Airborne and Bloodborne Infection Control in Primary Healthcare

Overview of Transmission Risks

The risk of occupational transmission of hepatitis B, hepatitis C, and HIV varies significantly by pathogen, with hepatitis B carrying a 6-30% transmission risk after percutaneous exposure, hepatitis C approximately 1.8%, and HIV approximately 0.3% 1, 2
Airborne transmission of tuberculosis represents a recognized occupational hazard, particularly in settings serving populations with high TB prevalence or HIV-infected patients 1, 2

The Centers for Disease Control and Prevention recommends treating all blood and body fluids as potentially infectious, regardless of a patient's known infection status, and wearing gloves whenever touching blood, body fluids, or contaminated items 3, 4
Never recap used needles using both hands or any technique directing the needle point toward any body part, and place used sharps immediately in puncture-resistant containers located at the point of use 3

Airborne infection isolation rooms must maintain continuous negative air pressure of 2.5 Pa relative to corridors, monitored daily with audible manometers or visual monitoring systems 6, 7
Renovated and new airborne infection isolation rooms require greater than 12 air changes per hour, while existing rooms require at least 6 air changes per hour 6, 7, 8

The American College of Occupational and Environmental Medicine recommends that all healthcare workers with potential occupational exposure to blood be offered hepatitis B vaccination series, with antibody testing 1-2 months after completing the three-dose series 3
Workers should receive baseline tuberculin skin testing at employment, with frequency of repeat testing determined by facility risk assessment 1, 2

Healthcare workers entering rooms of patients with confirmed or suspected tuberculosis must wear N95 respirators approved by NIOSH 8
Respirators without exhalation valves should be used in operating rooms when infectious TB patients require emergency surgery 8

Never reuse or share syringes, needles, or drug-preparation equipment between patients, and medications must not be shared among patients 3
Implement engineering controls including safer devices with built-in safety features, evaluating and selecting such devices at least annually 3

Patients requiring cough-inducing procedures must be placed in airborne infection isolation rooms or enclosed booths engineered to provide greater than 12 air changes per hour, maintain 2.5 Pa negative pressure, and exhaust air directly outside or through HEPA filtration 6, 7, 8

Healthcare facilities must designate specific personnel responsible for infection control programs and maintain written TB infection-control plans reviewed at least every 7 years or when epidemiology changes 2
Direction of air flow must be established so air moves from clean areas to less-clean areas, with periodic verification using smoke tubes 5