| Exposures to blood and other body fluids occur across a wide variety of occupations. Health care workers, emergency response and public safety personnel, and other workers can be exposed to blood through needlestick and other sharps injuries, mucous membrane, and skin exposures. The pathogens of primary concern are the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Workers and employers are urged to take advantage of available engineering controls and work practices to prevent exposure to blood and other body fluids.
Have you experienced a needlestick injury or are you managing occupational exposure?
General Resources
OSHA Regulations: Bloodborne Pathogens Standard (29 CFR 1910.1030)
External link: http://www.osha.gov/SLTC/bloodbornepathogens/index.html
Provides information on OSHA standards, hazard recognition, post-exposure evaluation, more.
Exposure to Blood: What Health Care Personnel Need to Know
 PDF 364 KB (10 pages)
Focuses on human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV).
Overview of State Needle Safety Legislation
Listing of state laws aimed at adding safeguards for health care workers at the state level.
Biosafety in Microbiological and Biomedical Laboratories (BMBL), 5th Edition
External link: http://www.cdc.gov/od/ohs/biosfty/bmbl5/bmbl5toc.htm
Guidance for laboratory workers and the public on the practice of biosafety—the discipline addressing the safe handling and containment of infectious microorganisms and hazardous biological materials.
Universal Precautions for Prevention of Transmission of HIV and Other Bloodborne Infections
Universal Precautions for Prevention of Transmission of HIV and Other Bloodborne Infections
This CDC fact sheet presents information on the use of Universal Precautions to prevent transmission of bloodborne infections.
Recommendations for Preventing Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Patients During Exposure-Prone Invasive Procedures
MMWR, July 12, 1991/40 (RR08)
Updates recommendations for prevention of transmission of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in the health care setting.
CDC National AIDS Hotline Training Bulletin #37 (1993)
External link: http://www.aegis.com/pubs/Cdc_Fact_sheets/1993/CDC93139.html
Universal Precautions for morticians. Like healthcare workers, funeral home directors, morticians, undertakers, and embalmers should follow Universal Precautions. This fact sheet states that "No one knows exactly how long HIV will remain viable in the blood and tissues after an HIV-infected person dies. To find this answer, the exact time of death would have to be noted and then timed sampling of the deceased's blood would have to be performed. In addition, amounts of virus circulating in the blood vary. All blood, even that in corpses, should be considered potentially infectious; and all workers involved with preparation of the body (e.g., morticians, embalmers) should use universal precautions."
HIV Resources
HIV and Its Transmission
This CDC factsheet presents information on the ways in which HIV can be transmitted.
Preventing Occupational HIV Transmission to Health Care Personnel
The Centers for Disease Control and Prevention (CDC) offer several strategies for preventing transmission of HIV to health care personnel in the workplace.
Rapid HIV Testing
External link: http://www.cdc.gov/hiv/topics/testing/rapid/index.htm
This page includes descriptions of the rapid HIV tests approved by the Food and Drug Administration (FDA).
Updated Compendium of State HIV Testing Laws
External link: http://www.ucsf.edu/hivcntr/StateLaws/Index.html
The National HIV/AIDS Clinicians Consultation Center at San Francisco General Hospital has compiled this list, which describes policies, rules, and regulations for standard and rapid HIV testing.
Viral Hepatitis B
Information from the CDC on Hepatitis B Virus.
Hepatitis B and the Healthcare Worker
External link: http://www.immunize.org/catg.d/2109hcw.htm
CDC answers frequently asked questions about how to protect healthcare workers.
Viral Hepatitis C
Information from the CDC on Hepatitis C Virus.
Preventing Needlesticks and Sharps Injuries
Use of Blunt-Tip Suture Needles to Decrease Percutaneous Injuries to Surgical Personnel
DHHS (NIOSH) Publication No. 2008-101
This document was developed by the Occupational Safety and Health Administration (OSHA), Department of Labor, and the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Department of Health and Human Services.
Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program
The workbook includes several sections that describe each of the organizational steps and operational processes. A toolkit of forms and worksheets is included to help guide program development and implementation.
