Special Report – Bloodborne Infection

When asthma escalates to an emergency

In asthma, airway inflammation leads to airway obstruction, which may be chronic or arise as an acute symptom exacerbation. Asthma signs and symptoms range from mild to severe and may proceed to life-threatening complications, including respiratory failure and even death. What’s more, an asthma attack can cause fear and anxiety, which can worsen symptoms.

Approximately 22 million people in the United States have asthma; 6 million are children. Each year, 500,000 people are hospitalized with asthma and 4,000 people die. African-Americans are more likely than whites to be hospitalized and die from asthma. Asthma incidence has risen in the last 20 years, resulting in more emergency department (ED) visits, hospitalizations, and deaths.

Patient assessment

As asthma progresses, the patient may experience shortness of breath, cough, chest tightness, and wheezing. Treatment must be quick and effective to relieve symptoms and prevent further deterioration. Whether the patient presents to the ED or is admitted to the hospital, all nurses should be able to recognize asthma symptoms readily. (See the box below.)

Recognizing asthma quickly
Suspect asthma if your patient has:

  • chest tightness
  • tight, dry cough
  • wheezing with coarse rhonchi
  • increased heart and respiratory rates
  • breathlessness
  • excessive sweating
  • bluish skin and mucous membranes

Confusion and fatigue may indicate respiratory failure. As the attack subsides, the patient may have thick mucus secretions. Between asthma attacks, lung sounds may be clear.

Marcus: A case study

Marcus, age 20, is an African-American male who comes to the ED complaining “I can’t get my breath.” His friend Olivia, who has brought him to the hospital, reports he has a history of asthma. Gina, the triage nurse, quickly escorts them both to a nearby room, where she assesses Marcus. She finds his breathing is labored with audible wheezing and notes that he can speak only in short sentences.

Realizing he needs immediate evaluation and treatment, Gina positions him in high Fowler’s position. His vital signs are temperature 98.7° (37° C), blood pressure 190/88 mm Hg, pulse 122 beats/minute, and respiratory rate 32 breaths/minute. His oxygen saturation (O2 sat) is 88%. Gina administers oxygen 2 L per nasal cannula and places Marcus on a cardiac monitor, which reveals sinus tachycardia. Then she contacts the ED physician.

On arrival, the physician auscultates Marcus’s lungs and finds bilaterally diminished lung sounds with expiratory wheezing in the upper and lower fields. He orders an increase in supplemental O2 to 3 L to attain an O2 sat of 93%, along with a bronchodilator nebulizer breathing treatment and an I.V. corticosteroid to decrease inflammation and ease airway obstruction. As ordered, Gina obtains an arterial blood gas (ABG) sample, chest X-ray, and electrocardiogram. ABG results show an partial pressure of arterial oxygen (PaO2) of 62 mm Hg (below the normal range) and a partial pressure of arterial carbon dioxide (PaCO2) of 42 mm Hg.

During the history and physical exam, Olivia reports Marcus has been healthy except for asthma, which came on during childhood. She states his asthma seemed to be getting worse over the past 6 months, but he has refused to see his primary care provider. Marcus is in college and has been getting his inhaler refilled from a healthcare provider back home. Further questioning reveals Marcus had been using his albuterol inhaler almost daily, but only once a day. He admits he ran out of his inhaled corticosteroid months earlier and hasn’t refilled the prescription. Olivia reports this is his second ED visit for asthma exacerbation in the past year, but states he hasn’t been admitted to the hospital since childhood. She is concerned because his asthma has limited his activity level; he recently had to quit playing recreational college softball. Marcus states he awakens during the night two or three times a week with asthma symptoms. He admits to occasional alcohol use and smoking half a pack of cigarettes per day for the past 2 years.

Important questions to ask

Healthcare providers don’t always ask patients the right questions, which can hinder development of an appropriate treatment plan and care. In 2007, The National Heart, Lung, and Blood Institute and National Asthma Education and Prevention Program released evidence-based guidelines, called the Third Expert Panel Report (EPR-3). These guidelines direct healthcare providers to the latest evidence-based practice guidelines to support accurate asthma diagnosis and management.

