As the novel coronavirus SARS-CoV-2 began sweeping the world, researchers face new challenges as they realize how contagious it can be. A recent peer-review publication from Andrea Cossarizza, MD, PhD, Professor of Pathology, Immunology and Clinical Immunology, University of Modena and Reggio Emilia (UNIMORE), in Modena, Italy offers recommendations for lab workers on the frontlines seeking to gain control of the global crisis.

  • First, it’s recommended that each facility define and characterize risks locally to address safety, security, or procedural vulnerabilities, and outline any new mitigation measures to be implemented.
  • This includes handling, processing and all laboratory processes, procedures, and equipment used in testing SARS-CoV-2 positive blood samples.

Laboratories present two different dangers to workers:

  1. working with infected blood samples
  2. working in close contact with each other

Since spread of the virus is mostly spread person-to-person in aerosol droplets and can be spread by asymptomatic individuals, the researchers felt that working with viral RNA in blood samples was less of a threat than the possibility of infection by colleagues.

  • All lab personnel handling positive blood samples are thoroughly trained in safety measures
  • All lab equipment is up to date
  • Use of Class II biological safety cabinets (BSCs) with waste disposal containing 0.5% bleach
  • Lab doors are kept closed
  • Lab personnel make an effort to maintain a one-meter distance
  • One person in a room at a time

All laboratory workers wear proper personal protective equipment (PPE):

  • Gloves
  • Lab coats
  • The PPE never leaves the lab

When sample is handled and transported:

  • It is transported nested in two containers to prevent breakage
  • Opened inside the lab

People working with blood samples must:

  • Wear two pairs of disposable gloves, with the outside disposed of and replaced after each procedure
  • A laboratory coat
  • A surgical mask
  • Eye protection

Certain procedures can generate aerosols or droplets so extra precautions must be taken. Centrifugation, for example, is used to isolate PBMCs from peripheral blood. However, if the equipment is properly secured and sealed and every step taken to minimize exposure, it can be done safely.

Only disposable plasticware and pipettes are used and then sent to internal waste. Before leaving, all surfaces are decontaminated by wiping them down with 0.5% bleach and then 70% ethanol. Although it is not known if SARS-CoV-2 can infect PBMCs, it is advised to act as though it could. In flow cytometry analysis of cell phenotype, the technician must first isolate the PMBCs, stain them with monoclonal antibodies (mAbs), incubate them, then wash and fix.

Once the sample data has been acquired, the flow cytometer is decontaminated for 15 minutes with 0.5% bleach, another 15 minutes with cleaning solution and finally 15 minutes with deionized water. The working area is disinfected, disposable materials are discarded into biohazard containers, and all work surfaces wiped down.

  • SARS-CoV-2 has been known to increase cytokine levels and create a “cytokine storm” in some cases.
  • The cytokine storm is driven by and causes inflammation by producing molecules like interleukin IL-1 or IL-6 that are produced by a variety of cells.
  • Andrea Cossarizza’s hypothesis that the inflammatory or non-inflammatory interleukin molecules depend on which type of helper cell cytokines (TH) produces them.

Hypothetically, TH1 could produce cytokines that are inflammatory, while TH2 produces cytokines that are less inflammatory. Investigating this theory could help with the management and understanding of COVID-19. The profiling of immune cells for their ability to produce TH1 or TH2 cytokines is done in vitro assay based upon isolation of PBMCs, stimulation with different stimuli, and quantification of intracellular cytokines.

The publication referenced this assay extensively with various stimuli, incubation periods in capped tubes. Once the samples were acquired, the quantification was done with the Invitrogen™ Attune™ NxT Flow Cytometer with Autosampler. They found that the assay could have importance in the response to viral infections that play a major defensive role and can perhaps predict the course of the infection.

The Attune NxT Flow Cytometer is indispensable nowadays because it is easily operated by one person and is clog-resistant. Using the Attune NxT Autosampler, walk-away automation increases productivity and decreases exposure risk. More and more labs are discovering the need for equipment that is accurate, easy to use, easy to maintain and easy to clean. Please see the Attune NxT Flow Cytometer decontamination guidance in the SARS-CoV-2 Decontamination Guidance for Thermo Fisher Scientific Instrumentation, Learn More: Continue to stay safe in the lab with more safe benchtop instruments, Additional Blogs that may be of interest to you Accelerate test development research for SARS-CoV-2 Reference

Cossarizza, A., Gibellini, L., Biasi, S.D., et al. (2020). Handling and Processing of Blood Specimens from Patients with COVID-19 for Safe Studies on Cell Phenotype and Cytokine Storm, Cytometry Part A. doi:10.1002/cyto.a.24009

For Research Use Only. Not for use in diagnostic procedures.

What are standard precautions when dealing with blood or bodily fluids?

Standard Precautions Standard Precautions are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect DHCP and prevent DHCP from spreading infections among patients.

Standard Precautions include — Each element of Standard Precautions is described in the following sections. Education and training are critical elements of Standard Precautions, because they help DHCP make appropriate decisions and comply with recommended practices. When Standard Precautions alone cannot prevent transmission, they are supplemented with Transmission-Based Precautions.

