.

Health care professionals caring for exposed health care workers can call the National Clinicians’ Post-exposure Prophylaxis Hotline (PEPline) for advice on managing occupational exposures to HIV and hepatitis B and C viruses. PEPline is available 24 hours a day, 7 days a week, at 1-888-448-4911.

Employers should follow all federal (including the Occupational Safety and Health Administration [OSHA]) and state requirements for recording and reporting occupational injuries and exposures.  The exposure report should be recorded in the exposed person's confidential medical record and made available to qualified health care professionals.¹ Information included in the exposure report can be found on page 17 of the following guidance document: www.cdc.gov/mmwr/PDF/rr/rr5011.pdf [PDF-333K].

Many needlesticks and other cuts can be prevented by using engineering controls (for example, disposing of used needles in appropriate sharps disposal containers and using medical devices with safety features designed to prevent injuries) and safer techniques (for example, not recapping needles by hand). Exposures to the eyes, nose, mouth, and skin can be prevented by using personal protective equipment such as gloves, eye and face protection, and gowns.

The Needlestick and Prevention Act of 2001 requires employers to identify, evaluate, and select devices with engineered safety features at least annually and as new devices become available. It further mandates involving non-managerial dental health care personnel (DHCP) who are directly responsible for patient care (e.g., dentists, hygienists, dental assistants) in evaluating and choosing these devices and maintaining a sharps injury log.  If after inquiring about the availability of new safety devices or safer options none are identified, DHCP should document these findings in their office exposure control plan. Engineering controls should be used whenever possible as the primary method to reduce exposures to bloodborne pathogens; when engineering controls are not available or appropriate, work practice controls should be used.

The following resources provide additional information about developing a safety program and identifying and evaluating safe dental devices:

• Device Screening and Evaluation Forms
• National Institute for Occupational Safety and Health's Stop Sticks Campaign
• Overview of State Needle Safety Legislation