blood born pathogen q&a

7/28/2019 Blood Born Pathogen Q&A

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BloodbornePathogens:Questions and Answers

about Occupational Exposur

Oregon OSHA


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Layout and cover design, Patricia Young, Oregon OSHA


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TABLE OF CONTENTS

Introduction ................................................................................................................................... 3

Section I Bloodborne Pathogens Standard............................................................................. 4

Section II Exposure Control Plans

Exposure determination ............................................................................................. 8

Training ...................................................................................................................... 9

Section III Preventive Measures

Hepatitis B vaccination ............................................................................................ 10

Universal precautions ............................................................................................... 11

Section IV Methods of Control

Engineering controls and work practices ................................................................. 12

Personal protective equipment (PPE) ....................................................................... 14

Housekeeping ........................................................................................................... 16

Labeling ................................................................................................................... 18

Labeling requirements ............................................................................................. 19

Section V Exposure Incidents................................................................................................. 20

Section VI Record Keeping ...................................................................................................... 21

Appendix A Statement of Declination .................................................................................. 23

Appendix B Bloodborne Pathogens Exposure Control Plan .............................................. 24

Appendix C Example of Sharps Injury Log ........................................................................ 30

Oregon OSHA Services .............................................................................................................. 31


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In compliance with the Americans with Disabilities Act (ADA),

this publication is available in alternative formats. Call the

Oregon OSHA public relations manager, 503-378-3272.

Material contained in this publication is in the public domain

and may be reproduced without permission from Oregon OSHA.


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INTRODUCTION

The intent of this question-and-answer manual isto help employers and employees understand theOregon Occupational Safety and Health Division(Oregon OSHA) requirements regarding exposureto the hepatitis B virus (HBV), the human im-

munodeciency virus (HIV), and other bloodbornepathogens, including the hepatitis C virus (HCV).

Acquired immunodeciency syndrome (AIDS)and hepatitis B merit serious concern for workersoccupationally exposed to blood, other potentiallyinfectious materials, and certain other body uidsthat contain such bloodborne pathogens as HIV andHBV. According to estimates of the OccupationalSafety and Health Administration, more than 5.6million workers in health care and public safetyoccupations could be exposed to these viruses.

Such workers include physicians, dentists, dentalemployees, phlebotomists, nurses, morticians, para-medics, medical examiners, laboratory and bloodbank technologists and technicians, housekeeping

personnel in health care institutions, laundry work-ers, employees in long-term care facilities, andhome-care workers. Other workers who may beoccupationally exposed to blood or other potentiallyinfectious materials, depending on their work

assignments, include research laboratory workers,rst-aid responders, and public safety personnel(re, police, rescue, correctional ofcers, etc.).

Exposure to bloodborne pathogens occurs in manyways. Although needlestick injuries are the mostcommon means of exposure for health care workers,bloodborne pathogens can also be transmittedthrough contact with eyes, nose, and mouth orthrough broken skin.

Oregon OSHA recognizes the need to safeguard

workers from health hazards related to bloodbornepathogens. With the bloodborne pathogens standard,Oregon OSHA aims to reduce the risk of occupa-tional exposure to bloodborne diseases.


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* Occupationally exposed means exposed during theperformance of job duties to blood or other potentiallyinfectious materials through skin, eyes, mucousmembranes, or broken skin by needlesticks, human bites,cuts, abrasions, splashes, or other means.

SECTION I

Bloodborne Pathogens StandardOAR 437-002-1910.1030

The bloodborne pathogens standard tells how to de-

termine who has occupational exposure and how toreduce workplace exposure to bloodborne pathogens.

Q What are bloodborne pathogens?ABloodborne pathogens are microorgan-

isms that can cause disease when transmit-ted from an infected individual to anotherindividual through blood and certain bodyuids. Bloodborne pathogens are capable ofcausing serious illness and death. The mostcommon illnesses caused by bloodborne

pathogens are hepatitis B (HBV), hepatitisC (HCV), and acquired immunodeciencysyndrome (AIDS) from HIV, or humanimmunodeciency virus.

Q What is hepatitis B?AHepatitis B is a liver disease caused

by the hepatitis B virus (HBV). HepatitisB, formerly called serum hepatitis, is alife-threatening bloodborne pathogen and a

major risk to employees in jobs where thereis exposure to blood and other potentiallyinfectious material (OPIM). Hepatitis, whichmeans inammation of the liver, can becaused by drugs, toxins, autoimmune dis-ease, and infectious agents, including vi-ruses.

Q What is hepatitis C?AHepatitis C is a liver disease caused by

the hepatitis C virus (HCV). It is the most

common chronic bloodborne infection in theUnited States and is primarily transmittedthrough large or repeated direct percutane-ous exposures to blood. Most people who arechronically infected are not aware of theirinfection because they are not clinically ill.Infected people can infect others and are atrisk for chronic liver disease or other HCV-related chronic diseases. Currently there isno vaccine against hepatitis C.

Q Who is covered by the bloodbornepathogens standard?