This second tier of infection prevention is used when patients have diseases that can spread through contact, droplet or airborne routes (e.g., skin contact, sneezing, coughing) and are always used in addition to Standard Precautions. Dental settings are not typically designed to carry out all of the Transmission-Based Precautions (e.g., Airborne Precautions for patients with suspected tuberculosis, measles, or chickenpox) that are recommended for hospital and other ambulatory care settings.

Patients, however, do not usually seek routine dental outpatient care when acutely ill with diseases requiring Transmission-Based Precautions. Nonetheless, DHCP should develop and carry out systems for early detection and management of potentially infectious patients at initial points of entry to the dental setting.

To the extent possible, this includes rescheduling non-urgent dental care until the patient is no longer infectious or referral to a dental setting with appropriate infection prevention precautions when urgent dental treatment is needed. Hand hygiene is the most important measure to prevent the spread of infections among patients and DHCP.

Education and training programs should thoroughly address indications and techniques for hand hygiene practices before performing routine and oral surgical procedures. For routine dental examinations and nonsurgical procedures, use water and plain soap (hand washing) or antimicrobial soap (hand antisepsis) specific for health care settings or use an alcohol-based hand rub.

Although alcohol-based hand rubs are effective for hand hygiene in health care settings, soap and water should be used when hands are visibly soiled (e.g., dirt, blood, body fluids). For surgical procedures, 1 perform a surgical hand scrub before putting on sterile surgeon’s gloves.

  • For all types of hand hygiene products, follow the product manufacturer’s label for instructions.
  • Complete guidance on how and when hand hygiene should be performed, including recommendations regarding surgical hand antisepsis and artificial nails can be found in the,a.
  • When hands are visibly soiled.b.

After barehanded touching of instruments, equipment, materials, and other objects likely to be contaminated by blood, saliva, or respiratory secretions.c. Before and after treating each patient.d. Before putting on gloves and again immediately after removing gloves.

Use soap and water when hands are visibly soiled (e.g., blood, body fluids); otherwise, an alcohol-based hand rub may be used.

Footnote 1 Definition from 2003 CDC Dental Guidelines—Oral surgical procedures involve the incision, excision, or reflection of tissue that exposes the normally sterile areas of the oral cavity. Examples include biopsy, periodontal surgery, apical surgery, implant surgery, and surgical extractions of teeth (e.g., removal of erupted or nonerupted tooth requiring elevation of mucoperiosteal flap, removal of bone or section of tooth, and suturing if needed).

Personal protective equipment (PPE) refers to wearable equipment that is designed to protect DHCP from exposure to or contact with infectious agents. PPE that is appropriate for various types of patient interactions and effectively covers personal clothing and skin likely to be soiled with blood, saliva, or other potentially infectious materials (OPIM) should be available.

These include gloves, face masks, protective eye wear, face shields, and protective clothing (e.g., reusable or disposable gown, jacket, laboratory coat). Examples of appropriate use of PPE for adherence to Standard Precautions include—

  • Use of gloves in situations involving possible contact with blood or body fluids, mucous membranes, non-intact skin (e.g., exposed skin that is chapped, abraded, or with dermatitis) or OPIM.
  • Use of protective clothing to protect skin and clothing during procedures or activities where contact with blood or body fluids is anticipated.
  • Use of mouth, nose, and eye protection during procedures that are likely to generate splashes or sprays of blood or other body fluids.

DHCP should be trained to select and put on appropriate PPE and remove PPE so that the chance for skin or clothing contamination is reduced. Hand hygiene is always the final step after removing and disposing of PPE. Training should also stress preventing further spread of contamination while wearing PPE by:

  • Keeping hands away from face.
  • Limiting surfaces touched.
  • Removing PPE when leaving work areas.
  • Performing hand hygiene.

The application of Standard Precautions and guidance on appropriate selection and an example of putting on and removal of personal protective equipment is described in detail in the,

  1. Provide sufficient and appropriate PPE and ensure it is accessible to DHCP.
  2. Educate all DHCP on proper selection and use of PPE.
  3. Wear gloves whenever there is potential for contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment.

a. Do not wear the same pair of gloves for the care of more than one patient.b. Do not wash gloves. Gloves cannot be reused.c. Perform hand hygiene immediately after removing gloves.

  1. Wear protective clothing that covers skin and personal clothing during procedures or activities where contact with blood, saliva, or OPIM is anticipated.
  2. Wear mouth, nose, and eye protection during procedures that are likely to generate splashes or spattering of blood or other body fluids.
  3. Remove PPE before leaving the work area.

Respiratory hygiene/cough etiquette infection prevention measures are designed to limit the transmission of respiratory pathogens spread by droplet or airborne routes. The strategies target primarily patients and individuals accompanying patients to the dental setting who might have undiagnosed transmissible respiratory infections, but also apply to anyone (including DHCP) with signs of illness including cough, congestion, runny nose, or increased production of respiratory secretions.

