Universal Precautions emphasizes the need for workers and students to consider all blood and body fluids as potentially infected with HIV, HBV, and / or other blood-borne pathogens, and to adhere rigorously to infection control precautions for minimizing the risk of exposure. They are to be used at any time that blood, body fluids, or extracts of the above are handled within a laboratory. Since the advent of HIV in our population, there has been great concern about the transmission of the disease and the following precautions are intended to protect from all blood-borne pathogens. ROLE OF SUPERVISOR Supervisors (eg. research faculty) must ensure there is: 1. Initial orientation and continuing education and training of all workers - including students and trainees - on the epidemiology, modes of transmission and prevention of blood-borne infections and the need for routine use of universal precautions. 2. Provision of equipment and supplies necessary to minimize the risk of infection with blood-borne pathogens. 3. Monitoring adherence to recommended protective measures. When monitoring reveals a failure to follow recommended precautions, counseling, education, and / or retraining should be provided, and if necessary, appropriate disciplinary action should be considered. BODY FLUIDS HIV has been isolated from blood, semen, vaginal secretions, saliva, tears, breast milk, cerebral spinal fluid, amniotic fluid, and urine. However, epidemiologic evidence has implicated only blood, semen, vaginal secretions and breast milk. Universal Precautions also apply to tissues, synovial fluid, pleural fluid, peritoneal fluid and pericardial fluid. The Canadian Diseases Weekly Report indicates that the risk of acquiring HIV infection, from needle stick exposure, is less than one percent compared with 25-30 percent for Hepatitis B virus. FHSc Safety Office July 16, 2008 Page 1 of 5
UNIVERSAL PRECAUTIONS Universal Precautions 1. All workers should routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure when contact with blood or other body fluids of any person 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. 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. Lab coats/gowns or aprons should be worn during procedures that are likely to generate splashes. 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 workers should take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments; during procedures; when cleaning dirty instruments, and during disposal. To prevent needlestick 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. 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. Workers who have exudative lesions or weeping dermatitis should refrain from all direct contact until the condition resolves. 6. 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 paperwork accompanying the specimen. 7. All persons processing blood and body-fluid specimens (e.g.: removing tops from vacuum tubes) should wear gloves, masks and protective eyewear if mucous membrane contact with blood or body fluids is anticipated. Gloves should be changed and hands washed after completion of specimen processing. FHSc Safety Office July 16, 2008 Page 2 of 5
8. Fumehoods or biological safety cabinets (Class I or II) should be used whenever procedures are conducted that have a high potential for generating droplets. These include activities such as opening vacuum tubes, blending, sonicating, and vigorous mixing, 9. Mechanical pipetting devices should be used for manipulating all liquids in the laboratory. Mouth pipetting must not be done. 10. Use of needles and syringes should be limited to situations in which there is no alternative, and the recommendations for preventing injuries with needles should be followed. 11. 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, e.g. 1:10 household bleach. 12. Contaminated materials used in laboratory tests should be decontaminated before reprocessing or be placed in yellow or red bags to be incinerated. 13. 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. 14. All persons should wash their hands after completing laboratory activities and should remove protective clothing before leaving the laboratory. FHSc Safety Office July 16, 2008 Page 3 of 5
LABELING All blood and other body fluids should be considered infective, use the WHMIS biosafety label. DECONTAMINATION Studies have shown that HIV is inactivated rapidly after being exposed to commonly used chemical germicides at concentrations that are much lower than used in practice. In addition to commercially available chemical germicides, a solution of sodium hypochlorite (household bleach) prepared daily is an inexpensive and effective germicide. Concentrations ranging from approximately 500 ppm (1:100 dilution of household bleach) sodium hypochlorite to 5000 ppm (1:10 dilution of household bleach) are effective depending on the amount of organic material (e.g.: blood, mucus) present on the surface to be cleaned and disinfected. Commercially available chemical germicides may be more compatible with certain medical devices that might be corroded by repeated exposures to sodium hypochlorite. SPILLS The contaminated area should be flooded with a liquid germicide before cleaning, then decontaminated with fresh germicidal chemical. Gloves and mucoscal protection should be worn during the cleaning and decontaminating procedures. LAUNDRY Laundry should be processed through Mohawk Laundry Services. WASTE Place waste into biohazard waste disposal stream of your institution. TRANSPORTATION 1. Specimens transported within an institution should be labeled with biohazard symbols, placed in a water proof bag or container. Any contamination should be cleaned with one part bleach, nine parts water and left for 20 minutes. FHSc Safety Office July 16, 2008 Page 4 of 5
PLEASE POST HANDLING BLOOD OR BODY FLUIDS All blood and body substances should be considered potentially infectious Handled only by personnel knowledgeable in biological safety procedures Liquid specimens are not to be discarded except into the biohazard waste stream No drink, food, or cosmetics in work areas Gloves to be worn when in direct contact No mouth pipetting Any techniques creating aerosols should be in a Class II biological safety hood Centrifugation should be in a safety centrifuge with an enclosed autoclavable head or in a safety cabinet At the end of the day, laboratory work surfaces should be decontaminated All laboratory items to be decontaminated before re-use Protective clothing to be removed before leaving the labs Hand washing following completion of any laboratory activities FHSc Safety Office July 16, 2008 Page 5 of 5