Healthcare providers should ask patients questions that focus on asthma severity and control with regard to impairment and risk. Questions that focus on impairment include:

  • What were you doing when your symptoms began, or what triggered your attack?
  • How often do you experience asthma symptoms?
  • Do your asthma symptoms affect your normal daily activities?
  • How often do asthma symptoms awaken you during the night?
  • How often do you use your inhaler?
  • •Have you undergone lung function studies recently?

Questions that focus on risk include:

  • How many exacerbations have you experienced in the past 1 or 2 years that required oral corticosteroid treatment?
  • When was your last asthma attack?
  • What kinds of medications were you given to treat the attack?
  • Have you ever been admitted to the hospital for asthma?

Answers to these questions help healthcare providers determine the patient’s asthma severity. EPR-3 classifies asthma into four categories—intermittent, mild persistent, moderate persistent, and severe persistent. For Marcus, the detailed history and physical exam help the healthcare team determine he has moderate persistent asthma, based on his daily inhaler use, nighttime awakenings more than once a week but not nightly, limitations in daily activity, and more than two exacerbations in the past year.

EPR-3 recommends spirometry as the preferred test to determine lung function. It should be done before and after treatment with short-acting bronchodilators. Initial ABG analysis helps the healthcare team determine severity of the exacerbation.

Developing a plan of action

During an acute asthma exacerbation like the one Marcus is experiencing, the initial priority is to stabilize the patient. Treatment goals are to decrease bronchospasms and edema and improve pulmonary function. Inhalation nebulizer treatments used for in-hospital care include beta2-adrenergic agonists (such as albuterol), continued hourly as needed. ED patients with severe or moderate asthma exacerbation may benefit from an anticholinergic bronchodilator, such as ipratropium bromide. This drug is given in multiple doses along with beta2-adrenergic agonists. If the patient doesn’t respond promptly to nebulizer treatment, the healthcare team should consider giving a systemic I.V. corticosteroid or epinephrine I.M. They may give I.V. fluids to help loosen thick secretions and administer O2 by nasal cannula or mask to improve O2 sat. If the patient continues to deteriorate, intubation may be required.

Fortunately, Marcus responds well to albuterol and an I.V. corticosteroid. His lung fields have cleared and he has maintained O2 sat in the high 90s after O2 therapy is discontinued. Further evaluation of his blood work reveals a normal complete blood count and chest X-ray. If either test had suggested an infection or if Marcus had reported a recent respiratory infection, clinicians would have considered antibiotic therapy.

Discharge education

Based on EPR-3 guidelines, Marcus needs to step up his current asthma therapy. Recommendations for patients with moderate persistent asthma include stepping up to step 3, which means continuing a short-acting B2-adrenergic agonist as needed and adding a low-dose inhaled corticosteroid plus a long-acting B2-adrenergic agonist or a medium-dose inhaled corticosteroid. A course of oral corticosteroids should be considered.

For patients with persistent asthma, inhaled corticosteroids are the foundation of therapy, providing the most effective long-term control. Follow-up evaluation is recommended in 2 to 6 weeks. A step-down approach should be considered for patients who achieve good asthma control for 3 months or more. Referral to an asthma specialist also should be considered.

Marcus obviously hasn’t taken his asthma seriously, as shown by his failure to refill his inhaler, worsening asthma, and refusal to see a primary healthcare provider. Also, despite his asthma symptoms, he continues to smokes half a pack of cigarettes daily. What’s more, further questioning reveals that he and his roommate got a cat 6 months ago, and his symptoms got worse shortly afterward. Discharge education for Marcus should focus on smoking cessation counseling, education on proper inhaler technique and use, giving away his cat, and controlling other asthma triggers. (See the box below.)

Potential asthma triggers
Asthma can be triggered by:

  • pollen
  • mold
  • dust mites
  • animal dander
  • sulfite food additives
  • cigarette smoke
  • severe respiratory infection
  • air pollution
  • emotional stress
  • high humidity
  • exercise
  • certain medications, such as aspirin and nonsteroidal anti-inflammatory drugs.