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Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and continuing throughout the visit.

a. Post signs at entrances with instructions to patients with symptoms of respiratory infection to— i. Cover their mouths/noses when coughing or sneezing. ii. Use and dispose of tissues. iii. Perform hand hygiene after hands have been in contact with respiratory secretions.b.

Provide tissues and no-touch receptacles for disposal of tissues.c. Provide resources for performing hand hygiene in or near waiting areas.d. Offer masks to coughing patients and other symptomatic persons when they enter the dental setting.e. Provide space and encourage persons with symptoms of respiratory infections to sit as far away from others as possible.

If available, facilities may wish to place these patients in a separate area while waiting for care.

Educate DHCP on the importance of infection prevention measures to contain respiratory secretions to prevent the spread of respiratory pathogens when examining and caring for patients with signs and symptoms of a respiratory infection.

Most percutaneous injuries (e.g., needlestick, cut with a sharp object) among DHCP involve burs, needles, and other sharp instruments. Implementation of the OSHA Bloodborne Pathogens Standard has helped to protect DHCP from blood exposure and sharps injuries.

However, sharps injuries continue to occur and pose the risk of bloodborne pathogen transmission to DHCP and patients. Most exposures in dentistry are preventable; therefore, each dental practice should have policies and procedures available addressing sharps safety. DHCP should be aware of the risk of injury whenever sharps are exposed.

When using or working around sharp devices, DHCP should take precautions while using sharps, during cleanup, and during disposal. Engineering and work-practice controls are the primary methods to reduce exposures to blood and OPIM from sharp instruments and needles.

  1. Whenever possible, engineering controls should be used as the primary method to reduce exposures to bloodborne pathogens.
  2. Engineering controls remove or isolate a hazard in the workplace and are frequently technology-based (e.g., self-sheathing anesthetic needles, safety scalpels, and needleless IV ports).

Employers should involve those DHCP who are directly responsible for patient care (e.g., dentists, hygienists, dental assistants) in identifying, evaluating and selecting devices with engineered safety features at least annually and as they become available.

Other examples of engineering controls include sharps containers and needle recapping devices. When engineering controls are not available or appropriate, work-practice controls should be used. Work-practice controls are behavior-based and are intended to reduce the risk of blood exposure by changing the way DHCP perform tasks, such as using a one-handed scoop technique for recapping needles between uses and before disposal.

Other work-practice controls include not bending or breaking needles before disposal, not passing a syringe with an unsheathed needle by hand, removing burs before disassembling the handpiece from the dental unit, and using instruments in place of fingers for tissue retraction or palpation during suturing and administration of anesthesia.

  1. Consider sharp items (e.g., needles, scalers, burs, lab knives, and wires) that are contaminated with patient blood and saliva as potentially infective and establish engineering controls and work practices to prevent injuries.
  2. Do not recap used needles by using both hands or any other technique that involves directing the point of a needle toward any part of the body.
  3. Use either a one-handed scoop technique or a mechanical device designed for holding the needle cap when recapping needles (e.g., between multiple injections and before removing from a non-disposable aspirating syringe).
  4. Place used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers located as close as possible to the area where the items are used.

Safe injection practices are intended to prevent transmission of infectious diseases between one patient and another, or between a patient and DHCP during preparation and administration of parenteral (e.g., intravenous or intramuscular injection) medications.

  • Safe injection practices are a set of measures DHCP should follow to perform injections in the safest possible manner for the protection of patients.
  • DHCP most frequently handle parenteral medications when administering local anesthesia, during which needles and cartridges containing local anesthetics are used for one patient only and the dental cartridge syringe is cleaned and heat sterilized between patients.

Other safe practices described here primarily apply to use of parenteral medications combined with fluid infusion systems, such as for patients undergoing conscious sedation. Unsafe practices that have led to patient harm include 1) use of a single syringe — with or without the same needle — to administer medication to multiple patients, 2) reinsertion of a used syringe — with or without the same needle — into a medication vial or solution container (e.g., saline bag) to obtain additional medication for a single patient and thenusing that vial or solution container for subsequent patients, and 3) preparation of medications in close proximity to contaminated supplies or equipment.

Safe injection practices were covered in the Special Considerations section (Aseptic Technique for Parenteral Medications) of the 2003 CDC dental guidelines. However, because of reports of transmission of infectious diseases by inappropriate handling of injectable medications, CDC now considers safe injection practices to be a formal element of Standard Precautions.

Complete guidance on safe injection practices can be found in the, Additional materials, including a list of, are also available. The One & Only Campaign is a public health effort to eliminate unsafe medical injections. The campaign is led by CDC and the Safe Injection Practices Coalition (SIPC).