Safer Medical Device Implementation in Health Care Facilities: Sharing Lessons Learned
NIOSH asked a small number of health care facilities to share their experiences on how they implemented safer medical devices in their settings. These facilities described each step in the process and discussed the barriers they encountered. They explained how problems were resolved, and most important, shared lessons learned.
NIOSH ALERT: Preventing Needlestick Injuries in Health Care Settings
DHHS (NIOSH) Publication No. 2000-108, 1999
 En Espanol
This booklet describes the risk of needlestick injury and prevention strategies.
How to Protect Yourself From Needlestick Injuries
DHHS (NIOSH) Publication No. 2000-135
En Espanol
This pamphlet describes needlestick protection strategies.
OSHA Bloodborne Pathogens and Needlestick Prevention Topic Page
http://www.osha.gov/SLTC/bloodbornepathogens/index.html
Occupational Safety: Selected Cost and Benefit Implications of Needlestick Prevention Devices for Hospitals
GAO Report (GAO-01-60R), November 17, 2000
PDF 203 KB (18 pages)
International Health Care Worker Safety Center
External link: http://www.healthsystem.virginia.edu/internet/epinet/
The University of Virginia's International Health Care Worker Safety Center is dedicated to identifying effective measures for reducing occupational exposures to and transmission of bloodborne pathogens to health care workers worldwide.
Training for Development of Innovative Control Technologies Project
External link: http://www.tdict.org/
TDICT, based at San Francisco General Hospital, is a collaborative effort of frontline health care workers, product designers, and industrial hygienists dedicated to preventing exposure to blood through better design and evaluation of medical devices and equipment.
List of Devices Designed to Prevent Percutaneous Injury and Exposures to Bloodborne Pathogens in the Health Care Setting
External link: http://www.healthsystem.virginia.edu/internet/epinet/NEW/safetydevice.cfm
Developed by the University of Virginia's International Health Care Worker Safety Center.
Needle-Free Injection Technology
This page provides information about administering vaccines and other drugs through the skin without conventional needles.
International Sharps Injury Prevention Society (ISIPS)
External link: http://www.isips.org/safety_products.html
ISIPS is an international group of medical device and pharmaceutical manufacturers, health organizations, healthcare professionals, and medical waste disposal experts. It was formed to reduce the number of accidental sharps injuries that occur globally by promoting the use of safety-engineered products and services.
Needlestick-Prevention Device Selection Guide
External link: http://www.ecri.org/
Sponsored by ECRI, an independent nonprofit health services research agency.
Association of Needle-Free Injection Manufacturers
External link: http://www.anfim.com/
The ANFIM mission is to actively seeks affiliations with others who share the common goal of discovering safer healthcare technologies to avoid sharps injuries.
TDICT
External link: http://www.tdict.org/performance.html
A user-based performance standard for the design, evaluation, and selection of medical devices.
TDICT: Evaluation Tools
External link: http://www.tdict.org/evaluation2.html
Evaluation tools for evaluating medical devices.
Other Engineering Controls
NIOSH Safety and Health Topic: Eye Protection for Infection Control
Glass Capillary
Tubes: Joint Safety Advisory About Potential Risks, February 1999
External link:http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=22695&p_table=INTERPRETATIONS
Recommended steps that can minimize the potential risk of injury and/or
infection from bloodborne pathogens due to accidental breakage of glass
capillary tubes.
Selecting, Evaluating, and Using Sharps Disposal Containers
DHHS (NIOSH) Publication No. 97-111, January 1998
This document presents a comprehensive framework for selecting sharps disposal
containers and evaluating their efficacy as part of an overall needlestick
injury prevention plan.
Management and Treatment Guidelines
National HIV/AIDS Clinicians'
Consultation Center (PEPline)
External link: http://www.ucsf.edu/hivcntr/
Provides health care professionals with up-to-the-minute HIV clinical information
and individualized, expert case consultation.