AOregon OSHAs rule applies to all peopleoccupationally exposed*to blood or other

potentially infectious materials. Blood meanshuman blood, blood products, or bloodcomponents. OPIM includes the following:

Human body uids: semen, vaginal secre-tions, cerebrospinal uid, synovial uid,pleural uid, pericardial uid, peritonealuid, amniotic uid, saliva in dental proce-dures, any body uid visibly contaminatedwith blood, and all body uids when it isdifcult or impossible to differentiatebetween body uids.

Any unxed tissue or organ (other thanintact skin) from a human (living or dead).

HIV-containing cell or tissue cultures, organcultures, and HIV- or HBV-containingculture medium or other solutions as well asblood, organs, or other tissues from animalsexperimentally infected with HIV or HBV.

Q Are there specic occupations covered bythe standard?

AThe hazard of exposure to infectiousmaterials affects employees in many typesof jobs. The following occupations are likely

to be covered by the standard, but the scopeof the standard is not limited to employees inthese occupations:

Physicians, physician assistants, nurses,nurse practitioners, and health care employ-ees in clinics and physicians ofces

Employees of clinical and diagnosticlaboratories

Housekeepers in health care facilities

Workers in hospital laundries or commerciallaundries that serve health care or publicsafety institutions

Tissue bank personnel

Employees of blood banks and plasma cen-ters who collect, transport, and test blood


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* Collateral duty is not addressed in the standard, but isaddressed in a Letter of Interpretation (Jan. 15, 1997) and

Program Directive (A-154), Bloodborne Pathogens.

Employees of freestanding clinics such ashemodialysis clinics, urgent-care clinics,health maintenance clinics, and family-planning clinics

Employees of clinics in industrial, education,and correctional facilities (e.g., those whocollect blood and clean and dress wounds)

Employees assigned to provide emergencyrst aid

Dentists, dental hygienists, dental assistants,and dental laboratory technicians

Employees of institutions for the develop-mentally disabled

Hospice employees

Home health care workers

Employees of nursing homes and long-term

care facilities

Employees of funeral homes and mortuaries

HIV and HBV research laboratory andproduction-facility workers

Employees handling regulated waste

Emergency medical technicians, paramedics,and other emergency medical service provid-ers

Fireghters, law enforcement personnel, and

correctional ofcers

Q How do employers determine if theiremployees are included in the scope ofthe standard?

AThe standard requires employers to evalu-ate each job task and procedure to determinewhich employees may be expected to beoccupationally exposed to blood or otherpotentially infectious materials. The expo-sure determination is made without regard

to the use of personal protective equipment(PPE), because employees are considered to beexposed even if they wear PPE. If it is deter-mined that sufcient evidence of reasonablyanticipated exposure exists, the employerwill be held responsible for providing theprotections of OAR 437-002-1910.1030 to theemployees with occupational exposure.

Q If I have employees who may rarely comeinto contact with blood or OPIM, do all of

the rules still apply?

AEmployers with employees who are notroutinely exposed to blood or OPIM may fallunder the collateral duty* clause, in whichcase the hepatitis B vaccination would not

need to be offered until an incident involvingthe presence of blood or OPIM occurs.

In order for an employer to qualify under thecollateral duty clause, the following condi-tions must be met:

Reporting procedures must be in place underyour organizations exposure control plan toensure that all incidents involving blood orOPIM are reported before the end of the workshift during which the incident occurred.

Reports of incidents must include the namesof all involved employees; a description ofthe circumstances of the incident, includingthe date and time; and a determination ofwhether an exposure incident, as dened bythe standard, has occurred.

Exposure reports must be included on a listof such incidents, readily available to allemployees, and provided to Oregon OSHAupon request.

The specics of the reporting procedure musbe included in the bloodborne pathogenstraining.

All employees who are involved in any situa-tion involving the presence of blood or OPIMregardless of whether a specic exposure incident occurs, must be offered the full hepatitisB vaccination series as soon as possible, butno later than 24 hours after the incident. If anexposure incident, as dened in 1910.1030,occurs, all other post-exposure follow-up

procedures according to the standard must beinitiated immediately, and the employer mustensure that the medical provider is famil-iar with and follows the recommendationsfor post-exposure follow-up set forth by theOregon Department of Human Services orthe Centers for Disease Control.


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Bloodborne pathogens training must beprovided to all affected employees.

Appropriate PPE, cleanup materials, andequipment must be provided.

Q Are Good Samaritan acts consideredoccupational exposure?

AGood Samaritan acts are not coveredunder the standard. If an employee has anexposure incident while acting as a GoodSamaritan and that employee is not expectedto render assistance as part of his or her jobduties, the employer is not required by thestandard to provide the HBV vaccinationseries, post-exposure evaluation, follow-upprocedures, or any other protections of thestandard, although Oregon OSHA encour-ages employers to do so.

Q Do cleanup activities of blood or OPIMconstitute occupational exposure?

AYes. Employees who clean up and decon-taminate areas or surfaces are considered tohave occupational exposure. Such employeesare covered under the standard.

Q Are motel/hotel housekeepers included inthe scope of the rules?