  1. Prepare injections using aseptic technique2 in a clean area.
  2. Disinfect the rubber septum on a medication vial with alcohol before piercing.
  3. Do not use needles or syringes* for more than one patient (this includes manufactured prefilled syringes and other devices such as insulin pens).
  4. Medication containers (single and multidose vials, ampules, and bags) are entered with a new needle and new syringe, even when obtaining additional doses for the same patient.
  5. Use single-dose vials for parenteral medications when possible.
  6. Do not use single-dose (single-use) medication vials, ampules, and bags or bottles of intravenous solution for more than one patient.
  7. Do not combine the leftover contents of single-use vials for later use.
  8. The following apply if multidose vials are used—

a. Dedicate multidose vials to a single patient whenever possible.b. If multidose vials will be used for more than one patient, they should be restricted to a centralized medication area and should not enter the immediate patient treatment area (e.g., dental operatory) to prevent inadvertent contamination.c.

Do not use fluid infusion or administration sets (e.g., IV bags, tubings, connections) for more than one patient.

Footnotes 2 A technique that prevents or reduces the spread of microorganisms from one site to another, such as from patient to DHCP, from patient to operatory surfaces, or from one operatory surface to another. * A Note about Administering Local Dental Anesthesia: When using a dental cartridge syringe to administer local anesthesia, do not use the needle or anesthetic cartridge for more than one patient.

  1. Ensure that the dental cartridge syringe is appropriately cleaned and heat sterilized before use on another patient.
  2. Instrument processing requires multiple steps using specialized equipment.
  3. Each dental practice should have policies and procedures in place for containing, transporting, and handling instruments and equipment that may be contaminated with blood or body fluids.

Manufacturer’s instructions for reprocessing reusable dental instruments and equipment should be readily available—ideally in or near the reprocessing area. Most single-use devices are labeled by the manufacturer for only a single use and do not have reprocessing instructions.

Use single-use devices for one patient only and dispose of appropriately. Cleaning, disinfection and sterilization of dental equipment should be assigned to DHCP with training in the required reprocessing steps to ensure reprocessing results in a device that can be safely used for patient care. Training should also include the appropriate use of PPE necessary for safe handling of contaminated equipment.

Patient-care items (e.g., dental instruments, devices, and equipment) are categorized as critical, semicritical, or noncritical, depending on the potential risk for infection associated with their intended use.

  • Critical items, such as surgical instruments and periodontal scalers, are those used to penetrate soft tissue or bone. They have the greatest risk of transmitting infection and should always be sterilized using heat.
  • Semicritical items (e.g., mouth mirrors, amalgam condensers, reusable dental impression trays) are those that come in contact with mucous membranes or non-intact skin (e.g., exposed skin that is chapped, abraded, or has dermatitis). These items have a lower risk of transmission. Because the majority of semicritical items in dentistry are heat-tolerant, they should also be sterilized using heat. If a semicritical item is heat-sensitive, DHCP should replace it with a heat-tolerant or disposable alternative. If none are available, it should, at a minimum, be processed using high-level disinfection.

Note: Dental handpieces and associated attachments, including low-speed motors and reusable prophylaxis angles, should always be heat sterilized between patients and not high-level or surface disinfected. Although these devices are considered semicritical, studies have shown that their internal surfaces can become contaminated with patient materials during use.

If these devices are not properly cleaned and heat sterilized, the next patient may be exposed to potentially infectious materials. Digital radiography sensors are also considered semicritical and should be protected with a Food and Drug Administration (FDA)-cleared barrier to reduce contamination during use, followed by cleaning and heat-sterilization or high-level disinfection between patients.

If the item cannot tolerate these procedures then, at a minimum, protect with an FDA-cleared barrier. In addition, clean and disinfect with an Environmental Protection Agency (EPA)-registered hospital disinfectant with intermediate-level (i.e., tuberculocidal claim) activity between patients.

Noncritical patient-care items (e.g., radiograph head/cone, blood pressure cuff, facebow) are those that only contact intact skin. These items pose the least risk of transmission of infection. In the majority of cases, cleaning, or if visibly soiled, cleaning followed by disinfection with an EPA-registered hospital disinfectant is adequate. Protecting these surfaces with disposable barriers might be a preferred alternative.

Cleaning to remove debris and organic contamination from instruments should always occur before disinfection or sterilization. If blood, saliva, and other contamination are not removed, these materials can shield microorganisms and potentially compromise the disinfection or sterilization process.

Automated cleaning equipment (e.g., ultrasonic cleaner, washer-disinfector) should be used to remove debris to improve cleaning effectiveness and decrease worker exposure to blood. After cleaning, dried instruments should be inspected, wrapped, packaged, or placed into container systems before heat sterilization.

Packages should be labeled to show the sterilizer used, the cycle or load number, the date of sterilization, and, if applicable, the expiration date. This information can help in retrieving processed items in the event of an instrument processing/sterilization failure.

The ability of a sterilizer to reach conditions necessary to achieve sterilization should be monitored using a combination of biological, mechanical, and chemical indicators. Biological indicators, or spore tests, are the most accepted method for monitoring the sterilization process because they assess the sterilization process directly by killing known highly resistant microorganisms (e.g., Geobacillus or Bacillus species).

