It’s all about universal blood and bodily fluids – and this information can save your life!
"Universal Precautions," as defined by Centers for Disease Control and Prevention, are a set of Precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens. Under Universal Precautions, blood and certain body fluids of all cases are considered potentially infectious.
Universal Precautions apply to blood, other body fluids containing visible blood, semen, and vaginal secretions. Universal Precautions also apply to tissues and to the following fluids: cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids.
Universal Precautions involve the use of protective barriers such as gloves, gowns, aprons, masks, and protective eyewear, which can reduce the risk of exposure of the embalmer’s, and funeral director’s skin or mucous membranes to potentially infective materials. In addition, under Universal Precautions, it is recommended that all death care workers take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices.
Pregnant embalmers and funeral directors are not known to be at greater risk of contracting HIV infection than directors and embalmers who are not pregnant. However, if an embalmer develops HIV infection during pregnancy, the infant is at risk of infection resulting from perinatal transmission. Because of this risk, pregnant embalmers should be especially familiar with, and strictly adhere to, precautions to minimize the risk of HIV transmission.
The Reasons for Universal Precautions
Human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), is transmitted through sexual contact and exposure to infected blood or blood components and perinatally from mother to neonate. HIV has been isolated from blood, semen, vaginal secretions, saliva, tears, breast milk, cerebrospinal fluid, amniotic fluid, and urine and is likely to be isolated from other body fluids, secretions, and excretions. However, epidemiologic evidence has implicated only blood, semen, vaginal secretions, and possibly breast milk in transmission.
The increasing prevalence of HIV, beginning in the 1980s and ‘90s increased the risk that embalmers, and funeral directors will be exposed to blood from patients infected with HIV. Therefore, Universal Precautions emphasize the need for mortuary workers to consider ALL cases as potentially infected with HIV and/or other bloodborne pathogens and to adhere rigorously to infection-control precautions for minimizing the risk of exposure to blood and body fluids of all cases.
In 1983, the Centers for Disease Control published a document entitled "Guideline for Isolation Precautions in Hospitals" that contained a section entitled "Blood and Body Fluid Precautions." The recommendations in this section called for blood and body fluid precautions when a patient was known, or suspected, to be infected with bloodborne pathogens.
In August 1987, the CDC published a document entitled "Recommendations for Prevention of HIV Transmission in Health-Care Settings,” which included mortuaries and the prep rooms of funeral homes. This document recommended that blood and body fluid precautions be consistently used for all embalming cases regardless of their bloodborne infection status. This extension of blood and body fluid precautions to all cases, whether they are known carriers of AIDS or other infectious diseases is referred to as "Universal Blood and Body Fluid Precautions" or "Universal Precautions."
Under Universal Precautions, blood and certain body fluids of all embalming cases are considered potentially infectious for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens.
Universal Precautions are intended to prevent parenteral, mucous membrane, and nonintact skin exposures of embalmers, and funeral directors to bloodborne pathogens. In addition, immunization with HBV vaccine is recommended as an important adjunct to Universal Precautions for embalmers, and funeral directors who have exposures to blood.
Workers in many different occupations are at risk of exposure to bloodborne pathogens. First Aid team members, embalmers, housekeeping personnel in some settings, and nurses are examples of workers who may be at risk of exposure.
In 1991, OSHA issued the Bloodborne Pathogens Standard to protect workers from this risk. In 2001, in response to the Needlestick Safety and Prevention Act, OSHA revised the Bloodborne Pathogens Standard 1910.1030. The revised standard clarifies the need for employers to select safer needle devices and to involve employees in identifying and choosing these devices. The updated standard also requires employers to maintain a log of injuries from contaminated sharps.
Information for Employers, Complying with OSHA's Bloodborne Pathogens Standard
DHHS (NIOSH) Publication No. 2009-111, 2009
This flyer, distributed in 2009, summarizes the major provisions of the Bloodborne Pathogens standard and provides links to resources for employers.
The Bloodborne Pathogens Standard applies to employees who have occupational exposure (reasonably anticipated job-related contact with blood or other potentially infectious materials). The three most common bloodborne pathogens (BBPs) are human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV).
This flyer was sent to employers as an aid to understanding and complying with the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard. This standard seeks to prevent serious occupational infections among employees.
OSHA Regulations: Bloodborne Pathogens Standard (29 CFR 1910.1030)
External link: http://www.osha.gov/SLTC/bloodbornepathogens/index.html
Provides information on OSHA standards, hazard recognition, post-exposure evaluation, more.
Exposure to Blood: What Health Care Personnel Need to Know
PDF 364 KB (10 pages)
Focuses on human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV).
Overview of State Needle Safety Legislation
Listing of state laws aimed at adding safeguards for health care workers at the state level.
Biosafety in Microbiological and Biomedical Laboratories (BMBL), 5th Edition
External link: http://www.cdc.gov/od/ohs/biosfty/bmbl5/bmbl5toc.htm
Guidance for laboratory workers and the public on the practice of biosafety—the discipline addressing the safe handling and containment of infectious microorganisms and hazardous biological materials.
Universal Precautions for Prevention of Transmission of HIV and Other Bloodborne Infections
This CDC fact sheet presents information on the use of Universal Precautions to prevent transmission of bloodborne infections.
Recommendations for Preventing Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Patients During Exposure-Prone Invasive Procedures
MMWR, July 12, 1991/40 (RR08)
Updates recommendations for prevention of transmission of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in the health care setting.
CDC National AIDS Hotline Training Bulletin #37 (1993)
External link: http://www.aegis.com/pubs/Cdc_Fact_sheets/1993/CDC93139.html
Universal Precautions for morticians. Like healthcare workers, funeral home directors, morticians, undertakers, and embalmers should follow Universal Precautions. This fact sheet states that "No one knows exactly how long HIV will remain viable in the blood and tissues after an HIV-infected person dies. To find this answer, the exact time of death would have to be noted and then timed sampling of the deceased's blood would have to be performed. In addition, amounts of virus circulating in the blood vary. All blood, even that in corpses, should be considered potentially infectious; and all workers involved with preparation of the body (e.g., morticians, embalmers) should use universal precautions."
Preventing Needlesticks and Sharps Injuries
Use of Blunt-Tip Suture Needles to Decrease Percutaneous Injuries to Surgical Personnel
DHHS (NIOSH) Publication No. 2008-101
This document was developed by the Occupational Safety and Health Administration (OSHA), Department of Labor, and the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Department of Health and Human Services.
Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program
The workbook includes several sections that describe each of the organizational steps and operational processes. A toolkit of forms and worksheets is included to help guide program development and implementation.
Safer Medical Device Implementation in Health Care Facilities: Sharing Lessons Learned
NIOSH asked a small number of health care facilities to share their experiences on how they implemented safer medical devices in their settings. These facilities described each step in the process and discussed the barriers they encountered. They explained how problems were resolved, and most important, shared lessons learned.