AEmployees in the lodging industry are

covered under the standard if there is areasonable expectation that occupationalexposures to blood or other potentially infec-tious material will occur in the performanceof their job duties. The standard is a perfor-mance standard and requires the employer todetermine occupational exposures withoutregard to personal protective clothing orequipment. Every location may have individ-ual considerations that must be evaluated todetermine exposures. If it is determined that

the standard applies to the work location,action should be taken to develop an expo-sure control plan; provide employee training,information, and PPE; offer the hepatitisB vaccination series; and comply with theother provisions of the standard.

Q Are janitorial services covered by thestandard?

AJanitorial, custodial, or maintenanceemployees are covered under the standard insituations where there is reasonable expecta-tion that exposure to blood or other poten-tially infectious materials may occur. These

situations can include work in a health carefacility, cleanup after an accident where

blood is present, or removing used syringesin a parking lot. Every employer must deter-mine if there is a reasonable expectation forexposure in their given set of circumstances.

Q Are chiropractors who may performinvasive procedures involving bloodcovered by the standard?

AChiropractors with no paid employees andno workers compensation coverage are notcovered by the standard. Chiropractors withpaid employees not reasonably expected tobe exposed to blood or OPIM in the per-formance of their duties do not fall underthe standard. If chiropractors themselves,who are covered by workers compensa-tion, perform procedures for which there is areasonable anticipation of exposure to bloodor OPIM, they fall under the scope of thestandard, as would any of their employees

whose job duties placed them at risk.

Q ABC Healthcare Employment Agency hasa large personnel pool providing hospitalstafng and private-duty nursing services.

The employees are on ABCs payroll. Whois responsible, the employment agency orthe client?

APersonnel providers who send employeesto work at other facilities are consideredemployers whose employees may be exposed

to hazards. Because ABC maintains a con-tinuing relationship with the employees, butanother employer creates and controls thehazards, there is a shared responsibility tocomply with the standard. ABC is requiredto provide generic training in universal pre-cautions, ensure that employees are provided


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with required vaccinations, and ensure thatproper follow-up evaluation is provided afterany exposure incident. The client is respon-sible for providing site-specic training andPPE and for controlling potential exposureconditions. The client may specify qualica-tions for personnel, including vaccination

status. It is in the best interest of ABC toensure that all requirements of the standardare met by the client employer to ensure asafe and healthful workplace for the leasedemployees.

Q Are construction, maritime, andagricultural industries covered by the

bloodborne pathogen standard?

AYes. The bloodborne pathogen standardapplies to all employers at worksites where

there is reasonably anticipated skin, eye, mu-cous membrane, or other parenteral contactwith blood or OPIM that may result fromthe performance of an employees duties. Itis the employers responsibility to determinewhich job classications or specic tasks andprocedures involve occupational exposure.

Q Are drycleaning and laundromatoperations covered by the standard?

AOregon OSHA believes that some laundryworkers are at risk of exposure to blood-borne pathogens. These individuals may beemployed in hospital or commercial laun-dries that serve health care, public safety, orother institutions where occupational expo-sure to blood or OPIM occurs.

Q Are rst-aid-trained employees coveredby the standard?

AFirst-aid-trained employees assignedto provide emergency rst aid as part oftheir specic job duties are covered by thestandard. Examples include occupationalnurses or employees in charge of rst-aidstations. Position descriptions for suchemployees would stipulate rendering rstaid to fellow employees.

Any rst-aid-trained employee who hasrendered rst aid should receive treatmentunder post-exposure evaluation and follow-up, Section (f)(3). All rst-aid-trainedemployees must have PPE available tothem and must be informed about exposurehazards and post-exposure procedures.

Q Can ambulance drivers or helicopterpilots eat while transporting a patient or

human body parts or organs?

AAmbulance drivers or pilots can eat anddrink during transportation of patients,body parts, or organs provided that the cab,compartment, or operator have not beencontaminated with blood or other potentiallyinfectious materials. The employer mayimplement procedures for changing contam-

inated clothing and washing prior to enter-ing the vehicle or ensuring that patients andpotentially contaminated material remainbehind a separating partition.

Q When is urine or feces covered as otherpotentially infectious material?

AWhen there is visible blood. Nasal secre-tions and tears that have visible blood arealso dened as OPIM.


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SECTION II

Exposure Control PlansOAR 437-002-1910.1030(c)

The standard requires the employer to develop a

written exposure control plan to identify work-ers with occupational exposure to blood and otherpotentially infectious material and to specify themethods of protecting and training the employees.

Q What is required in the exposure controlplan?

AAt a minimum, the exposure control planmust include:

The exposure determination.

The procedures for evaluating the circum-stances surrounding an exposure incident.

The schedule and method for implementingthe provisions of the standard. This schedulemay be as simple as a calendar with brief no-tations describing the methods of implemen-tation and an annotated copy of the standard.

The plan must be reviewed and updated annually orwhenever new tasks and procedures affect employeesoccupational exposure. It must be made accessible toemployees according to OAR 437-002-1910.1020(e).The annual audit must review all sections of theexposure control plan.

Q Does Oregon OSHA have a sampleexposure control plan?

AYes. See Appendix B in this publication.

Exposure determination

OAR 437-002-1910.1030(c)(2)

As an element of the exposure control plan, everyemployer must identify workers with occupationalexposure to blood and other potentially infectiousmaterials.

