When do you use universal precautions

Complete guidance on how and when hand hygiene should be performed, including recommendations regarding surgical hand antisepsis and artificial nails can be found in the Guideline for Hand Hygiene in Health-Care Settings pdf icon [PDF — KB]. After barehanded touching of instruments, equipment, materials, and other objects likely to be contaminated by blood, saliva, or respiratory secretions.

Examples include biopsy, periodontal surgery, apical surgery, implant surgery, and surgical extractions of teeth e. Personal protective equipment PPE refers to wearable equipment that is designed to protect DHCP from exposure to or contact with infectious agents.

PPE that is appropriate for various types of patient interactions and effectively covers personal clothing and skin likely to be soiled with blood, saliva, or other potentially infectious materials OPIM should be available.

These include gloves, face masks, protective eye wear, face shields, and protective clothing e. Hand hygiene is always the final step after removing and disposing of PPE.

Training should also stress preventing further spread of contamination while wearing PPE by:. The application of Standard Precautions and guidance on appropriate selection and an example of putting on and removal of personal protective equipment is described in detail in the Guideline for Isolation Precautions pdf icon [PDF — 1. The strategies target primarily patients and individuals accompanying patients to the dental setting who might have undiagnosed transmissible respiratory infections, but also apply to anyone including DHCP with signs of illness including cough, congestion, runny nose, or increased production of respiratory secretions.

DHCP should be educated on preventing the spread of respiratory pathogens when in contact with symptomatic persons. Post signs at entrances with instructions to patients with symptoms of respiratory infection to—. Perform hand hygiene after hands have been in contact with respiratory secretions. Offer masks to coughing patients and other symptomatic persons when they enter the dental setting. Provide space and encourage persons with symptoms of respiratory infections to sit as far away from others as possible.

If available, facilities may wish to place these patients in a separate area while waiting for care. Most percutaneous injuries e. However, sharps injuries continue to occur and pose the risk of bloodborne pathogen transmission to DHCP and patients. Most exposures in dentistry are preventable; therefore, each dental practice should have policies and procedures available addressing sharps safety.

DHCP should be aware of the risk of injury whenever sharps are exposed. When using or working around sharp devices, DHCP should take precautions while using sharps, during cleanup, and during disposal.

Engineering and work-practice controls are the primary methods to reduce exposures to blood and OPIM from sharp instruments and needles. Whenever possible, engineering controls should be used as the primary method to reduce exposures to bloodborne pathogens. Engineering controls remove or isolate a hazard in the workplace and are frequently technology-based e. Employers should involve those DHCP who are directly responsible for patient care e.

Other examples of engineering controls include sharps containers and needle recapping devices. When engineering controls are not available or appropriate, work-practice controls should be used. Work-practice controls are behavior-based and are intended to reduce the risk of blood exposure by changing the way DHCP perform tasks, such as using a one-handed scoop technique for recapping needles between uses and before disposal.

Other work-practice controls include not bending or breaking needles before disposal, not passing a syringe with an unsheathed needle by hand, removing burs before disassembling the handpiece from the dental unit, and using instruments in place of fingers for tissue retraction or palpation during suturing and administration of anesthesia. All used disposable syringes and needles, scalpel blades, and other sharp items should be placed in appropriate puncture-resistant containers located close to the area where they are used.

Sharps containers should be disposed of according to state and local regulated medical waste rules. Safe injection practices are intended to prevent transmission of infectious diseases between one patient and another, or between a patient and DHCP during preparation and administration of parenteral e. Safe injection practices are a set of measures DHCP should follow to perform injections in the safest possible manner for the protection of patients.

DHCP most frequently handle parenteral medications when administering local anesthesia, during which needles and cartridges containing local anesthetics are used for one patient only and the dental cartridge syringe is cleaned and heat sterilized between patients.

Other safe practices described here primarily apply to use of parenteral medications combined with fluid infusion systems, such as for patients undergoing conscious sedation. Unsafe practices that have led to patient harm include 1 use of a single syringe — with or without the same needle — to administer medication to multiple patients, 2 reinsertion of a used syringe — with or without the same needle — into a medication vial or solution container e.

However, because of reports of transmission of infectious diseases by inappropriate handling of injectable medications, CDC now considers safe injection practices to be a formal element of Standard Precautions.

