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Recommended Practices for Preventing Infection Transmission
The following are the standard recommended precautions for anyone working in a health-care setting
who may come in contact with blood or other body fluids that may contain HIV, HBV, HCV, or other
bloodborne pathogens (BBP). Syringe exchanges should develop their own protocols for biohazard
handling and disposal. To the extent possible, participants should be responsible for their own
returned syringes, needles, and/or injection supplies, including depositing any loose syringes and/or
injection supplies in biohazard containers on premises. If necessary, exchange workers should use
tongs to deposit used syringes or other supplies in biohazard containers. Please visit the CDC resources,
Human Immunodeficiency Virus (HIV) in Healthcare Settings (available at
http://www.cdc.gov/HAI/organisms/hiv/hiv.html) and Hepatitis in Healthcare Settings (available at
https://www.cdc.gov/hai/organisms/hepatitis.html), for more information.
Standard Precautions
Since medical history and examination cannot reliably identify all patients infected with HIV or other
BBP, blood and body fluid precautions should be consistently used for ALL patients. This approach,
referred to as "standard precautions," should be used in the care of ALL patients.
Hand hygiene
Hands should be cleansed with soap and water or alcohol-based hand sanitizer immediately before and
after patient contact, and before gloves are donned and after gloves are removed. Hand hygiene should
be performed regardless of signs of obvious contamination. Hands and other skin surfaces should be
washed with immediately and thoroughly with soap and water if contaminated with blood or other body
fluids, or if there are any visible signs of contamination. For more information, consult the CDC Guideline
for Hand Hygiene in Health-Care Settings (available from
https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf).
Personal protective equipment (PPE)
All health-care workers should routinely use appropriate barrier precautions to prevent skin and
mucous-membrane exposure when contact with blood or other body fluids from any patient is
anticipated. Gloves should be worn for touching blood and body fluids, mucous membranes, or nonintact skin of all patients, for handling items or surfaces soiled with blood or body fluids, and for
performing venipuncture and other vascular access procedures. Gloves should be changed after contact
with each patient. Masks and protective eyewear or face shields should be worn during procedures that
are likely to generate droplets of blood or other body fluids to prevent exposure of mucous membranes
of the mouth, nose, and eyes. Gowns or aprons should be worn during procedures that are likely to
generate splashes of blood or other body fluids.
Handling of needles and other sharps
All health-care workers should take precautions to prevent injuries caused by needles, scalpels, and
other sharp instruments or devices, particularly when handling or disposing of used instruments. To
prevent needlestick injuries, needles should not be recapped, purposely bent or broken by hand,
removed from disposable syringes, or otherwise manipulated by hand. After they are used, disposable
syringes and needles, scalpel blades, and other sharp items should be placed in puncture-resistant
containers for disposal. Puncture-resistant containers should be located as close as practical to the use
area.
Other considerations
Health-care workers who have exudative lesions or weeping dermatitis should refrain from all direct
patient care and from handling patient-care equipment until the condition resolves. Any lesions should
also be covered and remain covered until they resolve.
Pregnant health-care workers should be especially familiar with and strictly adhere to precautions to
minimize the risk of BBP transmission.
Table 1 summarizes standard precautions for the care of all patients in all health-care settings. Detailed
guidelines for preventing transmission of infectious agents in healthcare settings are described in the
document, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in
Healthcare Settings (available from https://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf).
Table 1. Recommendation for application of standard precautions for the care of all patients in all
health-care settings.
