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Post-Secondary Education Program

Session Four – Universal Precautions

Infections Control Systems

“Universal Precautions” is a system designed to prevent transmission of blood-borne pathogens in health care and other settings. Under universal precautions, blood, or other potentially infectious materials (OPIM) of all patients should always be considered potentially infectious for HIV and other pathogens.

“Standard Precautions” is a newer system that considers all body fluids, except sweat, should be considered to be potentially infectious.

Universal and Standard Precautions involve the use of protective barriers, defined later in the “personal protective equipment” section, to reduce the risk of exposure of the employee’s skin or mucous membranes to other potentially infectious materials (OPIM).

It is also recommended that all health care workers take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices. On TDCJ facilities, these types of instruments are located in the medical department.

Through Health Services, the TDCJ has an Occupational Exposure Program.

The Texas Department of Criminal Justice goes to great effort to prepare employees for potential occupational exposure to individuals who have blood borne infectious diseases – especially Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV).

To date there has never been a TDCJ correctional or medical employee who has filed with Workers’ Compensation claiming to have contracted HIV, HBV, or HCV as a result of work-related exposure.

HIV and hepatitis are viruses that can be contracted anywhere – not just the workplace. Employees should be as careful in their personal lives as they are at work about protecting themselves against infection.

Occupational exposure occurs when all three of the following criteria are met:

  • The exposure occurs during the performance of the employee’s duties
  • There is a route of exposure – in other words, a way for the virus to enter your body
  • The employee is exposed to a body fluid to which universal precautions apply. These fluids include:
    • Blood (including menstrual)
    • Semen
    • Vaginal secretions
    • Amniotic fluid
    • Cerebrospinal (brain and backbone) fluid
    • Synovial (joint) fluid
    • Pleural (chest) fluid
    • Peritoneal (abdominal) fluid
    • Pericardial (heart) fluid

Saliva in a dental setting is considered a risk factor for HIV exposure since it is possible that blood or tissue may be present in their saliva.

In a correctional setting the only fluids you should be concerned about coming into contact with are blood, semen, and possibly vaginal secretions. All the other fluids listed above are body cavity fluids and you should never be exposed to them.

The body fluids that correctional staff and/or non-security staff are most likely to come into contact with don’t transmit HIV or hepatitis unless visible blood is present.

  •  Feces
  • Nasal secretions
  • Saliva
  • Sputum
  • Sweat
  • Tears
  • Urine
  • Vomit

If an employee has an exposure that meets the CDC’s criteria, (s)he should immediately wash the exposed area with water or soap and water. Mucous membranes, such as eyes or mouth, should be flushed liberally with water.

HIV and AIDS

HIV stands for: Human Immunodeficiency Virus

The Human Immunodeficiency Virus (HIV) attacks the immune system, causing damage to the immune system. HIV damages the body's ability to fight diseases and infections. HIV infection leads to Acquired Immunodeficiency Syndrome (AIDS).

Without a healthy, functioning immune system, a person becomes vulnerable to infections by bacteria, other viruses and disease-causing organisms. These infections may cause life-threatening illnesses.

Definition of AIDS

AIDS stands for: Acquired Immunodeficiency Syndrome.

ACQUIRED: This disease is not hereditary. It is not passed casually from one person to another, HIV must enter the bloodstream in order to infect someone.

IMMUNO-DEFICIENCY: The immune system is the body's defense against infection and disease. When the immune system becomes damaged and loses its ability to fight off infectious diseases, it is called 'deficient'. Over time, a person with a deficient immune system becomes vulnerable to infections by disease-causing organisms such as bacteria or viruses. These infections may cause life-threatening illnesses.

SYNDROME: HIV infection causes a combination of symptoms, diseases and infections. A group of symptoms that tend to appear together is known as a syndrome.

