Implementing safe injection practices, monitoring blood glucose appropriately, and following the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard help prevent the transmission of bloodborne pathogens such as HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) in healthcare and residential settings.
Safe Injection Practices
Safe injection practices are a set of infection prevention recommendations intended to prevent transmission of infectious diseases between one patient/resident and another or between a patient/resident and care provider and to prevent injuries, such as needle sticks. Because we do not always know if a person has an infectious disease, safe injection practices are a part of standard precautions that are applied to every person every time to assure that injections are performed in a way that is safe and healthy for the patient/resident, care provider, and community. A safe injection does not harm the recipient, does not expose the care provider to any avoidable risks, and does not result in waste that is dangerous for the community. To follow safe injection practices, care providers should implement these recommendations:
- Use aseptic technique to avoid contamination of sterile injection equipment.
- Do not administer medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed.
- Needles, cannulae, and syringes are sterile, single-use items; they should not be reused for another patient.
- Use fluid infusion and administration sets (i.e., intravenous bags, tubing, and connectors) for one patient only and dispose appropriately after use. Consider a syringe or needle/cannula contaminated once it has been used to enter or connect to a patient's intravenous infusion bag or administration set.
- Use single-dose vials for parenteral medications whenever possible.
- Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use.
- If multidose vials must be used, both the needle or cannula and syringe used to access the multidose vial must be sterile.
- Do not keep multidose vials in the immediate patient treatment area and store in accordance with the manufacturer's recommendations; discard if sterility is compromised or questionable.
- Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients.
Safe Blood Glucose Monitoring (BGM)
To prevent the transmission of bloodborne pathogens when assisting patients or residents with BGM, care providers should:
- Always perform hand hygiene and use new gloves before conducting BGM and between each person tested.
- Use a single-use lancet to prick the skin. Restrict use of penlet devices to individuals who do not require assistance with BGM.
- NEVER share fingerstick devices between persons.
- NEVER use insulin pens and other medication cartridges and syringes for more than one person; they are for single-patient use only.
- When possible, assign blood glucose monitors to an individual person. If sharing is necessary, clean and disinfect the monitor after every use according to the manufacturer’s instructions. If the manufacturer does not specify how the device should be cleaned and disinfected, then it should not be shared.
- Dispose of used lancets in an approved sharps container and empty container appropriately.
OSHA Bloodborne Pathogens (BBP) Standard
This federal regulation describes the policies and practices that employers must establish to protect employees who may have contact with blood or other potentially infectious materials while performing their job duties. The Virginia Occupational Safety and Health (VOSH) Program has adopted the federal OSHA standard and has incorporated it by reference into the Virginia Administrative Code (16VAC25-90-1910). The strategies outlined in the OSHA BBP Standard that can reduce the risk of infection on the job include:
- Exposure control plan – document that describes how the employer will address the parts of the Bloodborne Pathogens Standard.
- Engineering controls – systems or mechanical devices that minimize hazards in the workplace, such as sharps disposal containers.
- Work practice controls – practices that reduce the possibility of exposure by changing the way a task is performed, such as appropriate practices for hand hygiene and handling laundry.
- Standard precautions – a set of measures designed to protect staff and patients or residents from exposure to disease that should be applied all the time for all patients and residents. Includes personal protective equipment, or protective wear that serves as a barrier between a person and the blood/body fluids of another person.
- Housekeeping – Facility should have a regular cleaning schedule and procedures for cleaning and disinfecting all areas of the facility as well as a plan to manage blood spills.
- Hepatitis B vaccine – Employers should offer the hepatitis B vaccination series at no cost to all employees covered under the OSHA BBP Standard, within 10 working days of initial assignment, after appropriate training has been completed, unless the worker has previously received the vaccine series, antibody testing has revealed the worker is immune, or the vaccine is contraindicated (not recommended) for medical reasons. The vaccination series must be provided in accordance with the recommendations of the U.S. Public Health Service current at the time of the vaccination. This includes follow-up testing one to two months after the completion of the three-dose vaccination series to test for antibody to hepatitis B surface antigen.
- Occupational exposure follow-up, training, and record keeping – exposures to blood or body fluids should be reported and follow-up care provided. Training in the BBP Standard is required upon hire and annually. A sharps injury log must be maintained and medical records kept for a specified amount of time.
Tools and Resources
- General resources
- Fact sheets
- Presentations, posters, and compliance logs
- Administrative tools
- Other resources
- OSHA Bloodborne Pathogens Standard – federal regulation that states what employers must do to protect workers who may be occupationally exposed to blood or other potentially infectious materials.
- The One & Only Campaign - a public health campaign, led by the Centers for Disease Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), to raise awareness among patients and healthcare providers about safe injection practices. The campaign aims to eradicate outbreaks resulting from unsafe injection practices.
- Healthcare Provider Toolkit – assists individuals and organizations with educating healthcare providers and patients about safe injection practices. Includes a narrated PowerPoint presentation, a no-cost Medscape CME activity, multimedia materials, print materials (posters, brochures, pocket cards, etc.), guidelines, position statements, and peer-reviewed published articles. Toolkit can be ordered free of charge.
- State/Local Health Department Toolkit – provides health departments with the background and information to implement the One & Only Campaign.
- CDC sharps safety website
- CDC injection safety website
- CDC website on infection prevention during blood glucose monitoring and insulin administration
- CDC FAQs regarding assisted blood glucose monitoring and insulin administration
- Safe In Common - a nonprofit organization of healthcare professionals and advocates that strives to raise awareness and save lives of workers at risk for needlestick injuries.
- Facility-specific resources
- Ambulatory surgical centers
Assisted living facilities and nursing homes
- Other resources