Education on asthma self-management should include information about asthma (such as the role of inflammation), as well as:

  • skills needed to manage asthma
  • self-monitoring (as with a peak flow monitor)\
  • differences between long-acting and short-acting asthma medications, and when and how to use each type
  • action plan that includes both daily management and what to do when asthma worsens
  • importance of getting follow-up care with a primary care provider.

Through effective patient teaching and timely follow-up care, Marcus and other asthma patients can receive the best care possible.

Amanda D. Gaudy is an advanced practice registered nurse and clinical nurse specialist at Total Life Care in Paducah, Kentucky.

Selected references
Evidence-Based Nursing Guide to Disease Management. Ambler, PA: Lippincott Williams & Wilkins; 2008.

National Asthma Education and Prevention Program. Expert Panel Report 3. Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health Publication Number 08-5846; October 2007. www.aanma.org/advocacy/guidelines-for-the-diagnosis-and-management-of-asthma. Accessed September 2, 2014.

Stoloff SW. Help patients gain better asthma control. J Fam Pract. 2008;57(9):594-602.

Urbano FL. Review of the NAEPP 2007 Expert Panel Report (EPR-3) on Asthma Diagnosis and Treatment Guidelines. J Manag Care Pharm. 2008;14(1):41-9.

Note: All names in clinical scenarios are fictitious.

Bloodborne infection from sharps and mucocutaneous exposure: A continuing problem

Since the Needlestick Safety and Prevention Act (NSPA) became law in 2000 and the revised bloodborne patho­gens standard (of the Occupational Safety & Health Administration [OSHA]) became fully effective in 2001, U.S. healthcare workers have gained more occupational rights and protections. NSPA gives frontline nurses the power to participate in selecting and evaluating devices that would be most effective for their own and their patients’ safety. Besides requiring the use of safety-engineered needles and sharps devices in the workplace, NSPA requires employers to develop and update exposure-control plans annually. (See Understanding the Needlestick Safety and Prevention Act by clicking the PDF icon above.) OSHA enforces NSPA and mandates that employers institute engineering and work-practice controls as the primary way to eliminate or minimize employee exposure.

Nonetheless, transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and other pathogens from patients to healthcare workers remains a significant occupational hazard. Although needlestick injuries get the most attention, nonsharps (mucocutaneous) exposure poses a problem as well. Such exposure can arise from incidents ranging from accidental splashing of blood into the eyes or a skin cut when starting or removing an I.V. catheter to disposing of body fluids or dressing an open wound. A 2003 study found nurses had a higher mucocutaneous exposure rate than physicians and medical technologists. More than one-third (39%) of registered nurses and one-fourth (27%) of licensed practical nurses said they’d experienced one or more mucocutaneous blood exposures in the previous 3 months—but few reported their exposures.

Over the past decade, we’ve seen major efforts to reduce the number of sharps injuries as the primary pathogen exposure route. Advances have been made in developing engineered safety devices to protect healthcare workers from sharps injuries and mucocutaneous exposure. (See Strides in safety-device technology by clicking the PDF icon above.) In a 2011 study, nurses who used blood-containing peripheral I.V. cathe­ters reported no blood leakage 89% of the time, compared to 10% for nurses who used traditional catheters.

Yet even with engineered safety devices, experts estimate more than 8 million U.S. healthcare workers continue to be exposed to patients’ blood and body fluids. Each year, an estimated 385,000 needlestick injuries occur in U.S. hospitals. Studies show these injuries take place most often in fast-paced, stressful, and understaffed facilities. But similar injuries occur in other settings, including nursing homes, clinics, emergency care services, and private homes.

In 2008, the American Nurses Association’s (ANA’s) online national survey of 700 nurses (Study of Nurses’ Views on Workplace Safety and Needlestick Injuries) found needlestick injuries and infections were major concerns for nearly two-thirds (64%) of nurses, and that two-thirds of nurses have been stuck accidentally by a needle while working. Also, 74% of respondents said they believed pathogen exposures continue to be underreported. ANA’s 2011 follow-up survey of more than 4,600 nurses brought some good news—safer needles are more prevalent than ever.