A spore test should be used at least weekly to monitor sterilizers. However, because spore tests are only performed periodically (e.g., once a week, once a day) and the results are usually not obtained immediately, mechanical and chemical monitoring should also be performed.

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Mechanical and chemical indicators do not guarantee sterilization; however, they help detect procedural errors and equipment malfunctions. Mechanical monitoring involves checking the sterilizer gauges, computer displays, or printouts; and documenting the sterilization pressure, temperature, and exposure time in your sterilization records.

Since these parameters can be observed during the sterilization cycle, this might be the first indication of a problem. Chemical monitoring uses sensitive chemicals that change color when exposed to high temperatures or combinations of time and temperature.

  • Examples include chemical indicator tapes, strips or tabs, and special markings on packaging materials.
  • Chemical monitoring results are obtained immediately following the sterilization cycle and therefore can provide more timely information about the sterilization cycle than a spore test.
  • A chemical indicator should be used inside every package to verify that the sterilizing agent (e.g., steam) has penetrated the package and reached the instruments inside.

If the internal chemical indicator is not visible from the outside of the package, an external indicator should also be used. External indicators can be inspected immediately when removing packages from the sterilizer. If the appropriate color change did not occur, do not use the instruments.

Chemical indicators also help to differentiate between processed and unprocessed items, eliminating the possibility of using instruments that have not been sterilized. Note: A single-parameter internal chemical indicator provides information regarding only one sterilization parameter (e.g., time or temperature).

Multiparameter internal chemical indicators are designed to react to ≥ 2 parameters (e.g., time and temperature; or time, temperature, and the presence of steam) and can provide a more reliable indication that sterilization conditions have been met. Sterilization monitoring (e.g., biological, mechanical, chemical monitoring) and equipment maintenance records are an important component of a dental infection prevention program.

Maintaining accurate records ensures cycle parameters have been met and establishes accountability. In addition, if there is a problem with a sterilizer (e.g., unchanged chemical indicator, positive spore test), documentation helps to determine if an instrument recall is necessary. Ideally, sterile instruments and supplies should be stored in covered or closed cabinets.

Wrapped packages of sterilized instruments should be inspected before opening and use to ensure the packaging material has not been compromised (e.g., wet, torn, punctured) during storage. The contents of any compromised packs should be reprocessed (i.e., cleaned, packaged, and heat-sterilized again) before use on a patient.

  1. Clean and reprocess (disinfect or sterilize) reusable dental equipment appropriately before use on another patient.
  2. Clean and reprocess reusable dental equipment according to manufacturer instructions. If the manufacturer does not provide such instructions, the device may not be suitable for multi-patient use.

a. Have manufacturer instructions for reprocessing reusable dental instruments/equipment readily available, ideally in or near the reprocessing area.

  1. Assign responsibilities for reprocessing of dental equipment to DHCP with appropriate training.
  2. Wear appropriate PPE when handling and reprocessing contaminated patient equipment.
  3. Use mechanical, chemical, and biological monitors according to manufacturer instructions to ensure the effectiveness of the sterilization process. Maintain sterilization records in accordance with state and local regulations.

Policies and procedures for routine cleaning and disinfection of environmental surfaces should be included as part of the infection prevention plan. Cleaning removes large numbers of microorganisms from surfaces and should always precede disinfection.

Disinfection is generally a less lethal process of microbial inactivation (compared with sterilization) that eliminates virtually all recognized pathogenic microorganisms but not necessarily all microbial forms (e.g., bacterial spores). Emphasis for cleaning and disinfection should be placed on surfaces that are most likely to become contaminated with pathogens, including clinical contact surfaces (e.g., frequently touched surfaces such as light handles, bracket trays, switches on dental units, computer equipment) in the patient-care area.

When these surfaces are touched, microorganisms can be transferred to other surfaces, instruments or to the nose, mouth, or eyes of DHCP or patients. Although hand hygiene is the key to minimizing the spread of microorganisms, clinical contact surfaces should be barrier protected or cleaned and disinfected between patients.

  • EPA-registered hospital disinfectants or detergents / disinfectants with label claims for use in health care settings should be used for disinfection.
  • Disinfectant products should not be used as cleaners unless the label indicates the product is suitable for such use.
  • DHCP should follow manufacturer recommendations for use of products selected for cleaning and disinfection (e.g., amount, dilution, contact time, safe use, and disposal).

Facility policies and procedures should also address prompt and appropriate cleaning and decontamination of spills of blood or other potentially infectious materials. Housekeeping surfaces, (e.g., floors, walls, sinks) carry less risk of disease transmission than clinical contact surfaces and can be cleaned with soap and water or cleaned and disinfected if visibly contaminated with blood.

Establish policies and procedures for routine cleaning and disinfection of environmental surfaces in dental health care settings.

a. Use surface barriers to protect clinical contact surfaces, particularly those that are difficult to clean (e.g., switches on dental chairs, computer equipment) and change surface barriers between patients.b. Clean and disinfect clinical contact surfaces that are not barrier-protected with an EPA-registered hospital disinfectant after each patient.

