How're We Doiri\> Preventing Occupational Infections With Blood-Borne Pathogens in Healthcare

testing can never provide 100% accuracy—that blood from all patients should be assumed to represent occupational risk. This concept, which arrived on the healthcare scene only with the implementation of the universal precautions guidelines in 1987, should have long since permeated the healthcare workplace, beginning in the late 1940s, when the occupational risks for hepatitis B infection were initially identified and characterized. Since the publication of the universal precautions guidelines, we have learned a great deal about primary prevention of occupational exposures (Table). In my view, thoughtful adherence to these precautions likely has contributed more to the reduction of occupational risk than any other single intervention. These guidelines effectively put the healthcare worker in the "driver's seat" regarding risk management. If, in the healthcare worker's view, a specific procedure is associated with a risk for getting blood on his or her hands, the healthcare worker should elect to wear gloves. If a risk for spattering or splattering is present, the healthcare worker could decide to protect his or her mucous membranes. That it took until the late 1980s for these guidelines to appear is problematic. Nonetheless, the major message of these guidelines—that blood equals risk in the healthcare environment—is both precisely correct and entirely reasonable.