Download PEP Steps, A Quick Guide to Postexposure Prophylaxis in the Health Care Setting (April 2006)
 PDF only 94 KB (16 pages)
External link: http://www.mpaetc.org/downloads/PEP%20final%20(2006).pdf
Download PEPline poster:
PDF only 158 KB (1 pages)
Recommendations for Postexposure Interventions to Prevent Infection with Hepatitis B Virus, Hepatitis C Virus, or Human Immunodeficiency Virus, and Tetanus in Persons Wounded During Bombings and Other Mass-Casualty Events - United States, 2008
MMWR, August 1, 2008/57 (RR-6)
PDF only 605 KB (28 pages)
External link: http://www.cdc.gov/mmwr/PDF/rr/rr5706.pdf
This report outlines recommendations for postexposure interventions to prevent infection with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus, and tetanus in persons during bombings or other events resulting in mass casualties.
Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis
MMWR, September 30, 2005/50 (RR-09)
PDF 266 KB (24 pages)
This report updates U.S. Public Health Service recommendations
for the management of health-care personnel (HCP) with occupational exposure
to blood and other body fluids that might contain human immunodeficiency
virus (HIV). This report emphasizes adherence to postexposure prophylaxis
(PEP) regimens when indicated, expert consultation in managing exposures,
follow-up to improve HCP adherence to PEP, and monitoring for adverse events,
including seroconversion. Clinicians should consider occupational exposures
as urgent medical concerns.
Updated U.S.
Public Health Service Guidelines for the Management of Occupational Exposures
to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis
MMWR, June 29, 2001/50 (RR-11)
PDF 333 KB (67 pages)
Updates previous U.S. Public Health Service recommendations for the management
of health-care personnel who have occupational exposure to blood and other
body fluids that might contain hepatitis B virus (HBV), hepatitis C virus
(HCV), or human immunodeficiency virus (HIV).
Immunization of Health-Care Workers: Recommendations of the Advisory
Committee on Immunization Practices (ACIP) and the Hospital Infection Control
Practices Advisory Committee(HICPAC)
MMWR, December 26, 1997/46 (RR-18)
PDF 423 KB (127 pages)
This report summarizes recommendations of the Advisory Committee on Immunization
Practices (ACIP) concerning the use of certain immunizing agents in health care
workers (HCWs) in the United States.
Surveillance
Sharps Injuries among Hospital Workers in Massachusetts
Data and Statistics Reports from 2002 - 2004
Massachusetts Sharps Injury Surveillance System
Massachusetts Department of Public Health
External link: http://www.mass.gov/?pageID=eohhs2terminal&L=5&L0=Home&L1=Consumer&L2=Community
+Health+and+Safety&L3=Workplace+Health+and+Safety&L4=Needlesticks+and+Other+Sharps+Injuries&sid
=Eeohhs2&b=terminalcontent&f=dph_occupational_health_c_sharps_data_stats&csid=Eeohhs2
Worker Health Chartbook 2004: Bloodborne Infections and Percutaneous Exposures
DHHS (NIOSH) Publication No. 2004-146
Provides data from the CDC about two of the major occupational bloodborne
infections—hepatitis B and HIV, the virus that causes AIDS
Surveillance
of Health Care Personnel with HIV/AIDS
CDC Fact Sheet provides current information on adult employees in the
health care setting with reported AIDS cases.
HIV/AIDS
Surveillance Report
The HIV/AIDS Surveillance Report contains information about U.S. AIDS and
HIV case reports, including data by state, metropolitan statistical area,
mode of exposure to HIV, sex, race/ethnicity, age group, vital status, and
case definition category.
National Surveillance System for Health Care Workers
The Centers for Disease Control and Prevention developed the National Surveillance
System for Health Care Workers (NaSH) and collaborates with health care facilities
to systematically collect information important to prevent occupational
exposures and infections among health care workers.
Exposure
Prevention Information Network (EPINet)
External link:
http://www.healthsystem.virginia.edu/internet/epinet/
EPINet was developed to provide standardized methods for recording percutaneous
injuries and blood and body fluid contacts, in order to assist hospitals
in complying with the OSHA recordkeeping requirements of the December 1991
Bloodborne Pathogens Standard.