Risk linked to peripheral catheters

Exposure during peripheral I.V. catheter insertion and removal is a particular problem. In a 2011 study of more than 400 nurses, 31% of respondents said they had one to three mucocutaneous exposures per month when inserting a peripheral I.V. catheter; 4% reported more than 10 exposures per month. Based on these findings, researchers estimate a mucocutaneous exposure rate of 4.4 per 100 I.V. catheter insertions (4,400 per 100,000 insertions). In addition, 31% of respondents said they experienced one to three mucocutaneous exposures per month when removing a peripheral I.V. catheter, and 3% reported more than 10 such monthly exposures. Researchers estimate the average mucocutaneous exposure rate is 4.5 per 100 I.V catheter removals (4,500 per 100,000 removals).

Understanding pathogen transmission

To protect yourself from both sharps and nonsharps injuries, you need to understand how pathogens are transmitted by these exposures. The greatest risk of infection transmission is from percutaneous exposure to infected blood.

  • Percutaneous transmission refers to exposure through any break in intact skin, whether from sharps injury (such as from needles, stylets, or surgical blades) or other types of tissue trauma. The chance of seroconversion after percutaneous exposure to blood infected with viruses varies significantly, from the relatively low rate with HIV (0.3%) to the much higher rate with HBV (up to 30%).
  • Mucocutaneous transmission occurs through a break in intact skin or from mucous-membrane exposure of the eyes, nose, or mouth. The chance of becoming infected with HIV after mucocutaneous exposure to infected blood is 0.1%, which is one-third the chance after a needlestick injury. Infection rates for HBV and HCV after mucocutaneous exposure are also much lower than those for needlestick injury.

Although the primary exposure risk comes from infected blood, other body fluids—including semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid—also present an infection risk. While mucocutaneous exposure is less likely to transmit infections, you should not underestimate the risk.

Risk factors and prevention

In 1987, the Centers for Disease Control and Prevention published its recommendation that all human blood should be considered infectious. Originally, this recommendation was known as universal precautions; with the 1991 revision, it became known as standard precautions. Following standard precautions is imperative to preventing bloodborne infection.

In many cases, exposure to path­­­o­gens from needlesticks and mucocutaneous injuries can be pre­vented, especially if you know the risk factors. For instance, be aware that globally, nurses experience the greatest number of needle­stick injuries from hollow-bore needles used for injections. A major cause of these injuries is inappropriate sharps handling during device activation and use, during transport of sharps to the con­tainer, during recapping, and during disposal. Sharps disposal containers pose a hazard if they’re not safely managed and maintained. During disposal, injuries have occurred due to overfilled or punctured containers, sharps protruding from the container, and manipulating the container by closing, moving, handling, or shaking it. Inappropriate sharps disposal also can lead to injuries if sharps are left on bedside tables, overbed tables, food trays, floors, beds, linens or if they’re discarded inappropriately into trash bags or bins.

Why exposures go underreported

The true magnitude of risk isn’t known because of widespread underreporting of exposures, ranging from 29% to 98%. Physicians have the highest underreporting rates. In many cases, underreporting stems from the belief that most exposures aren’t significant. Other reasons for not reporting exposures include the time required, confidentiality issues, not understanding the importance of reporting, and concern about negative repercus-sions. Nurses also tend to minimize the risk of blood exposure, considering it part of the job.

Mucocutaneous exposures are more widely underreported than sharps injuries. A 2007 survey of more than 500 healthcare workers (including nurses and nursing students) found that 33% of the 23% workers who’d had sharps exposures failed to report them. In contrast, 83% of the 23% who’d experienced mucocutaneous exposures failed to report them. Failure to report most commonly resulted from a belief that the exposure wasn’t significant, followed by a combination of being too busy and believing the exposure wasn’t significant. A 2011 survey found 69% of nurses who’d had mucocutaneous exposures over the previous year failed to report them; the most common reason (87%) was believing the incident wasn’t significant, followed by being too busy (35%) to report it.

Benefits of prompt reporting

The perception that such incidents aren’t significant needs to change. Healthcare workers must report sharps injuries and mucocutaneous exposures promptly so they can receive immediate medical evaluation and postexposure prophylaxis, if needed. HIV prophylaxis, for instance, is much more successful in preventing disease transmission if treatment begins within 2 hours of exposure. So be sure to take prompt action after a needlestick or mucocutaneous exposure. (See Postexposure prophylaxis by clicking the PDF icon above.)

