Bloodborne Pathogens & Aerosols
In dentistry, the diseases we are most concerned about are those caused by bloodborne pathogens (BBP). Examples are hepatitis B and C and human immunodeficiency virus (HIV). Transmission may occur from a patient to a dental health care provider (DHCP), from a DHCP to a patient, or from one patient to another patient. The best way to prevent the transmission of BBP is adherence to Standard Precautions.
Occupational exposures can occur through needlesticks or cuts from other sharp instruments contaminated with an infected patient’s blood (including blood contaminated saliva) or through contact of the eye, nose, mouth, or skin with a patient’s blood. Health care personnel are at risk for occupational exposure to bloodborne pathogens — pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV). Following a specific exposure, the risk of infection varies depending on factors such as:
- The pathogen involved.
- The type and severity of exposure.
- The amount of blood involved in the exposure.
- The amount of pathogen in the patient’s blood at the time of exposure.
Although most exposures do not result in infection, the exposed person should be evaluated immediately by a qualified health care professional1 in case treatment is needed.
If you experienced a needlestick, cut yourself with a sharp instrument, or were exposed to the blood or another body fluid of a patient, immediately follow these steps:
- Wash the site of the needlestick or cut with soap and water.
- Flush splashes to the nose, mouth, or skin with water.
- Irrigate eyes with clean water, saline, or sterile irrigants.
- Report the incident to your supervisor or the person in your practice responsible for managing exposures.
- Immediately seek medical evaluation from a qualified health care professional1 because, in some cases, postexposure treatment may be recommended and should be started as soon as possible.
Health care professionals who evaluate the exposures of dental health care personnel (DHCP) should be:
- Selected before DHCP are placed at risk of exposure.
- Experienced in providing antiretroviral therapy.
- Familiar with the unique nature of dental injuries so they can provide appropriate guidance on the need for antiretroviral prophylaxis.
- Because not all exposure assessors are experienced in antiretroviral therapy, it may be necessary to identify more than one health care professional to perform these tasks.
Health care professionals caring for exposed health care workers can call the National Clinicians’ Post-exposure Prophylaxis Hotline (PEPline) for advice on managing occupational exposures to HIV and hepatitis B and C viruses. PEPline is available 24 hours a day, 7 days a week, at 1-888-448-4911.
Employers should follow all federal (including the Occupational Safety and Health Administration [OSHA]) and state requirements for recording and reporting occupational injuries and exposures. The exposure report should be recorded in the exposed person’s confidential medical record and made available to qualified health care professionals.1 Information included in the exposure report can be found on page 17 of the following guidance document: www.cdc.gov/mmwr/PDF/rr/rr5011.pdf Cdc-pdf[PDF-333K].
Many needlesticks and other cuts can be prevented by using engineering controls (for example, disposing of used needles in appropriate sharps disposal containers and using medical devices with safety features designed to prevent injuries) and safer techniques (for example, not recapping needles by hand). Exposures to the eyes, nose, mouth, and skin can be prevented by using personal protective equipment such as gloves, eye and face protection, and gowns.
The Needlestick and Prevention Act of 2001 requires employers to identify, evaluate, and select devices with engineered safety features at least annually and as new devices become available. It further mandates involving non-managerial dental health care personnel (DHCP) who are directly responsible for patient care (e.g., dentists, hygienists, dental assistants) in evaluating and choosing these devices and maintaining a sharps injury log. If after inquiring about the availability of new safety devices or safer options none are identified, DHCP should document these findings in their office exposure control plan. Engineering controls should be used whenever possible as the primary method to reduce exposures to bloodborne pathogens; when engineering controls are not available or appropriate, work practice controls should be used.
The following resources provide additional information about developing a safety program and identifying and evaluating safe dental devices:
CDC. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR 2013:62(No.RR-10). Available at: www.cdc.gov/mmwr/PDF/rr/rr6210.pdf Cdc-pdf[PDF-712K].
CDC. Exposure to Blood: What healthcare personnel need to know. Updated July 2003. https://www.cdc.gov/HAI/pdfs/bbp/Exp_to_Blood.pdf Cdc-pdf[PDF-329K].
CDC. National Institute for Occupational Safety and Health. NIOSH Alert: Preventing needlestick injuries in health care settings. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, CDC, National Institute for Occupational Safety and Health, 1999.
CDC. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR 2001;50(No.RR-11). Available at: www.cdc.gov/mmwr/PDF/rr/rr5011.pdf Cdc-pdf[PDF-333K].
CDC. Workbook for designing, implementing, and evaluating a sharps injury prevention program. Available at: www.cdc.gov/sharpssafety/.
Cleveland JL, Cardo DM. Occupational exposures to human immunodeficiency virus, hepatitis B virus, and hepatitis C virus: risk, prevention, and management. Dental Clinics of North America 2003;47(4):681-96.
Kuhar DT, Henderson DK, Struble KA, Heneine W, Thomas V, Cheever LW, Gomaa A, Panlilio AL; US Public Health Service Working Group. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013;34(9):875–892.
US Department of Labor, Occupational Safety and Health Administration. 29 CFR Part 1910.1030. Occupational Exposure to Bloodborne Pathogens: Needlestick and Other Sharps Injuries: Final Rule. Federal Register 2001;66:5317–5325. Updated from and including 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; final rule. Federal Register December 6, 1991;56:64003–64182. Available at: www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051External.
- A qualified health care professional is any health care provider who can provide counseling and perform all medical evaluations and procedures in accordance with the most current recommendations of the U.S. Public Health Service, including providing postexposure chemotherapeutic prophylaxis when indicated.