Latex Gloves
NIOSH Safety and
Health Topic: Latex Allergy
Preventing Allergic
Reactions to Natural Rubber Latex in the Workplace
DHHS (NIOSH) Alert NIOSH Publication Number 97-135 (June 1997)
 En
Español
Describes six case reports of workers who developed latex allergy and presents
NIOSH recommendations for minimizing latex-related health problems.
Latex Allergy—A
Prevention Guide
DHHS (NIOSH) Publication Number 98-113 (February 1999)
Latex gloves have proved effective in preventing transmission of many infectious
diseases to health care workers, but for some workers exposures to latex
may result in allergic reactions.
Dental Infection Control
Dental Infection Control
Including fact sheets, FAQ's, Publications, and Guidelines from CDC.
OSHA:
Safety and Health Topics for Dentistry
External link: http://www.osha.gov/SLTC/dentistry/index.html
Includes information on hazard identification, compliance, and more.
Correctional Health Care Workers
Protect Your Employees with an Exposure Control Plan
DHHS (NIOSH) Publication No. 2007-158
PDF ONLY 248 KB (2 pages)
This page contains pdf versions of two posters and two brochures from NIOSH intended to help correctional health care workers and their management prevent work-related exposures to bloodborne pathogens.
First Responders
First Responders: Protect Your Employees with an Exposure Control Plan
DHHS (NIOSH) Publication No. 2008-115
This page contains pdf versions of two posters and two brochures from NIOSH intended to help first responders and their management prevent work-related exposures to bloodborne pathogens.
Body Art
NIOSH Safety and Health Topic Page: Body Art
International
World Health Organization Safe Injection Toolbox
ExternalLink: <http://www.who.int/injection_safety/toolbox/en/
The World Health Organization (WHO) established a voluntary coalition
called the "Safe Injection Global Network" (SIGN) to promote the safe
and appropriate use of injections throughout the world. One of their products
is a "Toolbox" containing resources to assist in the management
of national policies on the safe and appropriate use of injection.
Safe Community Needle Disposal
Individuals living in the community use needles and syringes to treat
medical conditions or to inject illegal drugs. Workers such as waste
haulers, recycling plant workers, janitors, housekeepers, and sewage
treatment workers can experience needlestick injuries when used needles
are improperly disposed of. Members of the general public, including
children, can also be exposed. The following websites provide resources
for properly disposing of used syringes and needles.
Safe Community Needle
Disposal
This CDC site provides information by state on public health laws and
regulations affecting community syringe disposal.
The Medical Waste Management Act
PDF ONLY 74 KB (3 pages)
External link: http://www.cdph.ca.gov/certlic/medicalwaste/Documents/MedicalWaste/MedicalWasteManagementAct.pdf
This California law will require, starting Sept. 1, 2008, that needles
and sharps used at home be transported only in approved containers
and managed at state-approved facilities.
Preventing Blood-Borne Infections Through Pharmacy Syringe Sales and Safe Community Syringe Disposal
Supplement from the Journal of the American Pharmaceutical Association (2002)
PDF 1.1 MB (122 pages)
External link: http://www.pharmacist.com/JAPhA/suppl2_cdc.pdf
Environmental Protection Agency's Medical Waste Website
External link: http://www.epa.gov/epaoswer/other/medical
For regulations regarding medical waste disposal.
Coalition for Safe Community Needle Disposal
External link: http://www.safeneedledisposal.org
Earth 911
External link: http://www.earth911.org
Search for a needle disposal program near you by entering
your zipcode at the Household Hazardous Waste section of this website.
North American Syringe Exchange Network
External link: http://www.nasen.org
NIOSHTIC-2 Search
NIOSHTIC-2
search results on Bloodborne Infectious Disease
 is
a searchable bibliographic database of occupational safety and health publications,
documents, grant reports, and journal articles supported in whole or in
part by NIOSH.
Related Sites
NIOSH Safety and Health Topic Page: Health Care Workers
National Center for Preparedness, Detection, and Control of Infectious Diseases
Protecting Healthcare Personnel
Division of Healthcare Quality Promotion
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Occupational Safety and Health Administration (OSHA)
External link: http://www.osha.gov/
Food and Drug Administration (FDA)
External link: http://www.fda.gov/
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