Louisiana Administrative Code › Title 46 - PROFESSIONAL AND OCCUPATIONAL STANDARDS › Part XLVII - Nurses: Practical Nurses and Registered Nurses › Subpart 1 - Practical Nurses › Chapter 3 - Board of Practical Nurse Examiners › Section XLVII-308 - Preventing Transmission of Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) to Patients during Exposure-Prone Invasive Procedures

Current through Register Vol. 50, No. 6, June 20, 2024
A. Definitions. As
				  used in this Chapter, the following terms shall have the meaning
				  specified.
Board
- Louisiana State Board of Practical
					 Nurse Examiners.
Exposure-Prone Procedure
- an invasive
					 procedure in which there is an increased risk of percutaneous injury to the
					 practitioner by virtue of palpation of a needle tip or other sharp instrument
					 in a body cavity or the simultaneous presence of the practitioner's fingers and
					 a needle or other sharp instrument or object in a poorly visualized or highly
					 confined anatomic site, or any other invasive procedure in which there is a
					 significant risk of contact between the blood or body fluids of the practical
					 nurse and the blood or body fluids of the patient.
Function Ancillary to an Invasive
					 Procedure
- the preparation, processing, handling of blood, fluids,
					 tissue or instruments which may be introduced into or come into contact with
					 any body cavity, internal organ, subcutaneous tissue, submucosal tissue, mucous
					 membrane or percutaneous wound of the human body in connection with the
					 performance of an invasive procedure.
HBV
- the Hepatitis B Virus.
HBV Seronegative
- a condition where one
					 has been HBV seropositive but is no longer infectious under the criteria of the
					 Federal Centers for Disease Control or the Association of State and Territorial
					 Public Health Laboratory Directors.
HBV Seropositive
- a condition where one
					 has developed antigens sufficient to diagnose seropositivity to HBV evidencing
					 infectability under the criteria of the Federal Centers for Disease Control or
					 of the Association of State and Territorial Public Health Laboratory
					 Directors.
HIV
- the human immunodeficiency
					 virus.
HIV Seropositive
- a condition where one
					 has developed antibodies sufficient to diagnose seropositivity to HIV under the
					 criteria of the Federal Centers for Disease Control or of the Association of
					 State and Territorial Public Health Laboratory Directors.
Invasive Procedure
- any surgical or other
					 diagnostic or therapeutic procedure involving manual or instrumental contact
					 with or entry into any blood, body fluids, cavity, internal organ, subcutaneous
					 tissue, mucous membrane, or percutaneous wound of the human body.
Practical Nurse
- a licensed practical
					 nurse and/or a practical nursing student/graduate.
Universal Precautions
- those generally
					 accepted infection control practices, principles, procedures, techniques and
					 programs as recommended by the Federal Centers for Disease Control to minimize
					 the risk of transmission of HBV or HIV from a practical nurse to a patient,
					 from a patient to a practical nurse, or a patient to a patient, as such
					 recommendations may be amended or supplemented from time to time.
B. Universal Precautions. All practical
				  nurses must at all times comply with the universal precautions set forth below.
1. All practical nurses should routinely use
				  appropriate barrier precautions to prevent skin and mucous-membrane exposure
				  when contact with blood or other body fluids of any patient is anticipated.
				  Gloves should be worn for touching blood and body fluids, mucous membranes, or
				  non-intact skin of all patients, for handling items or surfaces soiled with
				  blood or body fluids and for performing venipuncture and other vascular access
				  procedures. Gloves should be changed after contact with each patient. Masks and
				  protective eyewear or face shields should be worn during procedures that are
				  likely to generate droplets of blood or other body fluids to prevent exposure
				  of mucous membranes of the mouth, nose and eyes. Gowns or aprons should be worn
				  during procedures that are likely to generate splashes of blood or other body
				  fluids.
2. Hands and other skin
				  surfaces should be washed immediately and thoroughly if contaminated with blood
				  or other body fluids. Hands should be washed immediately after gloves are
				  removed.
3. All practical nurses
				  should take precautions to prevent injuries caused by needles, scalpels, and
				  other sharp instruments or devices during procedures; when cleaning used
				  instruments; during disposal of used needles; and when handling sharp
				  instruments after procedures. To prevent needlestick injuries, needles should
				  not be recapped, purposely bent or broken by hand, removed from disposable
				  syringes, or otherwise manipulated by hand. After they are used, disposable
				  syringes and needles, scalpel blades and other sharp items should be placed in
				  puncture-resistant containers for disposal; the puncture resistant containers
				  should be located as close as practical to the use area. Large bore reusable
				  needles should be placed in a puncture container for transport to the
				  reprocessing area.
4. To minimize
				  the need for emergency mouth-to-mouth resuscitation, a practical nurse shall
				  ensure that mouthpieces, resuscitation bags, or other ventilation devices are
				  available for use in areas in which the need for resuscitation is
				  predictable.
5. Implementation of
				  universal blood and body-fluid precautions for all patients eliminates the need
				  for use of the isolation category of "Blood and Body Fluid Precautions"
				  previously recommended by CDC (7) for patients known or suspected to be
				  infected with blood-borne pathogens. Isolation precautions [e.g., enteric,
				  "AFB" (7)] should be used as necessary if associated conditions, such as
				  infectious diarrhea or tuberculosis, are diagnosed or suspected.
6. Precautions for Dialysis
a. Patients with end-stage renal disease who
				  are undergoing maintenance dialysis and who have HIV infection can be dialyzed
				  in hospital-based or free-standing dialysis units using conventional
				  infection-control precautions (21). Universal blood and body-fluid precautions
				  should be used when dialyzing all patients.
b. Strategies for disinfecting the dialysis
				  fluid pathways of the hemodialysis machine are targeted to control bacterial
				  contamination and generally consist of using 500-750 parts per million (ppm) of
				  sodium hypochlorite (household bleach) for 30-40 minutes or 1.5-2.0 percent
				  formaldehyde overnight. In addition, several chemical germicides formulated to
				  disinfect dialysis machines are commercially available. None of these protocols
				  or procedures need to be changed for dialyzing patients infected with
				  HIV.
c. Patients infected with HIV
				  can be dialyzed by either hemodialysis or peritoneal dialysis and do not need
				  to be isolated from other patients.
d. The type of dialysis treatment (i.e.,
				  hemodialysis or peritoneal dialysis) should be based on the needs of the
				  patient. The dialyzer may be discarded after each use. Alternatively, centers
				  that reuse dialyzers, i.e., a specific single-user dialyzer is issued to a
				  specific patient, removed, cleaned, disinfected, and reused several times on
				  the same patient only, may include HIV-infected patients in the dialyzer use
				  program. An individual dialyzer must never be used on more than one
				  patient.