Prompt reporting also provides a better understanding of the circumstances and factors surrounding the event, an opportunity to analyze compliance, and the ability to lead prevention improvements and identify educational trends and strategies. To encourage exposure reporting, workers must be assured of confidentiality during reporting, counseling, and medical follow-up. Although the financial cost of the initial workup and treatment for each exposure incident may be high, the intangible costs of exposure (such as emotional distress and decreased employee productivity) may be even greater.

“It will never happen to me”

Clinicians report a wide range of barriers to following standard precautions, including lack of time, unavailable or inconveniently placed supplies, forgetfulness, and competing activities of perceived higher priority. Many have a false sense of security when they knowingly break standard precautions during such procedures as inserting short peripheral access devices without gloves, or when they wear gloves but remove one digit so they can better feel for a vein. Some complain that wearing gloves restricts their dexterity and impairs the touch sensation.

But the notion that “it will never happen to me” is dangerous. Adherence to recommended practices, including strict use of personal protective equipment (PPE), is essential to prevent bloodborne pathogen exposures. Remember—it only takes a small paper cut on a finger to expose yourself to a mucocutaneous infection with a potentially deadly virus.

Ways to protect yourself

Here are some ways you can protect yourself against bloodborne infections in the workplace:

  • Know the law (NSPA).
  • Educate yourself and your peers about sharps and nonsharps safety.
  • Report incidents of sharps inju­ries and mucocutaneous exposures.
  • Follow up with postexposure treatment recommendations.
  • Serve on committees that evaluate and select medical devices.
  • Advocate strongly for the safest technology available.
  • Champion a culture of safety and report unsafe conditions.
  • Contact OSHA at 1-800-321-OSHA (6742) if efforts to work with your employer in complying with standards fail.

Knowledge is power

Healthcare workers remain at risk for infection related to pathogen exposures from blood and body fluids. To reduce this hazard, additional efforts are needed for training, education, data reporting, and continued safety precautions. (For information on injury recording and tracking, see Surveillance programs by clicking the PDF icon above.)

The greatest weapon in reducing infection risk from accidental exposures is knowing the factors that contribute to risk, strategies for reducing risk (including selection of safer devices), and obtaining postexposure prophylaxis when an exposure occurs. In all healthcare settings, opportunities for improved compliance exist.

What’s more, we need to defeat resistance to change. Mark Twain said, “It’s not the progress I mind, it’s the change I don’t like.” Like Twain, some clinicians resist change. But they need to be part of the solution, not part of the problem, by boosting their awareness of the problem and potential solutions. They need to implement safe work practices and use standard precautions and PPE to help protect themselves, colleagues, patients, and others who could be exposed to pathogens inadvertently. And they need to participate in product selection and provide feedback.

Knowledge is power. Make sure you understand the risks of pathogen transmission from sharps and nonsharps injuries and take steps to reduce those risks to yourself, your patients, and your family. Preventing all types of bloodborne pathogen exposures and providing a safer workplace is a goal all of us should work toward.

Selected references

American Nurses Association. 2008 study of nurses’ views on workplace safety and needle­stick injuries. Summer 2008. http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Work-Environment/SafeNeedles/2008-Study/2008InviroStudy.pdf. Accessed April 3, 2012.

Centers for Disease Control and Prevention. Bloodborne infectious diseases: HIV/AIDS, Hepatitis B, Hepatitis C; Emergency Needlestick Information. http://www.cdc.gov/niosh/topics/bbp/emergnedl.html. Accessed April 3, 2012.

Centers for Disease Control and Prevention. Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program. http://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf. Accessed April 3, 2012.

Doebbeling BN, Vaughn TE, McCoy KD, et al. Percutaneous injury, blood exposure, and adherence to standard precautions: are hospital-based health care providers still at risk? Clin Infectious Dis. 2003 Oct;37(8):1006-13.

Jagger J, Perry J, Gomaa A, Phillips EK. The impact of U.S. policies to protect healthcare workers from bloodborne pathogens: the critical role of safety-engineered devices. J Infect Public Health. 2008;1(2):62-71.

