Recommendations for Prevention of HIV Transmission in Health-Care Settings [MMWR Vol. 36. No. 2S]

August 21, 1987 - Supplement

room, emergency department, or outpatient setting, including both physicians' and
dentists' offices; 2) cardiac catheterization and angiographic procedures; 3) a vaginal
or cesarean delivery or other invasive obstetric procedure during which bleeding may
occur; or 4) the manipulation, cutting, or removal of any oral or perioral tissues,
including tooth structure, during which bleeding occurs or the potential for bleeding
exists. The universal blood and body-fluid precautions listed above, combined with
the precautions listed below, should be the minimum precautions for all such
invasive procedures.
1. All health-care workers who participate in invasive procedures must routinely
use appropriate barrier precautions to prevent skin and mucous-membrane
contact with blood and other body fluids of all patients. Gloves and surgical
masks must be worn for all invasive procedures. Protective eyewear or face
shields should be worn for procedures that commonly result in the generation
of droplets, splashing of blood or other body fluids, or the generation of bone
chips. Gowns or aprons made of materials that provide an effective barrier
should be worn during invasive procedures that are likely to result in the
splashing of blood or other body fluids. All health-care workers who perform or
assist in vaginal or cesarean deliveries should wear gloves and gowns when
handling the placenta or the infant until blood and amniotic fluid have been
removed from the infant's skin and should wear gloves during post-delivery
care of the umbilical cord.
2. If a glove is torn or a needlestick or other injury occurs, the glove should be
removed and a new glove used as promptly as patient safety permits; the
needle or instrument involved in the incident should also be removed from the
sterile field.
Precautions for Dentistry*
Blood, saliva, and gingival fluid from all dental patients should be considered
infective. Special emphasis should be placed on the following precautions for
preventing transmission of blood-borne pathogens in dental practice in both institutional and non-institutional settings.
1. In addition to wearing gloves for contact with oral mucous membranes of all
patients, all dental workers should wear surgical masks and protective eyewear
or chin-length plastic face shields during dental procedures in which splashing
or spattering of blood, saliva, or gingival fluids is likely. Rubber dams, highspeed evacuation, and proper patient positioning, when appropriate, should be
utilized to minimize generation of droplets and spatter.
2. Handpieces should be sterilized after use with each patient, since blood, saliva,
or gingival fluid of patients may be aspirated into the handpiece or waterline.
Handpieces that cannot be sterilized should at least be flushed, the outside
surface cleaned and wiped with a suitable chemical germicide, and then rinsed.
Handpieces should be flushed at the beginning of the day and after use with
each patient. Manufacturers' recommendations should be followed for use and
maintenance of waterlines and check valves and for flushing of handpieces. The
same precautions should be used for ultrasonic scalers and air/water syringes.
*General infection-control precautions are more specifically addressed in previous recommendations for infection-control practices for dentistry (8).

7S