Protection of healthcare workers from bloodborne pathogens.
OBJECTIVE
For decades, healthcare workers have been known to be at risk from acquiring a variety of bloodborne pathogen infections as a result of occupational exposure. Primary prevention of exposures, as recommended by universal precautions guidelines, remains the cornerstone of protecting healthcare workers. Nonetheless, a substantial number of parenteral exposures continue to occur. Updated developments are summarized here, and recommendations for the protection of healthcare workers from bloodborne pathogens are provided.


RESULTS
The predominant evidence suggests that total percutaneous injuries have decreased over the last decade. Thoughtful adherence to universal precautions remains the primary means of preventing occupational exposures and thus of reducing occupational risk of infection with bloodborne pathogens. A number of studies have provided additional evidence for the efficacy of safety devices in reducing specific subsets of injuries when combined with education and administrative interventions. Barriers to and positive predictors of universal precautions compliance have been identified. Postexposure prophylaxis remains the second line of defense; several authorities have now recommended three antiretroviral agents in this setting.


CONCLUSIONS
In summary, almost two decades of experience with universal/standard precautions has resulted in a decrease in parenteral injuries, but much work remains to be done. Vaccines, effective infection control procedures, safer procedures, and safer devices will all be necessary, along with a better understanding of factors that influence healthcare worker behaviors that result in injury. In addition, a number of issues relating to the postexposure management of occupational exposures with bloodborne pathogens need to be better understood.
Beekmann
Susan E
SE
Department of Pathology, The University of Iowa College of Medicine, Iowa City, Iowa, USA. susan-beekmann@uiowa.edu
Henderson
David K
DK
D000890:Anti-Infective Agents / Q000627:therapeutic use; D017848:Blood-Borne Pathogens; D014943:Global Health; D006282:Health Personnel; D006509:Hepatitis B / Q000517:prevention & control; D006526:Hepatitis C / Q000517:prevention & control; D006801:Humans; D017053:Infection Control / Q000379:methods; D009784:Occupational Diseases / Q000517:prevention & control; D016273:Occupational Exposure / Q000517:prevention & control*; D017410:Practice Guidelines as Topic
D000890:Anti-Infective Agents