Jagger J, Perry J, Parker G, Phillips EK. Nursing2011 survey results: Blood exposure risk during peripheral I.V. catheter insertion and removal. Nursing. 2011 Dec;41(12):45-9.

Kessler CS, McGuinn M, Spec A, et al. Underreporting of blood and body fluid exposures among health care students and trainees in the acute care setting: a 2007 survey. Am J Infect Control. 2011 Mar;39(2):129-34.

National Surveillance System for Health Care Workers. Estimate of the annual number of percutaneous injuries in U.S. health-care workers. www.heart-intl.net/HEART/OccIssue/Comp/Nationalsurveillanceworkers.htm. Accessed April 3, 2012.

Ober S, Craven G. Public policy mandating needlestick injury prevention generates research and change creating safer workplaces. J Infus Nurs. 2009 Mar-Apr; 32(2):69-70.

Occupational exposure to pathogens. Fed Regist. 1991;56(235):64175–64182. 29 CFR §1910.1030.

Occupational Safety & Health Administration. Compliance Directive CPL 02-02-69D. Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens. www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=DIRECTIVES&p_id=2570. Accessed April 3, 2012.

Occupational Safety & Health Administration. Toxic and Hazardous Substances. Bloodborne pathogens. 1910.1030. http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10051. Accessed April 3, 2012.

Perry J, Parker G, Jagger J. EPINet Report: 2007 Percutaneous Injury Rates. International Healthcare Worker Safety Center; August 2009. http://www.medicalcenter.virginia.edu/epinet/home.html. Accessed April 37, 2011.

Phillips EK, Conaway MR, Jagger JC. Percutaneous injuries before and after the Needlestick Safety and Prevention Act. N Engl J Med. 2012 Feb 16;366(7):670-1.

Richardson D, Kaufman L. Reducing blood exposure risks and costs associated with SPIVC insertion. Nurs Manage. 2011 Dec;

Safeneedle.org. Needlestick Safety and Prevention Act of 2000. http://safeneedle.org/us-needlesticks/the-needlestick-safety-and-prevention-act. Accessed April 3, 2012.

Nancy Delisio is a nurse educator for the Infusion Nurses Society in Norwood, Massachusetts.


This special report was funded by BD Medical. Content of this special report was developed independently of the sponsor and all articles have undergone peer review according to American Nurse Today standards.

Taking action to prevent bloodborne infections

A common shared goal among registered nurses is to help people get better and stay healthier. In our pursuit of this goal, we sometimes sacrifice ourselves to keep our patients safe. We work extra hard. We work extra hours. We work faster. We put ourselves in awkward positions to lift and turn and transfer patients. And sometimes we don’t take precautions designed to keep us safe and healthy—or we can’t take them because of workplace conditions or lack of proper equipment and policies.

This special report on bloodborne infections provides vital information for all nurses. It serves as a valuable reminder that as we go about our work, we need to pause and consider how we can stay safe on the job. More often than not, this important pause—to don appropriate personal protective equipment (PPE), get a lifting device, or use only safe needle devices—keeps patients safer, too.

And if we don’t have the human resources, equipment, policies, and training that should be available in our workplaces to prevent injuries and infections, we need to advocate for change. We have to let employers, policymakers, and colleagues know that unbridled risks to our health and well-being won’t be tolerated. Preventing bloodborne infections is a topic I feel passionate about, both professionally and personally. Nearly 13 years ago, while working as a staff nurse in the emergency department, I was stuck by a needle protruding from a sharps container. In what seemed like the blink of an eye, I became hepatitis C-positive and HIV-positive. I made the difficult decision to leave direct-care nursing-a role I’d found incredibly rewarding for 26 years.