Q How do I know if any of my employeeshave occupational exposures?AExposure determination must be based on

the denition of occupational exposure with-out regard to personal protective clothingand equipment. Exposure determination ismade by reviewing job classications withinthe work environment and sorting exposuresinto two groups:

The rst group includes job classications inwhich allof the employees have occupation-al exposure, such as operating-room scrubnurses. Within this group, it is not necessaryto list specic work tasks.

The second group includes job classicationsin which some of the employees have oc-cupational exposure. In this group, specictasks and procedures causing occupationalexposure must be listed; for example, hos-pital laundry workers, if some workers areassigned the task of handling contaminatedlaundry.

Once employees with occupational exposure havebeen identied, communicate the hazards to theseemployees.

Q Do clinical or diagnostic laboratoriesthat analyze blood or other potentially

infectious materials have to comply withthis section of the rules?

AYes, but they are exempt from Section (e),which covers HIV and HBV researchlaboratories and production facilities.Oregon OSHA recommends that universalprecaution procedures be followed inclinical or diagnostic laboratories.


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Training

OAR 437-002-1910.1030(g)

Each occupationally exposed employee must begiven bloodborne pathogen information and trainingat the time of initial assignment. The training mustbe conducted during working hours and at no cost

to the employee. Training must be repeated at leastonce a year more often if new or modied tasksinvolve occupational exposure to bloodborne patho-gens that affect employees.

Q Who is qualied to conduct training andprovide information?

APossible trainers include a variety ofhealth care professionals such as infection-control practitioners, nurse practitioners,physician assistants, and emergency

medical technicians.Non-health care professionals such asindustrial hygienists, epidemiologists,professional trainers, or others knowledge-able in the subject matter may conduct thetraining if they can demonstrate knowledgeof the elements covered by the standard as itrelates to the workplace.

Trainers must provide information appro-priate to the educational level, literacy, andlanguage of the audience; the informationmust contain the following elements:

Explanation of the regulatory text and howto get a copy of the regulatory text

Information on the epidemiology and symp-toms of bloodborne diseases

How bloodborne pathogens are transmitted

Explanation of the exposure control plan andhow to get a copy of it

How to recognize tasks that might result in

occupational exposure Explanation of the use and limitations of work

practices, engineering controls, and PPE

Information on the types, selection, properuse, location, removal, handling, decontami-nation, and disposal of PPE

Information about the hepatitis B vaccina-tion series: its safety, benets, methods ofadministration, and availability

Who to contact and what to do in anemergency

How to report an exposure incident andconduct the post-exposure evaluationand follow-up

Information about warning labels, signs,and color-coding

Question-and-answer session on any aspectof the training

Additional training in standard microbio-logical practices and techniques, practicesand operations specic to the facility, andthe proper handling of human pathogensor tissue cultures is required for employeeswho work in HIV and HBV laboratories andHIV and HBV production facilities. Employ-ees must receive additional training before

beginning initial work assignments.

Q Can generic training programs, outsidetrainers, or videos be used?

AYes, as long as site specic informationand employee interaction with the trainer arealso provided. Oregon OSHA evaluatestraining based on employee knowledge or

performance. Audiovisual programs onbloodborne pathogens are available from theOregon OSHA AV Library, 800-922-2989 or

503-947-7453, or select Audiovisual LendingLibrary from the Information section ofour website, www.orosha.org.

Q Will Oregon OSHA train our employees?ANo; however, Oregon OSHA does provide

a class on the bloodborne pathogens standardfor employers and employees, at no charge.To obtain this assistance, contact the OregonOSHA Training Section, 888-292-5247 andselect option 2 or 503-947-7443, or visit our

website, www.orosha.org.

Q Will Oregon OSHA review and approveour exposure control plan, training, PPE,

or other products?

ANo.


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SECTION III

Preventive Measures

Hepatitis B vaccination

OAR 437-002-1910.1030(f)

The requirements for hepatitis B vaccinations aredesigned to protect employees from bloodborne-pathogen-caused infection by requiring employersto provide hepatitis B vaccinations and medicalfollow-up after an exposure incident. Early interven-tion, testing, counseling, and appropriate prophy-laxis can reduce the risk of infection and preventfurther transmission.

Q Who is required to have hepatitis Bvaccinations?

AEmployers must make the hepatitis Bvaccination series available to all employ-ees who have occupational exposure. Theymust also provide post-exposure evaluationand follow-up to all employees who experi-ence an exposure incident. The vaccinationsand all medical evaluations and follow-upmust be provided at no cost to the employee,provided at a reasonable time and place, andperformed by or under the supervision of alicensed physician or other licensed healthcare professional. Vaccinations must beadministered according to current recom-mendations of the U.S. Public Health Ser-vice. Employees who decline the vaccinationmust sign a declination form. (See AppendixA, Page 23.) Employees who request the vac-cination series later must receive it at no costif they continue to be exposed.

Q When must the hepatitis B vaccinationbe offered?