COMPONENT
Hand hygiene
Personal protective equipment (PPE)
Gloves
Gown
Mask, eye protection (goggles), face shield
Soiled patient-care equipment
Environmental control
Textiles and laundry
RECOMMENDATIONS
After touching blood, body fluids, secretions,
excretions, contaminated items; immediately after
removing gloves; between patient contacts
For touching blood, body fluids, secretions,
excretions, contaminated items; for touching
mucous membranes and nonintact skin
During procedures and patient-care activities when
contact of clothing/exposed skin with blood/body
fluids, secretions, and excretions is anticipated
During procedures and patient-care activities likely
to generate splashes or sprays of blood, body fluids,
secretions, especially suctioning, endotracheal
intubation
Handle in a manner that prevents transfer of
microorganisms to others and to the environment;
wear gloves if visibly contaminated; perform hand
hygiene
Develop procedures for routine care, cleaning, and
disinfection of environmental surfaces, especially
frequently touched surfaces in patient-care areas
Handle in a manner that prevents transfer of
Needles and other sharps
Patient resuscitation
Patient placement
Respiratory hygiene/cough etiquette (source
containment of infectious respiratory
secretions in symptomatic patients, beginning
at initial point of encounter e.g., triage and
reception areas in emergency departments
and physician offices)
microorganisms to others and to the environment
Do not recap, bend, break, or hand-manipulate used
needles; if recapping is required, use a one-handed
scoop technique only; use safety features when
available; place used sharps in puncture-resistant
container
Use mouthpiece, resuscitation bag, other ventilation
devices to prevent contact with mouth and oral
secretions
Prioritize for single-patient room if patient is at
increased risk of transmission, is likely to
contaminate the environment, does not maintain
appropriate hygiene, or is at increased risk of
acquiring infection or developing adverse outcome
following infection
Instruct symptomatic persons to cover mouth/nose
when sneezing/coughing; use tissues and dispose in
no-touch receptacle; observe hand hygiene after
soiling of hands with respiratory secretions; wear
surgical mask if tolerated or maintain spatial
separation, >3 feet if possible
CDC. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.
Specific Recommendations for Prevention of HIV Transmission in Health-Care Settings
The following recommendations are described in CDC’s Updated U.S. Public Health Service Guidelines for
the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis
(PEP) (available from https://stacks.cdc.gov/view/cdc/20711).
PEP is recommended when occupational exposures to HIV occur. Determine the HIV status of the
exposure source patient to guide need for HIV PEP, if possible. Start PEP medication regimens as soon as
possible after occupational exposure to HIV and continue them for a 4-week duration. PEP medication
regimens should contain 3 (or more) antiretroviral drugs for all occupational exposures to HIV. Refer to
appendix A of Updated U.S. Public Health Service Guidelines for the Management of Occupational
Exposures to HIV and Recommendations for Postexposure Prophylaxis for a list of antiretroviral drugs.
Expert consultation is recommended for any occupational exposures to HIV and at a minimum for the
following situations: delayed (i.e. later than 72 hours) exposure report, unknown source (e.g. needle in
sharps disposal container or laundry), known or suspected pregnancy in the exposed person,
breastfeeding in the exposed person, known or suspected resistance of the source virus to antiretroviral
agents; toxicity of the initial PEP regimen, or serious medical illness in the exposed person.
Provide close follow-up for exposed personnel that includes counseling, baseline and follow-up HIV
testing, and monitoring for drug toxicity and interactions. Follow-up appointments should begin within
72 hours of an HIV exposure. Refer to Box 2 of Updated U.S. Public Health Service Guidelines for the
Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis for
more information.
If a newer 4th generation combination HIV p24 antigen-HIV antibody test is utilized for follow-up HIV
testing of exposed healthcare providers, HIV testing may be concluded at 4 months after exposure. If a
newer testing platform is not available, follow-up HIV testing is typically concluded at 6 months after an
HIV exposure. Refer to Box 2 of Updated U.S. Public Health Service Guidelines for the Management of
Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis for more
information.
Specific Recommendations for Prevention of Hepatitis B Transmission in Health-Care Settings
The following recommendations are described in CDC’s Management of Occupational Exposures to HBV,
HCV, and HIV and Recommendations for Postexposure Prophylaxis (available from
https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm).
For percutaneous or mucosal exposures to blood, several factors must be considered when making a
decision to provide prophylaxis, including the hepatitis B virus surface antigen (HBsAg) status of the
source and the hepatitis B vaccination and vaccine-response status of the exposed person. Such
exposures usually involve persons for whom hepatitis B vaccination is recommended. Any blood or body
fluid exposure to an unvaccinated person should lead to initiation of the hepatitis B vaccine series.
The hepatitis B vaccination status and the vaccine-response status (if known) of the exposed person
should be reviewed. A summary of prophylaxis recommendations for percutaneous or mucosal
exposure to blood according to the HBsAg status of the exposure source and the vaccination and
vaccine-response status of the exposed person is included in Table 3 of Management of Occupational
Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis.
