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This chapter examines standard precautions, routes of infectious disease exposure, and infection control practices. This discussion includes an overview of exposure management and commonly encountered occupational exposures in the ED.

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The Centers for Disease Control and Prevention (CDC) estimates that 8 million health care workers are at risk of acquiring infections in the course of providing care for their patients. An additional 1.2 million non–health care workers are also at risk for infectious exposure, and include those engaged in law enforcement; fire, rescue, and EMS; correctional facilities; research laboratories; and the funeral industry.

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The U.S. Occupational Safety and Health Administration (OSHA) defines occupational exposure as a “reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of the employee’s duties.”1 Blood is defined as “human blood, blood products, or blood components.”1 Other potentially infectious materials are defined as “human body fluids, such as saliva, semen, and vaginal secretions; cerebrospinal, synovial, pleural, pericardial, peritoneal, and amniotic fluids; any body fluids visibly contaminated with blood; unfixed human tissue or organs; HIV (human immunodeficiency virus) or HBV (hepatitis B virus) containing cell or tissue cultures, culture mediums, or other solutions; and all body fluids where it is difficult or impossible to differentiate between body fluids.”1 Health care workers should treat all bodily secretions, fluids, and tissues as potentially infectious substances.

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The Hospital Infection Control Practices Advisory Committee of the CDC has developed a listing of selected infections and conditions that may be encountered in the ED, along with recommended occupational exposure precautions.2–4 Although the geographic distribution and population incidence of most infectious diseases are well known, this does not imply that infectivity is limited to specific ethnic groups, races, or subsets of the population. As the world population becomes increasingly mobile, patients with geographically isolated diseases may migrate to regions where the disease incidence may be low or nonexistent. In addition, many infectious diseases display heterogeneous and varying symptom complexes, including prolonged latent or asymptomatic stages. Therefore, providing care to an apparently healthy, asymptomatic patient does not preclude the possibility of disease infectivity and exposure. Because health care workers cannot readily identify those who are infected or who have risky behaviors, it is prudent to employ infection control practices and utilize personal protective equipment (PPE) during all patient care activities. It is on this premise that the concept of standard precautions is based.

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Portals for Exposure

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Portals for infectious disease entry are percutaneous, mucous membrane (oral, ocular, nasal, or rectal), respiratory, and dermal.

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Percutaneous exposures pose the highest risk for the contraction of bloodborne disease. Needle sticks or cuts by sharp objects account for the majority of percutaneous injuries. Workplace activities that put personnel at risk for percutaneous injuries include phlebotomy, initiation of IV access, manipulation of access devices, suturing, and medication injection. Because ...

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