AThe hepatitis B vaccination series mustbe offered to employees who have occupa-tional exposure to blood or other potentiallyinfectious materials within 10 working daysof initial assignment, unless the employeehas previously received the series; antibodytesting reveals that the employee is immune;or, for medical reasons, the employee cannotbe vaccinated.

Employers are not required to providemedical prescreening, and employees are notrequired to submit to prescreening.

The employer must obtain and provide theemployee with a copy of the health care pro-fessionals written opinion stating whethera hepatitis B vaccination was indicated for

the employee and whether the employeereceived such vaccination.

Any booster doses of the hepatitis B vaccinerecommended by the U.S. Public Health Ser-vice also must be provided by the employer.

Q What if an employee refuses to bevaccinated?

AThe standard requires the employer to ob-tain a signed declination from each employ-

ee who refuses vaccination. The declinationstatement used by the employer must containthe language found in Appendix A, Page23; no words may be added or subtracted. Asentence releasing the employer from liabil-ity may notbe added.

Q If an employee who wants an HBV vaccinebelieves he or she is allergic to the vaccine,

is the employer required to pay for allergytests to determine if the employee can

safely receive the vaccination?

AIt is the employers responsibility to bearthe cost of allergy tests recommended by thephysician.

Q Is prescreening required for hepatitis Bserum?

ANo. The standard does not requirepre-screening of employees for hepatitisB; neither is prescreening prohibited. Pre-

screening for immunity cannot be used inlieu of offering hepatitis B vaccination.


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Q If an employee begins the vaccinationseries and terminates employment beforethe series is complete, can he or she becharged for the remaining vaccine?

ANo. Section (f)(1)(ii)(A) of the standardrequires the employer to offer hepatitis Bvaccination at no cost to the employee.

Q Do my employees need to have a test forhepatitis B antibodies after they completethe vaccination series?

AYes. Oregon OSHA requires that youprovide vaccinations, evaluations, or follow-up procedures for hepatitis B in accordancewith Centers for Disease Control and Pre-vention (CDC) recommendations in placewhen these procedures took place.

The current CDC guidelines recommendthat employees who have ongoing contactwith patients or blood and are at ongoingrisk for injuries with sharp instruments orneedlesticks be tested for antibody to hepati-tis B surface antigen one to two months afterthe completion of the three-dose vaccinationseries. Employees who do not respond to theprimary vaccination series must be revac-cinated with a second three-dose vaccineseries and retested. Employees who do not

respond to the second vaccine series must beevaluated by a physician.

Q What if an employee starts thevaccination series, but doesnt nish it?AHepatitis B vaccination is a series of three

shots. If the employee starts the series, butdoesnt get all three shots, they either haveto redo the series or sign the declinationstatement. If the employee chooses to redothe series, the employer must still pay for it.

Universal precautions

OAR 437-002-1910.1030(d)(1)

Universal precautions must be observed. Thismethod of infection control requires the employerand employee to assume that all human blood andspecied human body uids are infectious for HIV,HBV, and other bloodborne pathogens. Where dif-

ferentiation between types of body uids is difcultor impossible, all body uids are to be consideredpotentially infectious.

Standard precautions and body

substance isolation

Alternative concepts in infection control are calledbody substance isolation (BSI) and standard pre-cautions. These methods dene blood and all bodyuids (whether or not they contain blood) and

mucous membranes as infectious. These methodsincorporate the uids and materials covered by thisstandard and expand coverage to include all bodyuids and substances. These concepts are acceptablealternatives to universal precautions, provided thatfacilities using them adhere to all other provisionsof the bloodborne pathogens standard.

SECTION IV


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SECTION IV

Methods of Control

Engineering controls

and work practicesOAR 437-002-1910.1030(d)(2)

Engineering controls and work practices are theprimary methods used to prevent occupationaltransmission of HBV, HCV, HIV, and other blood-borne pathogens. Personal protective clothing andequipment also are necessary when occupationalexposure to bloodborne pathogens remains evenafter instituting these controls.

Engineering controls reduce employee exposure

in the workplace by either removing or isolatingthe hazard or isolating the worker from exposure.Self-sheathing needles, needle systems, puncture-resistant disposal containers for contaminated sharpinstruments, resuscitation bags, and ventilationdevices are examples of engineering controls. Engi-neering controls must be examined and maintainedor replaced on a schedule.

OAR 437-002-1030 also requires that every em-ployer with employees who use medical sharps indirect patient care must identify, evaluate, and select

engineering and work-practice controls, includingsafer medical devices, at least annually.

Evaluation of safer medical devices must involvenonmanagerial front-line employees responsible fordirect patient care and must be done on a facility-by-facility basis. When a facility has multipledepartments with specic equipment or work-prac-tice concerns, evaluations must involve employeesfrom those departments.

Emergency departments should coordinate appro-

priate medical-device selections with the emergencymedical services from whom they receive patients.Example of a case in which it would be useful tocoordinate: An ambulance service using a needle-less system not compatible with the needlelesssystem used by personnel at a hospital can increaseemployee exposure potential.

