6
Definitions
Table 3. Categorization of Healthcare-Associated
Procedures According to Level of Risk for
Bloodborne Pathogen Transmission
Category III:
Procedures for which there is definite risk of bloodborne virus transmission or that
have been classified previously as "exposure-prone" (cont'd)
• Obstetrical/g ynecological surgery, including cesarean delivery, hysterectomy, forceps
delivery, episiotomy, cone biopsy, and ovarian cyst removal, and other transvaginal
obstetrical and g ynecological procedures involving hand-guided sharps
• Orthopedic procedures, including total knee arthroplasty, total hip arthroplasty,
major joint replacement surgery, open spine surgery, and open pelvic surgery
• Extensive plastic surgery, including extensive cosmetic procedures (e.g.,
abdominoplasty and thoracoplasty)
• Transplantation surgery (except skin and corneal transplantation)
• Trauma surgery, including open head injuries, facial and jaw fracture reductions,
extensive soft-tissue trauma, and ophthalmic trauma
• Interactions with patients in situations during which the risk of the patient biting the
physician is significant — for example, interactions with violent patients or patients
experiencing an epileptic seizure
• Any open surgical procedure with a duration of more than 3 hours, probably
necessitating glove change
Note: Modified from Reitsma et al. Clin Infect Dis 2005; 40:1665–1672.
a
Does not include subgingival scaling with hand instrumentation.
b
If done emergently (e.g., during acute trauma or resuscitation efforts), peripheral phlebotomy is
classified as Category III.
c
If there is no risk present of biting or of otherwise violent patients.
d
Use of an ultrasonic device for scaling and root planing would greatly reduce or eliminate the risk
for percutaneous injury to the provider. If significant physical force with hand instrumentation
is anticipated to be necessary, scaling and root planing and other Class II procedures could be
reasonably classified as Category III.
e
Making and suturing an episiotomy is classified as Category III.
f
If unexpected circumstances require moving to an open procedure (e.g., laparotomy or
thoracotomy), some of these procedures will be classified as Category III.
g
If moving to an open procedure is required, these procedures will be classified as Category III.
h
If opening a joint is indicated and/or use of power instruments (e.g., drills) is necessary, this
procedure is classified as Category III.
i
A procedure involving bones, major vasculature, and/or deep body cavities will be classified as
Category III.
j
Removal of an erupted or non-erupted tooth requiring elevation of a mucoperiosteal flap, removal
of bone, or sectioning of tooth and suturing if needed.
(cont'd)