  1. Select EPA-registered disinfectants or detergents / disinfectants with label claims for use in health care settings.
  2. Follow manufacturer instructions for use of cleaners and EPA-registered disinfectants (e.g., amount, dilution, contact time, safe use, disposal).
  • : Standard Precautions

    What are the risks of working with blood?

    What are bloodborne pathogens? – Bloodborne pathogens are infectious microorganisms in human blood that can cause disease in humans. These pathogens include, but are not limited to, hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV).

    What should you do if you touch blood?

    What should you do if you’re exposed to blood or body fluids? – Here are some steps to take if you are exposed to blood and body fluids.

    Wash your hands immediately after any exposure to blood or body fluids, even if you wear gloves. Flush with water if you get splashed in the eyes, nose, or mouth. Contact your doctor right away for further advice if you are pricked by a needle (needlestick).

    What basic rules need to be observed before blood transfusion?

    4: Safe transfusion – right blood, right patient, right time and right place Please note the Transfusion Handbook has not been updated since 2014 and requires review. Guidance within the Handbook may therefore be out of date with other current guidelines. Contact for more information.


    Avoid unnecessary and inappropriate transfusions. Preventable ‘wrong blood into patient’ incidents are nearly always caused by human error and may cause fatal reactions due to ABO incompatibility. Most mistransfusion incidents are caused by identification errors at the time of pre-transfusion blood sampling, sample handling in the laboratory, collecting the wrong component from the blood bank or transfusion to the patient. The identity check between patient and blood component is the crucial final opportunity to avoid potentially fatal mistransfusion. At every stage of the blood administration process the key elements are positive patient identification, excellent communication and good documentation. These can be enhanced by the use of electronic transfusion management systems and barcode technology. Hospitals should develop local transfusion policies based on national guidelines and ensure all staff involved in the clinical transfusion process are appropriately trained and competency assessed. Where possible, patients should give ‘valid consent’ for transfusion based on appropriate information and discussion, but signed consent is not a legal requirement. Non-essential ‘out of hours’ requests for transfusion and overnight administration of blood should be avoided wherever possible because of an increased risk of errors.

    Data from the UK Serious Hazards of Transfusion (SHOT) initiative ( show that around 1 in 13 000 blood units are administered to the wrong patient with occasional fatal outcomes. ‘Wrong blood into patient’ incidents are preventable and nearly always caused by human error.

    The root cause of most incidents is misidentification at the time of pre-transfusion blood sampling, laboratory testing, collecting the blood component from the blood bank or administration of the transfusion at the bedside. Potentially fatal ABO-incompatible transfusions still occur although improved clinical policies, staff training and introduction of methods to improve identification, resulting from the various Better Blood Transfusion initiatives, has significantly reduced their number over the last decade.

    Avoiding unnecessary or inappropriate transfusions is an essential starting point for safe transfusion practice. The British Committee for Standards in Haematology (BCSH) Guideline on the Administration of Blood Components (2009) () describes the essentials of safe requesting, collection and administration of blood components (summarised in Table 4.1) and should form the basis of local transfusion policies.

    Positive patient identification Good documentation Excellent communication.

    Table 4.1 Safe blood administration (adapted from the BCSH Guideline on Administration of Blood Components, 2009, with permission)

    Positive patient identification Positive patient identification at all stages of the transfusion process is essential. Minimum patient identifiers are:

    Last name, first name, date of birth, unique identification number. Whenever possible ask patients to state their full name and date of birth. For patients who are unable to identify themselves (paediatric, unconscious, confused or language barrier) seek verification of identity from a parent or carer at the bedside, This must exactly match the information on the identity band (or equivalent). All paperwork relating to the patient must include, and be identical in every detail, to the minimum patient identifiers on the identity band.

    Patient information and consent for transfusion Where possible, patients (and for children, those with parental responsibility) should have the risks, benefits and alternatives to transfusion explained to them in a timely and understandable manner. Standardised patient information, such as national patient information leaflets, should be used wherever possible.
    Pre-transfusion documentation Minimum dataset in patient’s clinical record:

    Reason for transfusion (clinical and laboratory data). Summary of information provided to patient (benefits, risks, alternatives) and patient consent.

    Prescription (authorisation) The transfusion ‘prescription’ must contain the minimum patient identifiers and specify:

    Components to be transfused Date of transfusion Volume/number of units to be transfused and the rate or duration of transfusion Special requirements (e.g. irradiated, CMV negative).

    Requests for transfusion Must include:

    Minimum patient identifiers and gender Diagnosis, any significant co-morbidities and reason for transfusion Component required, volume/number of units and special requirements Time and location of transfusion Name and contact number of requester.

    Blood samples for pre-transfusion testing All patients being sampled must be positively identified.

    Collection of the blood sample from the patient into the sample tubes and sample labelling must be a continuous, uninterrupted event involving one patient and one trained and competency assessed healthcare worker. Sample tubes must not be pre-labelled. The request form should be signed by the person collecting the sample.