After a device is evaluated and selected, the em-ployer must decide whether or not to use that device.If a device is not purchased because of employer oremployee concerns, those concerns must be docu-mented. However, if the employer does not purchasea device that had employee support, the employermust document the employee support as well as the

justication for not purchasing that device.If a device is purchased without the consent of theemployees who evaluated it, the employer mustdocument the employees concerns as well as theemployers justication for purchasing that device.

Required documentation must be kept as part of thewritten exposure control plan.

The employer must ensure that all affected employ-ees are informed on the process for selecting safermedical devices.

All employees must be trained in the use of safermedical devices before using them.

Properwork practices alter the manner in which atask is performed. In work areas where a reason-able likelihood of occupational exposure exists,work-practice controls include restricting eating,drinking, smoking, applying cosmetics or lip balm,and handling contact lenses; prohibiting mouthpipetting; preventing the storage of food or drinkin refrigerators or other locations where blood or

OPIM are kept; providing and requiring the useof handwashing facilities; and routinely checkingequipment and decontaminating it prior to servicingand shipping.

Washing hands when gloves are removed and assoon as possible after skin contact with blood orother potentially infectious materials is required.

The standard prohibits recapping, removing, orbending needles unless the employer can demon-strate that no alternative is feasible or that such

action is required by a specic medical procedure.When recapping, bending, or removing contami-nated needles is required by a medical procedure, itmust be done using a one-handed technique or bymechanical means such as the use of forceps.

The standard also prohibits shearing or breakingcontaminated needles.


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Q Are contaminated sharps dened?AYes. The rule denes contaminated sharps

as any contaminated object that can penetratethe skin, including, but not limited to, nee-dles, scalpels, broken glass, broken capillarytubes, and exposed ends of dental wire.

Q What must I do with contaminateddisposable sharps?ASharps must be placed immediately (or

as soon as feasible after use) in a puncture-resistant, leak-proof sharps container thatcan be closed for handling, storage, trans-portation, and disposal. The container mustbe color-coded (such as red) or labeled withthe biohazard symbol.

Q Where are sharps containers required?

ASharps containers are considered anengineering control and must be locatedwhere sharps are used. Containers shouldbe located in each room where sharps areused; however, containers may be placedon a tray and transported to each room foruse. Disposable and reusable sharps such aslarge-bore needles, scalpels, and saws mustbe contained in a manner that eliminates orminimizes the hazard until they are dis-

posed of or reprocessed.

Q If Ive never had an employee experiencea needlestick, do I still need to use saferdevices?

AYes. OSHA standards are intended tobe implemented to prevent occupationalinjuries and illnesses. In order to mosteffectively avoid percutaneous injuriesfrom contaminated sharps, employees mustuse engineering controls that include safer

medical devices.

Q By what date do we have to implementsafer medical devices?AThe requirement to implement safer medi-

cal devices is not new. However, the revisedstandard claries engineering controlsdescribed in the original 1991 bloodbornepathogens standard by adding language tothe denition section of the standard thatreects the development and availability ofsafer medical devices. The 1991 standardstates: engineering and work practice con-trols shall be used to eliminate or minimizeemployee exposure. The revision denesengineering controls as controls (e.g.,sharps disposal containers, self-sheathingneedles, safer medical devices, such assharps with engineered sharps injury protec-tions and needleless systems) that isolate or

remove the bloodborne pathogens hazardfrom the workplace. Consequently, youshould already have safer devices in place.If you have not already evaluated and imple-mented appropriate and available engineer-ing controls, you must do so now. Also,employees with occupational exposure toblood and OPIM must be trained regardingthe proper use of all engineering and workpractice controls.

Q What if a safer option is not available forthe medical device that I use?AA key element in choosing a safer medi-cal device, other than its effectiveness andappropriateness to the procedure, is itsavailability on the market. If there is nosafer medical device available, you are notrequired to use something other than thedevice normally used. During your annualreview of devices, you must investigate newand safer options and document this fact in

your written exposure control plan. If no en-gineering control is available, work-practicecontrols must be used and, if occupationalexposure still remains, personal protectiveequipment must also be used.


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Q Is recapping needles permissible?ARecapping, bending, or removing needles

is permissible only if there is no feasiblealternative or if required for a specic medi-cal procedure such as blood gas analysis. Ifrecapping, bending, or removal is necessary,workers must use a mechanical device or aone-handed technique. If recapping is essen-tial for example, between multiple injec-tions for the same patient employees mustavoid using both hands to recap. Recapping,using the needle itself to pick up the cap, canbe done using a one-handed scoop tech-nique, pushing the cap and sharp togetheragainst a hard surface to ensure a tight t.An alternative is to hold the cap with tongsor forceps to place it on the needle.

Q Is hand-washing addressed in the rules?AYes. The rule requires employers toprovide readily accessible hand-washingfacilities, where employees are required towash their hands immediately or as soonas feasible after removal of gloves or otherPPE. Any portion of an employees body thathas contacted blood or other potentially in-fectious materials, including saliva, must bewashed immediately or as soon as feasibleafter contact. When hand-washing facilities

are not feasible, such as in an ambulance, anantiseptic hand cleanser and clean towels orantiseptic towelettes must be provided by theemployer. The hands must be washed withsoap and running water as soon as feasibleafter reaching hand-washing facilities.

