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DISEASE CONTROL AND PREVENTION (CDC) developed the strategy of "universal blood and body fluid precautions" to address concerns regarding transmission of HIV in the health care setting. Now referred to simply as "universal precautions," the concept stresses that all patients should be assumed to be infectious for HIV, HBV, and other blood-borne pathogens. In hospitals and other health care settings, universal precautions should be followed when workers are exposed to blood, certain other body fluids (amniotic fluid, pericardial fluid, peritoneal fluid, pleural fluid, synovial fluid, cere-brospinal fluid, semen, and vaginal secretions), or any body fluid visibly contaminated with blood. Since HIV and HBV transmission has not been documented from exposure to feces, nasal secretions, sputum, sweat, tears, urine, and vomitus, universal precautions do not apply to these fluids, or to saliva, except in the dental setting, where it is likely to be contaminated with blood. The precautions recommend that because the unpredictable nature of exposures encountered by emergency and public safety workers may make differentiation between hazardous and nonhazardous body fluids difficult or impossible, these workers should treat all body fluids as potentially hazardous when they encounter them. Part I of the CDC's published "Guidelines for Prevention of Transmission of Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) to Health-Care and Public-Safety Workers" addresses disinfection (of equipment and surfaces), decontamination (of hands, soiled linen, protective clothing), and disposal (of needles and sharps, infective waste). Fire and emergency medical procedures and equipment are also addressed (gloves, masks, eyewear, gowns, resuscitation equipment), as are other considerations, such as handling bodies, autopsies, and forensic requirements. Part II, "Recommendations for Preventing Transmission of Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) During Exposure-Prone Invasive Procedures," discusses infection control during surgery and other invasive procedures, including oral, cardiothoracic, colorectal, and obstetric/gynecologic procedures, as well as digital palpation of needle tips in body cavities or any procedure involving simultaneous presence of a health care worker's fingers and a needle or other sharp instrument in a poorly visualized or highly confined anatomic site.

The most commonly referenced principles of universal precautions include appropriate hand-washing, protective barriers, and care in the use and disposal of needles and other sharp instruments. These should be maintained rigorously in all health care settings. Proper application of universal precautions is designed to minimize the risk of transmission from patient to health care worker, health care worker to patient, and patient to patient. "Recommendations for Preventing Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Patients During Exposure-Prone Invasive Procedures" were published in the Morbidity and Mortality Weekly Report (MMWR) 40 (no. RR-8), 1991.

The CDC's "Guidelines for Prevention of Transmission of Human Immunodefiency Virus and Hepatitis B Virus to Health-Care and Public-Safety

Workers" was published in MMWR 38 (No. S-6), 1989 (http://www.cdc.gov/epo/mmwr/preview/ mm wrhtml/00001450.htm).

unlabeled uses Generally accepted uses of a drug that are not currently included in food and drug administration approved labeling.

unprotected sex Sexual intercourse without the use of a condom or other prophylactic or contraceptive device.

unsafe sex Dangerous or risky sex. Unsafe sex is essentially unprotected sex.

While the concept of "safe sex" has been around since the early 1980s and the basic priorities of prevention have changed little since then, there is currently disagreement about how "safe" and "unsafe" should be defined. The biggest arguments involve oral sex, the condom-every-time message, and the pros and cons of negotiation between partners. Ultimately the arguments are over a question on which no one is an expert: how much risk is acceptable? For years the major prevention organizations and government agencies said none. By most accounts, a significant number of men, both gay and straight, have simply ignored the advice or have set a goal of safer rather than absolutely safe sex. It is difficult to draw conclusions, however, since for many reasons government agencies remain reluctant to fund research into infection trends, risk, and prevention, so most information remains anecdotal.

up-regulation An increase in the rate at which a process occurs, a substance is released, and so on.

uracil one of the pyrimidine nucleic acid bases that make up nucleotides, the building blocks of genetic material. Uracil takes the place of thymine (T) in RNA.

Ureaplasma A genus of gram-negative bacteria found in the human genitourinary tract, throat, and/or rectum. Ureaplasma may be sexually transmitted and is a cause of nongonococcal urethritis. Left untreated, infection can lead to inflammation of the prostate in men and pelvic inflammatory disease in women.

uremia A toxic condition caused by chronic or acute renal failure, resulting in an excessive amount of nitrogenous substances in the blood that are normally excreted by the kidneys; the constellation of symptoms associated with this condition, including anorexia, nausea, and vomiting.

ureter The long tube that carries urine from the kidney to the bladder.

urethra The tube that carries urine from the bladder out of the body. In the female it ends at the ure-thral opening in the vestibule between the vagina and clitoris. In the male it goes through the penis, where it also serves as the passage for semen.

urethritis Infection of the urethra.

uridine A nucleoside of uracil.

urinalysis A laboratory test performed on urine to detect disease.

urinary tract The four-part system, including two kidneys, two ureters, the bladder, and the urethra, that creates, processes, and removes urine from the body.

urinary tract infection (UTI) Infections of the urinary tract are usually caused by bacteria, such as Escherichia coli, which travel from the colon to the urethra and bladder (and occasionally to the kidneys). Low resistance, poor diet, stress, and damage to the urethra from childbirth, surgery, catheteriza-tion, and so on can predispose individuals to infection. often a sudden increase in sexual activity triggers symptoms. UTIs recur frequently in males and females. Pregnant women are especially susceptible (pressure of the growing fetus keeps some urine in the bladder and uterus, allowing bacteria to grow), as are postmenopausal women (because of hormonal changes). older men are susceptible due to benign enlarged prostates. This can cause obstruction of the urethra and lead to infection. The incidence and severity of UTIs in HIV-positive people is somewhat greater than in the general population. HIV-positive women get more frequent infections at a younger age than their counterparts. UTIs may also be referred to as bladder infections.

urine A yellow fluid, produced in the kidneys and passed through the urinary tract, in which waste is excreted from the body. In healthy persons, urine is amber color with a slightly acid reaction. urine is sterile and nontoxic, except in one who is suffering from an infection. Changes in the quantity, color, transparency, odor, proteinuria (the amount of protein found in urine), specific gravity, or acidity of urine are often significant as indicators of the presence of certain substances or of certain conditions or diseases.

urine culture A laboratory test that shows what bacteria are present in a sample of urine by creating ideal conditions for their growth.

urophilia The erotic attraction to urine; the desire to be urinated upon or to urinate upon a sex partner.

urticaria Itchy, raised swollen areas on the skin or mucous membranes, often a manifestation of an allergic reaction. Commonly referred to as hives.

us and them The "us"/"them" dichotomy is part of the familiar system of social classification—the way "difference" or "differentness" is conceived and made sense of—to which the discourse of AIDS, like other social discourse, is assimilated. other such oppositions are "self and other," "heterosexual and homosexual," "homosexual and general population," "active and passive," and so forth. The effect of such reflexive opposition is to isolate the self ("general population") from the other ("AIDS victims"), justifying indifference to or unequal treatment of the other. See stigma.

uterus The major female reproductive organ that nurtures the fetus during pregnancy. The lining of the uterus is excreted during the menstrual period. This is a possible site of infection.

UTI See urinary tract infection.

uveitis Inflammation of the uvea, the vascular middle coat of the eye within the outer part (the sclera). Anterior uveitis is an inflammation of the frontal membranes (e.g., the iris and the choroid). pain and redness characterize the condition.

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