Dr. M.J. Bazos,
SAFETY GUIDELINES FOR PERFORMING ARTHROCENTESIS
All physicians must comply with the
Occupational Safety and Health Administration's (OSHA) "Standard on
Occupational Exposure to Bloodborne Pathogens" published in the Federal Register
on December 6, 1991. This standard covers employees in all health care
facilities with one or more employees, including hospitals, clinics, dentists'
and physicians' offices.
To reduce the
risk of transmitting infection between patients and health care workers, the
Council on Rheumatologic Care (CORC) recommends the following safety guidelines
for performing arthrocentesis:
physician performing arthrocentesis or injection of joints, bursae, or
triggerpoints should be gloved. If the skin of the procedure area is prepped and
the needles and syringes are handled with usual sterile technique, the gloves
need not be sterile. Gloves should remain on the hands until the completion of
the procedure, the securing of the synovial fluid specimen in appropriate
containers, and disposal of all materials contaminated by blood or synovial
fluid into appropriate sharps and biohazard containers. Hand washing should
follow the procedure.
2. Nurses or
assistants preparing syringes or handling other material to be used in a joint
procedure should wear gloves.
Attendants and laboratory personnel handling synovial fluid, containers with
synovial fluid, or gauze or other materials contaminated by blood or synovial
fluid should wear gloves and should subsequently wash hands. If the nurse or
other assistant during a joint procedure follows sterile technique and is not
asked to handle synovial fluid specimens or gauze contaminated with blood or
synovial fluid and does not otherwise come in contact with the patient, then
this person need not wear gloves.
Since the chances that synovial fluid or blood will splash or splatter and
potentially soil garments or skin are so remote, the use of masks, goggles, and
gowns are not necessary during joint aspirations and injections. However,
physicians and assistants participating in joint procedures should exercise
judgement and should appropriately use gloves, gowns, masks, and goggles if
there is any reasonable likelihood of unusual exposure to a patient's synovial
fluid or blood during a procedure.
Proper disposal into sharps and biohazard containers should be made for all
needles and syringes, gloves, gauze pads, and any other material potentially
contaminated with synovial fluid or blood. All needles coming in contact with
the patient's skin or other tissues should be placed in disposable biohazard
containers designed for sharps directly by the physician doing the procedure,
without any transfer of such syringes or needles to the assistant. Sheering,
breaking, or recapping of contaminated needles should not be done unless
required by a specific medical procedure.