Alternate hand-washing procedures forhealth care workers are found in Centers forDisease Control and Preventions Guidelinesfor Hand Hygiene in Health care Settings.

Personal protective equipment (PPE)

OAR 437-002-1910.1030(d)(3)

PPE must be used if engineering and work practicecontrols do not eliminate the exposure hazard or ifsuch controls are not feasible.

PPE helps prevent occupational exposure to infec-

tious materials. Such equipment includes gloves,gowns, laboratory coats, face shields or masks, andeye protection. PPE is considered appropriate only ifit prevents blood or OPIM from passing through orreaching the employees work clothes, street clothes,undergarments, skin, eyes, mouth, or other mucousmembranes under normal conditions of use.

Under the standard, employers must provide, makeaccessible, and require the use of PPE at no cost toemployees. PPE must be provided in appropriatesizes. Hypoallergenic gloves or similar alternatives

must be made available to employees who have anallergic sensitivity to gloves. Employers must ensurethat protective equipment is properly used, cleaned,laundered, repaired, or replaced, as needed.

An employee may temporarily and briey decline towear PPE under extraordinary (usually, life threat-ening) circumstances and when, in the employeesprofessional judgment, it prevents the delivery ofhealth care or public safety services or poses anincreased hazard to workers. In general, appropriatePPE is expected to be used whenever occupationalexposure may occur.

The employer also must ensure that employees ob-serve the following precautions for safely handlingand using PPE:

Remove protective equipment when it be-comes contaminated and before leaving thework area.

Place used protective equipment in appropri-ately designated areas or containers for stor-

age, washing, decontamination, or discarding.


17/3615

Wear appropriate gloves when there is areasonable hazard of contact with blood orother potentially infectious materials, whenperforming vascular access procedures,*andwhen handling or touching contaminateditems or surfaces.

Replace gloves if torn, punctured, contami-nated, or if they no longer function as a bar-rier for other reasons.

Only decontaminate utility gloves forreuse if their integrity is not compromised.Discard utility gloves when theyre punc-tured, cracked, peeling, torn, or deteriorated.

Never wash or decontaminate disposablegloves for reuse.

Wear face and eye protection such as a

mask with glasses and solid side-shields ora chin-length face shield whenever splashes,sprays, spatters, or droplets of blood orOPIM may reach the eyes, nose, or mouth.

Wear protective body coverings such asgowns, aprons, caps, and boots when oc-cupational exposure is anticipated. The typeand characteristics will depend upon the taskand degree of exposure anticipated.

Remove garments when they become satu-rated with blood or OPIM.

Q Are gloves required when giving allergyimmunotherapy injections or otherinjections?

AGloves are not necessary if hand contactwith blood or OPIM is not anticipated. Ifbleeding is anticipated, and the employee isrequired to clean the site following injection,gloves must be worn. To prevent employeehand contact with blood, the patient can beinstructed to apply pressure to the injec-

tion site with an alcohol wipe or cotton ball,which the patient would then discard.

Q Are there standards that dene such PPEterms asuid-proof, uid-resistant, andpermeability?

ANo. There are no standards dening thepermeability of PPE. Paragraph (d)(3)(i) ofthe standard states: Personal protectiveequipment will be considered appropriate

only if it does not permit blood or other po-tentially infectious materials to pass throughto or reach the employees work clothes,street clothes, undergarments, skin, eyes,mouth, or other mucous membranes undernormal conditions of use and for the dura-tion of time which the protective equipmentwill be used.

Q Are latex gloves acceptable for all typesof jobs?

ANo. The employer has the responsibilityfor determining the type of glove requiredfor each job. Vinyl or other leak-proofgloves may be required to withstand heavi-er work duties.

Q Is the use of hand or barrier creamsacceptable when using latex gloves?

AYes, if the barrier cream does not causedegradation of the gloves, as petroleum-basedcreams can.

Q If employees wear scrubs in work areaswhere there are exposures to blood and

other potentially infectious materials, dothey have to remove the scrubs to go down

the hall to the restroom?

AYes. Removing contaminated scrubs priorto leaving the work area is necessary to pre-vent contamination of other areas. The termcontaminated means the presence or the

reasonably anticipated presence of blood orother potentially infectious materials.

* Some exceptions are made for voluntary blood donationcenters. See Section (d)(3)(ix)(D) of the bloodborne patho-

gens standard for clarication.


18/3616

Housekeeping

OAR 437-002-1910.1030(d)(4)

Under the standard, each place of employment mustbe kept clean and sanitary. Employers must developand implement a cleaning schedule that includes themethods of decontamination and procedures to beused. The cleaning schedule must explain which ar-

eas and surfaces are to be cleaned, the type of con-tamination present, and how they are to be cleaned.

Employers must ensure that the following house-keeping procedures are followed:

Cleaning and decontamination of the en-vironment, including equipment and worksurfaces that have been contaminated withblood or OPIM.

Decontamination of work surfaces with anappropriate disinfectant after completion

of procedures; immediately, if obviouslycontaminated; after spills of blood or OPIM;and at the end of work shifts if contaminatedsince last cleaning.