When hepatitis B immune globulin (HBIG) is indicated, it should be administered as soon as possible
after exposure (preferably within 24 hours). The effectiveness of HBIG when administered >7 days after
exposure is unknown. When hepatitis B vaccine is indicated, it should also be administered as soon as
possible (preferably within 24 hours) and can be administered simultaneously with HBIG at a separate
site (vaccine should always be administered in the deltoid muscle).
For exposed persons who are in the process of being vaccinated but have not completed the vaccination
series, vaccination should be completed as scheduled, and HBIG should be added as indicated in Table 3
of Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for
Postexposure Prophylaxis. Persons exposed to HBsAg-positive blood or body fluids who are known not
to have responded to a primary vaccine series should receive a single dose of HBIG and reinitiate the
hepatitis B vaccine series with the first dose of the hepatitis B vaccine as soon as possible after
exposure. Alternatively, they should receive two doses of HBIG, one dose as soon as possible after
exposure, and the second dose 1 month later. The option of administering one dose of HBIG and
reinitiating the vaccine series is preferred for nonresponders who did not complete a second 3-dose
vaccine series. For persons who previously completed a second vaccine series but failed to respond, two
doses of HBIG are preferred.
Specific Recommendations for Prevention of Hepatitis C Transmission in Health-Care Settings
The following recommendations are described in CDC’s Management of Occupational Exposures to HBV,
HCV, and HIV and Recommendations for Postexposure Prophylaxis (available from
https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm).
Individual institutions should establish policies and procedures for testing health-care workers for HCV
after percutaneous or mucosal exposures to blood and ensure that all personnel are familiar with these
policies and procedures.
Following an occupational HCV exposure, the source should be tested for anti-HCV. For the person
exposed to an HCV-positive source, baseline anti-HCV and ALT activity testing and follow-up testing
(e.g., at 4-6 months) for anti-HCV and ALT activity should be conducted (if earlier diagnosis of HCV
infection is desired, testing for HCV RNA may be performed at 4-6 weeks). All anti-HCV results reported
positive by enzyme immunoassay should be confirmed using supplemental anti-HCV testing (e.g.,
recombinant immunoblot assay [RIBA™]).
Health-care workers who provide care to persons exposed to HCV in the occupational setting should be
knowledgeable regarding the risk for HCV infection and appropriate counseling, testing, and medical
follow-up.
Immune globulin (IG) and antiviral agents are not recommended for PEP after exposure to HCV-positive
blood. In addition, no guidelines exist for administration of therapy during the acute phase of HCV
infection. However, limited data indicate that antiviral therapy might be beneficial when started early in
the course of HCV infection. When HCV infection is identified early, the person should be referred for
medical management to a specialist knowledgeable in this area.
Counseling for Health-care Workers Exposed to Viral Hepatitis
Health-care workers exposed to HBV- or HCV-infected blood do not need to take any special precautions
to prevent secondary transmission during the follow-up period; however, they should refrain from
donating blood, plasma, organs, tissue, or semen. The exposed person does not need to modify sexual
practices or refrain from becoming pregnant. If an exposed woman is breast feeding, she does not need
to discontinue.
No modifications to an exposed person's patient-care responsibilities are necessary to prevent
transmission to patients based solely on exposure to HBV- or HCV-positive blood. If an exposed person
becomes acutely infected with HBV, the person should be evaluated according to published
recommendations for infected health-care workers. No recommendations exist regarding restricting the
professional activities of health-care workers with HCV infection. As recommended for all health-care
workers, those who are chronically infected with HBV or HCV should follow all recommended infectioncontrol practices, including standard precautions and appropriate use of hand washing, protective
barriers, and care in the use and disposal of needles and other sharp instruments.
References
Centers for Disease Control and Prevention. 2007 Guideline for Isolation Precautions: Preventing
Transmission of Infectious Agents in Healthcare Settings. Available from
https://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf
Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-Care Settings.
Available from https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf
Centers for Disease Control and Prevention. Management of Occupational Exposures to HBV, HCV, and
HIV and Recommendations for Postexposure Prophylaxis. Available from
https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm
Centers for Disease Control and Prevention. Recommendations for prevention of HIV transmission in
health-care settings. Available from https://www.cdc.gov/mmwr/preview/mmwrhtml/00023587.htm
Centers for Disease Control and Prevention. Updated U.S. Public Health Service Guidelines for the
Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis.
Available from https://stacks.cdc.gov/view/cdc/20711