AIDS is a complex condition caused by the human immunodeficiency virus (HIV), which kills or impairs cells of the immune system and progressively destroys the body's ability to fight infection and disease. People with damaged immune systems are vulnerable to diseases that do not threaten people with healthy immune systems.

The term AIDS applies to the most advanced state of an HIV infection. Medical treatment can delay the onset of AIDS. HIV infection, seroconversion, asymptomatic HIV infection, symptomatic HIV infection, and AIDS. These states are sometimes called the "natural history" of disease progression.

It is the responsibility of the contracted personnel to report any signs of spills, contamination or exposed blood-borne pathogens that they may come into contact with.

If you feel that you have been exposed, clean the exposed area and report the incident to unit medical staff immediately. Obtain a medical evaluation as soon as possible. Discuss with a healthcare professional the extent of the exposure, treatment, follow-up care, personal prevention measures, the need for a tetanus shot and other care.

Personal Protective Equipment (PPE)

Gloves, masks, protective eyewear, and chin-length plastic face shields are examples of personal protective equipment. PPE must be provided and worn by employees in all instances where they will or may come into contact with blood or OPIM.

Traditionally, latex gloves have been advised to use when dealing with blood or OPIM unless an employee is allergic to latex. In most circumstances, nitrile, vinyl, and other glove alternatives meet the definition of “appropriate” gloves and may be used in place of latex gloves in these cases. Gloves can be obtained by medical staff and/or security personnel.

Hand Hygiene

Hand hygiene (soap and water washing or use of waterless alcohol-based hand rub) must be performed:

  • After removal of gloves and/or other protective equipment
  • Immediately after hand contact with blood or other infectious materials
  • Upon leaving the work area

It is recommended that hand hygiene be performed before and after patient contact and after using restroom facilities.

Disinfectants

Chemical germicides and disinfectants used at recommended dilutions must be used to decontaminate environmental surfaces. Consult the Environmental Protection Agency (EPA) lists of registered sterilants, tuberculocidal disinfectants, and antimicrobials with HIV-HBV efficacy claims for verification that the disinfectant used is appropriate.

If you have any questions, with regard to chemical germicides or disinfectants, you can contact the Unit Safety Officer or medical personnel.

Occupational Exposure

An occupational exposure is defined as a percutaneous injury (e.g., a needle stick or cut with a sharp object) or contact of mucous membrane or non-intact skin (e.g., exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or other potentially infectious materials.

Risks of Infection from an Exposure

The CDC states that the risk of infection varies case by case. Factors influencing the risk of infection include:

  • Exposure was from a hollow-bore needle or other sharp instrument
  • To non-intact skin or mucus membranes (such as eyes, nose and/or mouth)
  • Amount of blood that was involved and the amount of virus present in the source’s blood

Risk of HIV Transmission

The risk of HIV infection as an occupational hazard is slim, even in the health care profession. There have been no reports of HIV transmission from blood contact with intact skin.

There is a theoretical risk of blood contact to an area of skin that is damaged, or a large area of skin covered in blood for a long period of time.

As of 2010, the CDC reports 57 documented cases and 143 possible cases of occupational exposure to HIV since reporting started in 1985. No confirmed cases of occupational HIV transmission to health care workers have been reported since 1999.

Respiratory Hygiene/Cough Etiquette

Respiratory Hygiene/Cough Etiquette is an element of Standard Precautions that highlights the need for prompt implementation of infection prevention measures at the first point of encounter with the facility/ambulatory setting (e.g., chow hall, classroom).

Because a unit houses large numbers of people, confined to one location, illnesses may spread more rapidly. It is important to practice health etiquette when on the unit. If you yourself are sick or running a fever, it is best to stay off the unit until you are well again.

Key Recommendations for Respiratory Hygiene/Cough Etiquette

  • Cover mouths/noses when coughing or sneezing
  • Use and dispose of tissues
  • Perform hand hygiene after hands have been in contact with respiratory secretions
  • Do not shake hands
  • Keep your distance
  • Report suspected illnesses