Complete guidance on safe injection practices can be found in the Guideline for Isolation Precautions pdf icon [PDF — 1. Additional materials, including a list of frequently asked questions from providers and a patient notification toolkit , are also available. If multidose vials will be used for more than one patient, they should be restricted to a centralized medication area and should not enter the immediate patient treatment area e.

If a multidose vial enters the immediate patient treatment area, it should be dedicated for single-patient use and discarded immediately after use. Date multidose vials when first opened and discard within 28 days, unless the manufacturer specifies a shorter or longer date for that opened vial.

Ensure that the dental cartridge syringe is appropriately cleaned and heat sterilized before use on another patient. Instrument processing requires multiple steps using specialized equipment. Each dental practice should have policies and procedures in place for containing, transporting, and handling instruments and equipment that may be contaminated with blood or body fluids. Most single-use devices are labeled by the manufacturer for only a single use and do not have reprocessing instructions.

Use single-use devices for one patient only and dispose of appropriately. Cleaning, disinfection and sterilization of dental equipment should be assigned to DHCP with training in the required reprocessing steps to ensure reprocessing results in a device that can be safely used for patient care.

Training should also include the appropriate use of PPE necessary for safe handling of contaminated equipment. Patient-care items e. Note: Dental handpieces and associated attachments, including low-speed motors and reusable prophylaxis angles, should always be heat sterilized between patients and not high-level or surface disinfected.

Although these devices are considered semicritical, studies have shown that their internal surfaces can become contaminated with patient materials during use. If these devices are not properly cleaned and heat sterilized, the next patient may be exposed to potentially infectious materials. Digital radiography sensors are also considered semicritical and should be protected with a Food and Drug Administration FDA -cleared barrier to reduce contamination during use, followed by cleaning and heat-sterilization or high-level disinfection between patients.

If the item cannot tolerate these procedures then, at a minimum, protect with an FDA-cleared barrier. In addition, clean and disinfect with an Environmental Protection Agency EPA -registered hospital disinfectant with intermediate-level i. Because these items vary by manufacturer and their ability to be sterilized or high-level disinfected also vary, refer to manufacturer instructions for reprocessing. Cleaning to remove debris and organic contamination from instruments should always occur before disinfection or sterilization.

If blood, saliva, and other contamination are not removed, these materials can shield microorganisms and potentially compromise the disinfection or sterilization process. Automated cleaning equipment e. After cleaning, dried instruments should be inspected, wrapped, packaged, or placed into container systems before heat sterilization. Packages should be labeled to show the sterilizer used, the cycle or load number, the date of sterilization, and, if applicable, the expiration date.

The ability of a sterilizer to reach conditions necessary to achieve sterilization should be monitored using a combination of biological, mechanical, and chemical indicators. Biological indicators, or spore tests, are the most accepted method for monitoring the sterilization process because they assess the sterilization process directly by killing known highly resistant microorganisms e. The type of protective barrier s should be appropriate for the procedure being performed and the type of exposure anticipated.

Wear gloves when touching blood of body fluids, mucous membranes, or non-intact skin of all patients. Wear gloves when handling items or surfaces soiled with blood or body fluids. Wear gloves when performing venipuncture and other vascular access programs.

Wear gloves for performing phlebotomy if cuts, scratches, or other breaks in the skin are present. Wear gloves in situations in which contamination with blood may occur--for example, when performing phlebotomy on an uncooperative patient.

Wear gloves for performing finger or heel sticks on infants and children. Change gloves after contact with each patient. Do not wash or decontaminate disposable gloves for reuse.

Wear masks and protective eyewear or face shields during procedures that are likely to generate splashing or droplets of blood or other body fluids to prevent exposure of mucous membranes of the mouth, nose, and eyes. Wear gowns or aprons when you anticipate splashing of blood or other body fluids to which universal precautions apply.

Take care to prevent injuries when using, handling, or cleaning needles, scalpels, and other sharp instruments or devices. Although developed for healthcare professionals, universal precautions should be taken by anyone who may have contact with blood or body fluids.

It is recommended to call a bioremediation company to clean up a blood spill that is larger than a standard dinner plate. After an accident, homicide, suicide, or other trauma, many families do not know where to turn for help in the cleanup. Aftermath safely and thoroughly cleans up potential bloodborne pathogens that are left behind after a trauma, and like hospital workers, we employ universal precautions to ensure the safety of our technicians and those we serve.