    Collection and delivery of blood component to clinical area

    Before collection, ensure the patient (and staff) is ready to start transfusion and there is good venous access. Only trained and competent staff should collect blood from transfusion laboratory or satellite refrigerator. Authorised documentation with minimum patient identifiers must be checked against label on blood component. Minimum patient identifiers, date and time of collection and staff member ID must be recorded. Deliver to clinical area without delay.

    Administration to patient

    The final check must be conducted next to the patient by a trained and competent healthcare professional who also administers the component, All patients being transfused must be positively identified. Minimum patient identifiers on the patient’s identity band must exactly match those on blood component label. All components must be given through a blood administration set (170–200 µ m integral mesh filter). Transfusion should be completed within 4 hours of leaving controlled temperature storage.

    Monitoring the patient Patients should be under regular visual observation and, for every unit transfused, minimum monitoring should include:

    Pre-transfusion pulse (P), blood pressure (BP), temperature (T) and respiratory rate (RR). P, BP and T 15 minutes after start of transfusion – if significant change, check RR as well. If there are any symptoms or signs of a possible reaction – monitor and record P, BP, T and RR and take appropriate action. Post-transfusion P, BP and T – not more than 60 minutes after transfusion completed. Inpatients observed over next 24 hours and outpatients advised to report late symptoms (24-hour access to clinical advice).

    Completion of transfusion episode

    If further units are prescribed, repeat the administration/identity check with each unit, If no further units are prescribed, remove the blood administration set and ensure all transfusion documentation is completed.

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    Last updated 03/07/2023 : 4: Safe transfusion – right blood, right patient, right time and right place

    What is the most important step in the safe administration of blood?

    Blood product checks – Two staff members independently check:

    • Blood product type (e.g., red cells) is identical on EMR order, the blood product label and the luggage tag
    • Volume ordered appropriate for weight of the patient
    • Duration of transfusion
    • Blood product label checked for any modifications (e.g., irradiation)
    • DIN and check character on blood product label and luggage tag are identical
    • ABO/RhD on blood product label and luggage tag are identical
    • ABO/RhD of blood product is compatible with the patient (displayed in the BPAM window)
    • Expiry date
    • Integrity of blood product
    • Scan the blood product after the above checks are completed
    • Check the correct blood product has scanned into BPAM (DIN, ABO/RhD and product/component code)

    If the blood product is removed from the bedside after the patient identification check is complete, the whole checking process must be repeated. This includes blood products removed from the bedside for priming of circuits. Spike the unit only after all checks listed above are completed.

    • The person spiking the unit must be one of the clinicians undertaking the patient and blood product identification check.1 Prime blood administration set at the bedside.
    • IMPORTANT If there is any discrepancy between the blood product, patient details & pack tag/label or if you are concerned about the appearance of the product DO NOT TRANSFUSE,

    Report to Blood Bank immediately: extension 55829

    Is blood a safety hazard?

    Hazard Recognition – The CDC estimates that 5.6 million workers in the health care industry and related occupations are at risk of occupational exposure to bloodborne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and others.

    1. All occupational exposure to blood or other potentially infectious materials (OPIM) places workers at risk for infection from bloodborne pathogens.
    2. OSHA defines blood to mean human blood, human blood components, and products made from human blood.
    3. Other potentially infectious materials (OPIM) means: (1) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.

    The following references aid in recognizing workplace hazards associated with bloodborne pathogens.

    What are universal safety precautions?

    Download Word document available Universal Precautions

    Use barrier protection at all times. Use gloves for protection when working with or around blood and body fluids. Change glove between patients. Use glasses, goggles, masks, shields, and waterproof gowns/aprons to protect face from splashes. Wash hands if contaminated and after removing gloves. Use puncture-resistant sharps disposal containers (at point of use). Do not recap, bend or break needles and handle all sharps carefully. Use resuscitation equipment and devices for mouth-to-mouth resuscitation. Minimize spills and spatters; use leak-proof containers; appropriate biological safety cabinet. Decontaminate all surfaces and devices after use. Observe prudent laboratory practices. Use proper waste management/housekeeping. Promptly seek medical attention and counseling if exposed to contaminated materials (see below).

    Other Protection Procedures

    Use safe-design needle kits. Use needle guard or needlestick prevention devices if recapping needle is necessary. Reduce the use of needles and other sharps. Use occlusive bandages as needed. Follow infection control/body substance isolation practices. Review and monitor protocols and/or practices for improving safety conditions. Change or modify protocols/practices according to risk of tasks or biosafety level with additional use of personal protective equipment or special precautions.


    Use approved disinfectant (e.g.1:10 household bleach, etc.). Use proper personal protective equipment. Use a suitable strategy for decontamination and clean-up. Absorb, contain and decontaminate spills. Clean area with detergent and water after decontamination. Properly dispose of contaminated materials.

    Disposal Procedures

    Place infectious waste in labeled “red bag”/designated containers. Dispose of sharps in labeled, puncture-resistant containers. Utilize: proper storage/transport/treatment (decontamination) of infectious materials.

