2.5 Exposure Incidents: Standard Precautions, OSHA, CDC & Colorado's Blood-Exposure Rule

What Counts as an Exposure Incident

An exposure incident is specific contact of the eye, mouth or other mucous membrane, broken skin, or a puncture with blood or other potentially infectious material. At the nail table, it usually means a nipper nick on the cuticle area, a file abrasion on a sidewall, or a technician poking a finger with a contaminated implement. The pathogens of concern are the bloodborne pathogens, chiefly hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV. CDC reports that HBV can survive in dried blood on surfaces for at least 7 days, so a "small" spot of dried blood on a table still matters.

PSI's outline names the frameworks: "Procedures for exposure incidents (e.g., Standard/Universal Precautions, OSHA, CDC)."

Standard Precautions

Colorado's Rule 1.7(A)(14) defines Standard Precautions, previously called Universal Precautions, as infection-control practices that prevent transmission of communicable diseases, including HIV, hepatitis B and hepatitis C. Two parts of the definition are commonly tested:

• They apply to all body fluids, including blood, non-intact skin, mucous membranes, secretions and excretions, whether or not blood is visible.
• They include hand washing and personal protective equipment (PPE) such as gloves, gowns and masks whenever contact with blood or body fluid is anticipated.

The core idea is that you cannot tell who is infected by looking. Every client's blood is handled as if infectious, every time.

The Regulatory Layers

OSHA standards protect employees, so they bind employers. Booth renters who work for themselves are not "employees," but the same practices protect them and are what PSI tests.

Procedure: The Client Is Cut

The textbooks PSI cites describe a sequence like this, which also satisfies Colorado's rule:

1. Stop the service calmly and tell the client what happened.
2. Put on gloves if you are not already wearing them.
3. Control bleeding with direct pressure using clean gauze or cotton.
4. Clean the area with an antiseptic. Apply antiseptic or a liquid or powder styptic with a single-use applicator, never by touching a styptic pencil or container to the wound.
5. Cover the wound with an adhesive bandage from the first aid kit.
6. Clean and disinfect the workstation surfaces that blood touched, until all blood is removed, following the disinfectant's directions (Rule 1.7(F)(3)).
7. Dispose of contaminated single-use items. Many textbooks recommend double-bagging blood-soiled cotton, gauze and gloves and marking the bag with a biohazard label. OSHA classifies items as "regulated waste" only when they would release blood if compressed or are caked with dried blood. Put sharps in the biohazard sharps container.
8. Clean and disinfect contaminated implements. Remove them from service, then clean and disinfect them with a hospital disinfectant whose label covers bloodborne pathogens, following its contact time.
9. Remove gloves, wash your hands, put on fresh gloves if continuing, and resume the service only if it can be done safely. Do not continue working over the open wound.

Procedure: The Technician Is Cut

Rule 1.7(F)(2) gives the same structure for a licensee injury: stop, follow blood-exposure procedures, and return to service only when safe.

1. Stop and move away from the client and the station.
2. Wash the wound with soap and water; for an eye or mouth splash, flush with clean water.
3. Apply antiseptic and a bandage, and put on a glove over it before returning to work.
4. Clean and disinfect contaminated surfaces and implements as above.
5. Report the incident. An employer covered by OSHA must arrange a confidential medical evaluation and follow-up after an exposure incident. Even a self-employed technician should seek prompt medical advice after a puncture from an implement used on a client, because post-exposure treatment works best when started quickly.

Procedure: A Blood Spot on a Surface

When blood or body fluid touches a table, chair or floor, Rule 1.7(F)(3) requires you to clean and disinfect the area according to the manufacturer's instructions until all blood and body fluid is removed, using Standard Precautions. In practice:

• put on gloves;
• wipe up the visible material with disposable towels;
• clean the surface with detergent;
• apply the hospital disinfectant and keep the surface wet for the label's full contact time; and
• discard the towels and gloves and wash your hands.

PSI's practical lists the same skill in its infection-control examples: if blood, vomit or feces appears during a service, deal with it "without contaminating ourselves and others."

Prevention Beats Response

• Use nippers only on dead, detached tissue; never cut living skin.
• Keep a firm grip on the client's finger and a fulcrum for electric filing.
• Use sharp, well-maintained nippers so they cut cleanly.
• Decline or modify services on thin, fragile or diabetic skin (Chapter 5).
• Get the hepatitis B vaccine. There is no vaccine for hepatitis C or HIV.