Blood-Borne Disease : Part 3

by Food and Drug Administration (FDA)

(Page 3 of 3)

The basis of universal precautions is the assumption that blood and body fluids of all patients may be infectious, and that measures to protect against exposure must be observed at all times. FDA officials cooperated with CDC in the development of these precautions.

The major elements of universal precautions are: - Use of "protective barriers" — gloves, gowns, goggles, and face masks — when appropriate to reduce the risk of exposure to blood and other potentially infectious body fluids. For example, dentists should wear face masks when working in a patient's mouth. Between patients, hands should be washed, and gloves and other barriers changed. - Caution in handling needles, scalpels, and other sharp instruments. Needles should not be recapped, removed from disposable syringes, bent, broken, or otherwise manipulated by hand. - Disposal of needles and other sharp instruments in specially labeled, puncture-resistant containers located as close as is practical to the area where the "sharps" are used. - Use of gloves to draw blood when a health-care worker has skin cuts or scratches, when drawing blood from a child, when an inexperienced person is being trained to draw blood, or in any other situation in which hand contamination with blood might occur. - Immediate and thorough washing of hands or other parts of the body contaminated with blood or other potentially infectious body fluids.

CDC has also set guidelines for disposing of infected trash and for sterilization and disinfection of reusable equipment in hospitals and other health-care settings.

Nondisposable instruments that penetrate the skin, such as nondisposable needles and scalpels, must be sterilized before each use. In addition, FDA now recommends that dental instruments such as drills and air syringes be heat-sterilized before each use (see main article). Effective methods of sterilization are dry heat ovens and autoclaves. An autoclave is a device similar to a pressure cooker that uses steam to sterilize.

Gas and chemical vapor sterilizers are also cleared by FDA for sterilizing certain dental devices. In any case, the dental device must be compatible with the selected method of sterilization, and the sterilizer must be used according to its labeling.

Devices that do not penetrate the skin or come in contact with normally sterile areas of the body, such as several types of endoscopes, must be disinfected, at a minimum, with an EPA-registered and FDA-cleared disinfectant. The disinfectant selected must be of appropriate strength to kill the types of organisms that may contaminate the particular device.

Universal precautions have been endorsed by all the major health-care professional societies, including the American Medical Association, the American Dental Association, and the American Nurses Association. In 1991, Congress passed a law requiring states to adopt the CDC guidelines or their equivalent.

Most recently, the federal Occupational Safety and Health Administration has incorporated universal precautions into a new standard on occupational exposure to blood-borne pathogens, which became effective in March 1992.

The OSHA standard requires all employers to protect workers who risk exposure to blood and other potentially infectious body fluids on the job. The standard applies to hospitals, medical and dental offices, laboratories, and any other workplace where exposure to infected blood might occur. Employers found in violation of the standard may be fined up to $70,000.

The new standard also requires employers to offer free HBV vaccine to at-risk workers. The cost of the vaccination was one factor that previously deterred many workers from taking advantage of this preventive measure. n

Ask Your Dentist

FDA and other federal agencies agree with the American Dental Association (ADA) that the risk of acquiring HIV during dental treatment is extremely remote.

The ADA supports the use of universal precautions (see accompanying article) and suggests that consumers look for — and ask their dentists whether they are following — these infection control procedures:

• Dentist and staff wear gloves and a mask during all patient treatment.
• Dentist and staff wash their hands before and after each patient and change gloves after each patient.
• Dental instruments are cleaned and sterilized after each use.
• Surfaces and equipment in the treatment room are cleaned and disinfected after each patient.
• Needles and other sharp items are disposed of in special containers.

All dentists should be heat-sterilizing instruments such as drills, air and water syringes, and scalers after each patient use, as a result of an FDA recommendation last September.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.