Avoiding exposure to blood and other potentially infectious materials (OPIM), as well as protection by immunization, remain primary strategies for reducing occupationally-acquired infections, but occupational exposures can still occur.
In addition to blood, the following are considered to be potentially infectious with HIV, HBV or HCV:
• All body fluid where it is difficult or impossible to differentiate between body fluids and amniotic fluid
• Any body fluid visibly contaminated with blood
• Any fixed tissue or organ (other than intact skin) from human (living or dead) blood/organs or other tissues from experimental animals infected with blood-borne pathogens
• Cell, tissue or organ cultures containing blood-borne pathogens
• Cerebral spinal fluid
• Culture media or other solutions containing blood-borne pathogens
• Pericardial fluid
• Peritoneal fluid
• Saliva in dental procedures (whether or not there is visible blood)
• Synovial fluid
• Vaginal secretions
An exposure requiring evaluation and medical attention occurs when blood or OPIM is involved in:
• A puncture of the skin with a needle, lancet or other contaminated sharp item
• A splash or spray or other transmission into the eyes, mouth or nose
• Transmission into an open wound, an oozing lesion, or other area where there is significant
breakdown of skin
A strict protocol of standard precautions, instrument/equipment design, workplace setup, work practice and administrative controls is the best means to minimize occupational exposure.
Policies and procedures regarding prevention of exposure, accidental exposure, post-exposure management and reporting of exposure should be adequately discussed to all dental healthcare personnel. Written policies and procedures should likewise be made available to all persons who are at risk of exposure to blood or OPIM.
DHCP who have contact with patients can also be exposed to persons with infectious TB and should have a baseline tuberculin skin test (TST), preferably by using a two-step test, at the beginning of employment. Thus, if an unprotected occupational exposure occurs, TST conversions can be distinguished from positive TST results caused by previous exposures. The facility’s level of TB risk will determine the need for routine follow-up TSTs (see Indications for two-step TST).
Indications for two-step TST
|No previous TST result||Two-step baseline TST’s|
|Previous negative TST result (documented or not) >12 months before new employment||Two-step baseline TST’s|
|Previous documented negative TST result<12 months before new employment||Single TST needed for baseline testing|
|>2 previous documented negative TST’s but most recent TST >12 months before new employment||Single TST; two-step testing is not necessary|
|Previous documented positive TST result||No TST|
|Previous undocumented positive TST result||Two-step baseline TST’s|
|Previous BCG vaccination||Two-step baseline TST’s|
1. Develop a comprehensive post-exposure management and medical follow-up program
a. Include policies and procedures for prompt reporting, evaluation, counseling, treatment and medical follow-up of occupational exposures.
b. Establish mechanisms for referral to a qualified healthcare professional for medical evaluation and follow-up.
c. Conduct a baseline TST, preferably by using a two-step test, for all DHCP who might have contact with persons with suspected or confirmed infectious TB, regardless of the risk classification of the setting.