During dental procedures, saliva is predictably contaminated with blood. Even when blood is not visible, it can still be present in limited quantities and therefore considered a potentially infectious material by the Occupational Safety and Health Administration (OSHA).

After an occupational blood exposure, first aid should be administered as necessary. Puncture wounds and other injuries to the skin should be washed with soap and water, mucous membranes should be flushed with water. No evidence exists that using antiseptics for wound care or expressing fluid by squeezing the wound further reduces the risk of blood-borne pathogen transmission; however use of antiseptics is not contraindicated. Exposed DHCP should immediately report the exposure to the infection-control coordinator or other designated person, who should intiate referral to the qualified healthcare professional and complete necessary reports.

Because multiple factors contribute to the risk of infection after an occupational exposure to blood, the following information should be included in the exposure report, recorded in the exposed person's confidential medical record, and provided to the qualified healthcare professional:

1. Date and time of exposure.
2. Details of the procedure being performed, including where and how exposure occurred and whether the exposure involve a sharp device, the type and brand of device, and how and when during its handling the exposure occurred.
3. Details of the exposure, including its severity and type and amount of fluid or material. For a percutaneous injury, severity might measured by te depth of the wound, gauge of the needle, and whether fluid was injected; for a skin or mucous membrane exposure, the estimated volume of material, duration of contact and the condition of the skin (eg, chapped, abraded or intact) should be noted.
4. Details regarding whether the source material was known to contain HIV or other blood-borne pathogens, and, if the source was infected with HIV, the stage of disease, history of retroviral theraphy, and viral load, if known.
5. Details regarding the exposed person (eg, hepatitis B vaccination and vaccine-response status).
6. Details regarding counseling, post-exposure management and follow-up.

DHCP, including students, should have principles of post-exposure management, including PEP options, as part of their job orientation and training. Each occupational exposure should be evaluated individually for its potential to transmit HBV, HCV and HIV, based on the following:

1. The type and amount of body substance involved.
2. The type of exposure (eg, percutaneous injury, mucous membrane or non-intact skin exposure, or bites resulting in blood exposure to either person involved).
3. The infection status of the source person (eg, HIV positive or terminal AIDS).
4. The susceptibility of the exposed person.

All of these factors should be considered in assessing the risk for infection and the need for further follow-up (eg, PEP).

Public Health Services of the United States (PHS) published guidelines for PEP and other management of healthcare worker exposures to HBV, HCV or HIV. In 2001, these recommendations were updated and cosolidated into one set of PHS guidelines. The new guideline reflect the availability of new antiretroviral agents, new information regarding the use and safety of HIV PEP, and cosiderations regarding employing HIV PEP when resistance of the source patient's virus to antiretroviral agents is known or suspected. In addition, the 2001 guidelines provide guidance to clinicians and exposed HCP regarding when to consider HIV PEP and reccomendations for PEP regimens.

1. Post exposure management and prophylaxis
a. Follow Department of Health recommendations after percutaneous, mucous membrane, or non intact skin exposure to blood or other potentially infectious material.
b. Follow PHS guidelines for PEP and other management of DHCP exposure to HBV, HCv and HIV.