NIOSH Safety and Health Topic:

Bloodborne Infectious Diseases
HIV/AIDS, Hepatitis B Virus, and Hepatitis C Virus

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)
Provides information on OSHA standards, hazard recognition, post-exposure evaluation, more.
External link: http://www.osha.gov/SLTC/bloodbornepathogens/index.html

Exposure to Blood: What Health Care Personnel Need to Know
Focuses on human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV).
PDF 364 KB (10 pages)

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
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.
External link: http://www.cdc.gov/od/ohs/biosfty/bmbl5/bmbl5toc.htm

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
This page includes descriptions of the rapid HIV tests approved by the Food and Drug Administration (FDA).
External link: http://www.cdc.gov/hiv/topics/testing/rapid/index.htm

Updated Compendium of State HIV Testing Laws
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.
External link: http://www.ucsf.edu/hivcntr/StateLaws/Index.html

Hepatitis B Virus Resources

Viral Hepatitis B
Information from the CDC on Hepatitis B Virus.

Hepatitis C Virus Resources

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.

Sharps Safety
A workbook for designing, implementing, and evaluating a sharps-injury prevention program.

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
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.
External link: http://www.healthsystem.virginia.edu/internet/epinet/

Preventing Occupational Exposures to Bloodborne Pathogens: Articles from Advances in Exposure Prevention, 1994–2003
Book for sale from the International Health Care Worker Safety Center containing articles from the journal "Advances in Exposure Prevention."
External link: http://www.healthsystem.virginia.edu/internet/epinet/AEPBookWebsiteBlurb.cfm

Training for Development of Innovative Control Technologies Project
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.
External link: http://www.tdict.org/

California Department of Health Services Sharps Injury Control Program
The Sharps Injury Control Program was established by Senate Bill 2005 to study sharps injuries in hospitals, skilled nursing facilities, and home health agencies in California.
External link: http://www.sharpslist.org/PublicUser/AboutUs.aspx

Safer Needle Device Listings

List of Devices Designed to Prevent Percutaneous Injury and Exposures to Bloodborne Pathogens in the Health Care Setting
Developed by the University of Virginia's International Health Care Worker Safety Center.
External link: http://www.healthsystem.virginia.edu/internet/epinet/

Needle-Free Injection Technology
This page provides background information, scientific bibliography, history, and links to news reports, policy sources, device manufacturers, and related sites about needle-free injection technology.

International Sharps Injury Prevention Society (ISIPS)
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.
External link: http://www.isips.org/safety_products.html

Needlestick-Prevention Device Selection Guide
Sponsored by ECRI, an independent nonprofit health services research agency.
External link: http://www.ecri.org/

Association of Needle-Free Injection Manufacturers
The ANFIM mission is to actively seeks affiliations with others who share the common goal of discovering safer healthcare technologies to avoid sharps injuries.
External link: http://www.anfim.com/

TDICT
A user-based performance standard for the design, evaluation, and selection of medical devices.
External link: http://www.tdict.org/performance.html

TDICT: Evaluation Tools
Evaluation tools for evaluating medical devices.
External link: http://www.tdict.org/evaluation2.html

Other Engineering Controls

Physical Hazards: Eye Protection
Eye Protection for Infection Control (Topic Page)

Glass Capillary Tubes: Joint Safety Advisory About Potential Risks, February 1999
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)
Provides health care professionals with up-to-the-minute HIV clinical information and individualized, expert case consultation.
External link: http://www.ucsf.edu/hivcntr/

Download PEP Steps, A Quick Guide to Postexposure Prophylaxis in the Health Care Setting (April 2006)

PDF 94 KB (16 pages)
External link: http://www.mpaetc.org/downloads/PEP%20final%20(2006).pdf

Download PEPline poster:

PDF 158 KB (1 page)

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)
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.
PDF 266 KB (24 pages)

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)
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).

PDF 333 KB (67 pages)

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)
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.

PDF 423 KB (127 pages)

Surveillance

Sharps Injuries among Hospital Workers in Massachusetts, 2004 (April 2007)
Findings from the Massachusetts Sharps Injury Surveillance System
Massachusetts Department of Public Health
External link: http://mass.gov/Eeohhs2/docs/dph/occupational_health/injuries_hospital_2004.pdf

Sharps Injuries among Hospital Workers in Massachusetts, 2003 (January 2006)
Findings from the Massachusetts Sharps Injury Surveillance System
Massachusetts Department of Public Health
External link: http://www.mass.gov/Eeohhs2/docs/dph/occupational_health/injuries_hospital_2003.pdf

Sharps Injuries among Hospital Workers in Massachusetts, 2002 (June 2004)
Findings from the Massachusetts Sharps Injury Surveillance System
Massachusetts Department of Public Health
External link: http://www.mass.gov/dph/bhsre/ohsp/sharps/injuries_hospital.doc

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)
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.
External link: http://www.healthsystem.virginia.edu/internet/epinet/

Latex Gloves

NIOSH Safety and Health Topic: Latex Alergy

Preventing Allergic Reactions to Natural Rubber Latex in the Workplace
DHHS (NIOSH) Alert NIOSH Publication Number 97-135 (June 1997)
Describes six case reports of workers who developed latex allergy and presents NIOSH recommendations for minimizing latex-related health problems.

En Espanol

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.

Latex Allergy—Fact Sheet
DHHS (NIOSH) Publication Number 705006 (June 1997)
Rcommendations for selecting products and implementing work practices that reduce the risk of allergic reactions.

En Espanol

Dental Infection Control

Dental Infection Control
Including fact sheets, FAQ's, Publications, and Guidelines from CDC.

OSHA: Safety and Health Topics for Dentistry
Includes information on hazard identification, compliance, and more.
External link: http://www.osha.gov/SLTC/dentistry/index.html

Correctional Health Care Workers

Protect Your Employees with an Exposure Control Plan
DHHS (NIOSH) Publication No. 2007-158
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.PDF ONLY 248 KB (2 pages)

Body Art

NIOSH Safety and Health Topic Page: Body Art
This page describes how tattoo artists and body piercers can protect themselves from bloodborne infections.

International

World Health Organization Safe Injection Toolbox
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.
ExternalLink: <http://www.who.int/injection_safety/toolbox/en/

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
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.
External link: http://www.leginfo.ca.gov/pub/bill/sen/sb_1301-1350/sb_1305_bill_20060712_chaptered.pdf
PDF ONLY 74 KB (3 pages)

Preventing Blood-Borne Infections Through Pharmacy Syringe Sales and Safe Community Syringe Disposal
Supplement from the Journal of the American Pharmaceutical Association (2002).
PDF ONLY 1,120 KB (122 pages)

Environmental Protection Agency's Medical Waste Website
For regulations regarding medical waste disposal.
External link: http://www.epa.gov/epaoswer/other/medical

Community Options for Safe Needle Disposal
Environmental Protection Agency Publication EPA530-K-04-001 (October 2004)
External link: http://www.premierinc.com/all/safety/publications/02-05-downloads/10-med-govt.pdf
PDF ONLY 590 KB (8 pages)

Protect Yourself, Protect Others ─ Safe Options for Home Needle Disposal
Environmental Protection Agency Publication EPA530-F-04-004 (October 2004)
External link: http://www.premierinc.com/all/safety/publications/02-05-downloads/11-med-home.pdf
PDF ONLY 1,130 KB (2 pages)

Coalition for Safe Community Needle Disposal
External link: http://www.safeneedledisposal.org

Earth 911
Search for a needle disposal program near you by entering your zipcode at the Household Hazardous Waste section of this website.
External link: http://www.earth911.org

North American Syringe Exchange Program
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.