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Chapter 18 : Standard (Universal) Precautions for Handling Human Specimens

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Abstract:

This chapter reviews the risks associated with the blood-borne pathogens of major concern for work-places handling human clinical specimens, and the evolution and efficacy of prevention methods developed to reduce exposures and transmission of infection. It is important to review the documented cases in detail in order to emphasize rational precautions for work with human specimens. The major premise involved the careful handling of all human blood and certain body fluids as if all were contaminated with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) or other blood-borne pathogens. Standard microbiological practices form the basis for BSL-2, with additional protection available from personal protective equipment (PPE) and biological safety cabinets (BSCs) when appropriate. The National Institute for Occupational Safety and Health (NIOSH) guidelines establish criteria, such as the need to install container openings at a height of 52 to 56 in. to provide the ergonomically correct position for 95% of all adult female workers. The NIOSH guidelines also provide evaluation tools to help select the most appropriate container for the facility. Any defective personal protective equipment (PPE) must be replaced, and reusable protective clothing must be laundered and maintained by the institution. Finally, all laboratory workers must be instructed in the proper use of PPE and its location. The ultimate indication of compliance with standard (universal) precautions is the reduction in workplace exposures and infection with blood-borne pathogens.

Citation: Hunt D. 2006. Standard (Universal) Precautions for Handling Human Specimens, p 341-359. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch18

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FIGURE 1

Decision logic for selecting sharps disposal containers. (Adapted from .)

Citation: Hunt D. 2006. Standard (Universal) Precautions for Handling Human Specimens, p 341-359. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch18
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Image of FIGURE 2
FIGURE 2

Number of documented occupationally acquired HIV infections by year of exposure or injury, if known, as of December 2001. (Adapted from Do et al., 2003.)

Citation: Hunt D. 2006. Standard (Universal) Precautions for Handling Human Specimens, p 341-359. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch18
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References

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Tables

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TABLE 1

Sharp devices or objects causing 51 PIs among 50 health care workers with documented occupationally acquired HIV infection reported to the CDC as of December 2001

Citation: Hunt D. 2006. Standard (Universal) Precautions for Handling Human Specimens, p 341-359. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch18
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TABLE 2

Documented HIV seroconversions after occupational exposures of laboratory workers or phlebotomists, reported in literature

Citation: Hunt D. 2006. Standard (Universal) Precautions for Handling Human Specimens, p 341-359. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch18
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TABLE 3

Occupational HIV infection risks for health care workers

Citation: Hunt D. 2006. Standard (Universal) Precautions for Handling Human Specimens, p 341-359. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch18
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TABLE 4

CDC/NIH-recommended precautions for laboratory work with HIV-1

Citation: Hunt D. 2006. Standard (Universal) Precautions for Handling Human Specimens, p 341-359. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch18
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TABLE 5

Basic requirements of the OSHA Bloodborne Pathogen Standard

Citation: Hunt D. 2006. Standard (Universal) Precautions for Handling Human Specimens, p 341-359. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch18
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TABLE 6

New requirements of the revised OSHA Bloodborne Pathogen Standard, 2001

Citation: Hunt D. 2006. Standard (Universal) Precautions for Handling Human Specimens, p 341-359. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch18
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TABLE 7

Desired characteristics of safety features of sharps devices

Citation: Hunt D. 2006. Standard (Universal) Precautions for Handling Human Specimens, p 341-359. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch18
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TABLE 8

Required elements of a training program for blood-borne pathogens

Citation: Hunt D. 2006. Standard (Universal) Precautions for Handling Human Specimens, p 341-359. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch18

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