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