    In Case of Accident:

    Immediately report the incident to your supervisor and fill out “Supervisor’s First Report of Injury” form. Report the incident as soon as possible to Environmental Health & Safety at 500-8100 (Biological Safety 500-4193). Seek medical attention and/or counseling. Contact UT Student and Employee Health Services at 500-3267; take completed “Supervisor’s First Report of Injury” form with you for office appointment. Needlesticks should be reported to 951-8013 (a 24 hour pager).

    What are 4 common bloodborne diseases?

    Skip to main content Close Bloodborne diseases are caused by pathogenic microorganisms, which exist in blood and other body fluids. ​Bloodborne pathogens are microorganisms such as viruses or bacteria that are carried in blood and can cause disease in people.

    semen vaginal secretions cerebrospinal fluid synovial fluid pleural fluid peritoneal fluid amniotic fluid saliva (in dental procedures), and any body fluid that is visibly contaminated with blood.

    It is important to know the ways exposure and transmission are most likely to occur in your particular situation, be it providing first aid to a student in the classroom, handling blood samples in the laboratory, or cleaning up blood from a hallway. HBV and HIV are most commonly transmitted through:

    sexual contact sharing of hypodermic needles from mothers to their babies at/before birth accidental puncture from contaminated needles, broken glass, or other sharps contact between broken or damaged skin and infected body fluids contact between mucous membranes and infected body fluids accidental puncture from contaminated needles and other sharps can result in transmission of bloodborne pathogens.

    What is the 5 steps to safely manage a blood spillage?

    Blood spillage NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health. WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy. Geneva: World Health Organization; 2010. Blood spillage may occur because a laboratory sample breaks in the area or during transportation, or because there is excessive bleeding during the procedure.

    Wear a pair of non- gloves. Use tongs or a pan and brush to sweep up as much of the broken glass (or container) as possible. Do not pick up pieces with your hands. Discard the broken glass in a, If this is not possible due to the size of the broken glass, wrap the glass or container in several layers of paper and discard it carefully in a separate container. Do not place it in the regular waste container. Use disposable paper towels to absorb as much of the body fluids as possible. Wipe the area with water and detergent until it is visibly clean. Saturate the area again with sodium hypochlorite 0.5% (10 000 ppm available chlorine). This is a 1:10 dilution of 5.25% sodium hypochlorite bleach, which should be prepared daily. Rinse off the tongs, brush and pan, under running water and place to dry. Remove gloves and discard them. Wash hands carefully with soap and water, and dry thoroughly with single-use towels. Record the incident in the incident book if a specimen was lost, or persons were exposed to blood and body fluids.

    © 2010, World Health Organization. All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: ).

    How do you manage blood spills in the workplace?

    Absorb the spill using paper towels. Remove paper towels and discard into clinical waste bag. Disinfect area using prepared Haz Tab 1,000 ppm/Peracide Discard the mop into clinical waste bag. Clean the area with neutral detergent and water.

    What PPE is required for contact precautions?

    Health care personnel caring for patients on Contact Precautions must wear a gown and gloves for all interactions that involve contact with the patient and the patient environment. PPE should be donned prior to room entry and doffed at the point of exit.

    What are the nurses roles in standard safety precautions?

    Nurses should perform hand hygiene before and after all patient contact as well as before donning and after removing gloves. Other times hand hygiene should be performed include after touching a potentially contaminated surface such as the over-bed table in a patient’s hospital room.

    Which standard precautions mean handling all blood and body fluids as though they were infectious?

    How are Bloodborne Pathogens Spread? – According to the American National Red Cross: “Bloodborne pathogens, such as bacteria and viruses, are present in blood and body fluids and can cause disease in humans. The bloodborne pathogens of primary concern are hepatitis B, hepatitis C and HIV, These and other bloodborne pathogens are spread primarily through:

    Direct contact, Infected blood or body fluid from one person enters another person’s body at a correct entry site, such as infected blood splashing in the eye. Indirect contact, A person’s skin touches an object that contains the blood or body fluid of an infected person, such as picking up soiled dressings contaminated with an infected person’s blood or body fluid. Respiratory droplet transmission, A person inhales droplets from an infected person, such as through a cough or sneeze. Vector-borne transmission, A person’s skin is penetrated by an infectious source, such as an insect bite.

    Follow standard precautions to help prevent the spread of bloodborne pathogens and other diseases whenever there is a risk of exposure to blood or other body fluids. These precautions require that all blood and other body fluids be treated as if they are infectious.

    Is the basic concept of standard precautions to treat all blood and body fluids as if they are infectious material?

    Standard precautions is a management program that requires the blood and body fluids of all patients to be treated as potentially infectious with bloodborne pathogens including human immunodeficiency virus (HIV) or hepatitis.

    What PPE is required for handling bodily fluids?

    Gowns – Isolation gowns are used as part of standard and contact precautions to protect clothing and arms of health care workers. When used for standard precautions, gowns are worn only if contact with blood/body fluids is expected. Fluid resistant gowns should be used when splashes or sprays of blood/body fluids are expected.