Soon afterward, I made another important decision: I would share my story publicly as I worked with other nurses in my home state of Massachusetts and nationally through ANA’s Safe Needles Save Lives campaign to prevent others from sustaining such a life-changing injury. We’ve had many successes, including the Needlestick Safety and Prevention Act, signed into law by President Clinton in 2000. But more needs to be done. ANA and the International Healthcare Worker Safety Center at the University of Virginia recently issued a call to action aimed at protecting healthcare workers from exposure to bloodborne diseases. The Consensus Statement and Call to Action, endorsed by 19 nursing and healthcare organizations (available at www.healthsystem.virginia.edu/internet/safetycenter/Consensus_statement_sharps_injury_prevention.pdf) focuses on five crucial areas, including addressing gaps in available safety devices, involving frontline workers in selecting safety devices, and enhancing worker education and training.
At ANA, we believe employers must be held accountable for complying with the law, and we believe all nurses and healthcare workers-no matter the role or setting—should be able to work in an environment steeped in a culture of safety.

As nurses, each of us must do our part. We need to help create and get active on safety committees that address such issues as workplace hazards and selection and evaluation of safer needle devices. We need to educate ourselves on health and safety issues and ways to advocate for ourselves and, in turn, our patients. The ANA website has many resources available to help you in your efforts, including those addressing needlestick injury prevention (see http://www.nursingworld.org/MainMenuCategories/

We need to do our due diligence, such as using appropriate PPE to prevent exposure to bloodborne pathogens. Patients can be unpredictable and equipment can fail, so it makes sense to take precautions that can prevent an errant splash to the skin or eyes. We must report sharps injuries and mucocutaneous exposures, and seek necessary treatment.

And we need to demand and cultivate a safe working environment. We deserve no less.

Karen Daley is President of the American Nurses Association.

This special report was funded by BD Medical. Content of this special report was developed independently of the sponsor and all articles have undergone peer review according to American Nurse Today standards.

This Special Report has been funded by BD Medical

Please click the PDF icon above to download a PDF of this Special Report.

This special report was funded by BD Medical. Content of this special report was developed independently of the sponsor and all articles have undergone peer review according to American Nurse Today standards.

Additional resources on bloodborne infection

Additional resources on bloodborne infection

After you’ve read this special report, you might want to obtain additional information about bloodborne infections by accessing the online resources below.


This special report was funded by BD Medical. Content of this special report was developed independently of the sponsor and all articles have undergone peer review according to American Nurse Today standards.

Spotlight on safety: Preventing pathogen exposure on the job

As a nurse, you’re the healthcare professional at highest risk of exposure to path­o­gens in blood and body fluids—whether you work in a hospital, outpatient setting, or home care. Since the inception of universal precautions, we’ve come a long way toward preventing worker injury. Yet, nurses still find themselves in harm’s way from unexpected exposures.

The federal Needlestick Safety and Prevention Act strengthened worker protections by mandating safer devices and rigorous exposure-control plans—and it led to a significant reduction in needlestick injuries. The Centers for Disease Control and Prevention recommends healthcare facilities establish a culture of safety, including a sharps injury prevention program and use of appropriate safety devices. The Occupational Safety and Health Administration requires healthcare organizations to implement an exposure-control plan that addresses employee-protection measures. The plan must include a combination of personal protective clothing and equipment, training, surveillance, and work practices that eliminate or minimize employee exposure risk.

But needlestick injuries aren’t the only means of exposure to pathogens. Mucocutaneous exposure to contaminated blood and body fluids also can cause life-threatening illness in nurses and other healthcare workers. Blood and fluids can splash and splatter unexpectedly during care, use of protective devices, or specimen handling. As our investigation into practices and devices that create a safer work environment broadens, nurses need to be familiar not just with needleless devices but with the growing number of other devices that help prevent splash exposures to the eyes, nose, and mouth.

Preventing injuries is part of the “team sport” of health care. Staff must be included in planning and selecting approaches and equipment to provide a safe workplace. They must follow appropriate prevention strategies, obtain the necessary education (including annual updates), use safety devices routinely, and report lapses or injuries. Managers must help ensure integrity of the prevention plan, make education and protective equipment available, and monitor compliance with the plan.

We hope this special report provides the updated information you need to guard against bloodborne infections.

Pamela F. Cipriano, PhD, RN, FAAN, NEA-BC

This special report was funded by BD Medical. Content of this special report was developed independently of the sponsor and all articles have undergone peer review according to American Nurse Today standards.

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