Removal and replacing of protective cover-ings such as plastic wrap and aluminum foilwhen contaminated.

Regular inspection and decontamination ofreusable receptacles such as bins, pails, andcans that are likely to become contaminated.

When contamination is visible, clean anddecontaminate receptacles immediately oras soon as feasible.

Use of mechanical means such as tongs,forceps, or a brush and a dustpan to pick upcontaminated broken glass.

Storage or processing of reusable sharps in away that ensures safe handling.

Placement of other regulated waste in clos-able, leak-proof, and labeled or color-coded

containers for storage, handling, transport-ing, or shipping. Other regulated wastemeans liquid or semi-liquid blood or OPIM;items contaminated with blood or OPIM thatwould release these substances in a liquid orsemi-liquid state if compressed; items cakedwith dried blood or OPIM capable of releas-ing these materials during handling; contami-nated sharps; and pathological and microbio-logical wastes containing blood or OPIM.

Placement of discarded contaminated sharpsin labeled or color-coded containers that areclosable, puncture-resistant, and leak-proofon the sides and bottom.

Provision of sharps containers that are easilyaccessible to employees and as close as feasi-

ble to the area where sharps are used. Sharpscontainers must be kept upright during use,replaced routinely, closed when moved, andnot overlled. If cracked or punctured, sharpscontainers must be replaced.

Prohibiting the manual opening, emptying,or cleaning of reusable sharps containers andother employee exposure to percutaneousinjury.

Handling contaminated laundry as little aspossible and using appropriate PPE when

handling it.

Placement of wet contaminated laundry inlabeled or color-coded leak-proof containersfor transporting and bagging contaminatedlaundry without sorting or rinsing it in itsarea of use.

Q Are employees allowed to take gowns, labcoats, or PPE home to be laundered?

ANo. Section (d)(3)(iv) of the standard placesthe responsibility on the employer for clean-ing, laundering, and disposal of PPE. Thisprocedure is intended to reduce employeeexposure to bloodborne pathogens.

Q If an employee accidentally gets bloodor OPIM on his or her uniform, is theemployer responsible for cleaning that

uniform?

ANot necessarily. The employers responsi-bility for cleaning items used in the work area

is based on the intended function of thoseitems. If a uniform is to function as PPE, thenit is the employers responsibility to provide,clean, replace, and dispose of the uniform.


19/3617

Q Are there special handling requirementsfor PPE to be laundered?

AYes. Contaminated laundry, which islaundry that has been soiled with blood orOPIM, must be handled as little as possibleand placed promptly into bags or containersin the area where it has been used or worn

and removed. The bags or containers mustprevent leakage and be red or labeled withthe biohazard symbol. If the facility practic-es universal precautions, alternative labelingor color-coding is acceptable if it permitsall employees to recognize the laundry bagsor containers as requiring compliance withuniversal precautions. Protective gloves andother PPE must be worn when handling con-taminated laundry.

Q What disinfectants are acceptable fordecontaminating surfaces?AProducts registered by the EPA as steril-ants (List A), disinfectants that are effectiveagainst tuberculosis (List B), and disinfectantsthat are effective against Hepatitis B and HIV(List D). These lists are available from theEPA, 703-308-0127 and on its website,www.epa.gov/oppad001/chemregindex.htm.A solution of 5.25 percent sodium hypochlo-rite (household bleach) diluted 1:10 to 1:100

with water and prepared daily is acceptable forcleanup of contaminated items or surfaces.

Quaternary ammonia products are appropri-ate for general housekeeping procedures thatdo not involve the cleanup of contaminateditems or surfaces. Contaminated is denedas the presence orreasonably anticipatedpresence of blood or OPIM.

Q Is carpeting an acceptable oor coveringin medical examination rooms or other

areas that may become contaminated withblood or OPIM?

AThe regulations do not address require-ments for oor covering; however, the oorsurface or covering must be capable of being

cleaned and decontaminated. Some carpetsurfaces may be difcult to decontaminate.

Q Is there a standard reference that I canfollow for decontamination procedures?

A Yes. These procedures are foundin the Centers for Disease Control andPreventions Guideline for Hand Hygienein Health care Settings, October 25,2002/51(RR16);1-44. This publication, alongwithHand Hygiene Guidelines Fact Sheet,

is available on the CDC website, www.cdc.gov, or from the Centers for Disease Controland Prevention, 1600 Clifton Road, Atlanta,GA 30333. The phone number for CDC:404-639-3286.

Q What wastes are regulated?ARegulated waste: Blood in liquid or semi-liquid form, or other

potentially infectious materials, including

saliva in dental procedures Items that would release blood or other po-

tentially infectious materials if compressed

Contaminated sharps

Pathological and microbiological waste con-taining blood or other potentially infectiousmaterials

Items that are caked with dried blood orother potentially infectious materials andthat have the ability to release these materi-

als while being handled


20/3618

Q Are feminine hygiene products dened asregulated waste?

AOregon OSHA does not generally con-sider discarded feminine hygiene productsused to absorb menstrual ow to be regulat-ed waste. Oregon OSHA expects the wastecontainers in which these products are dis-

carded to be lined in such a way as to protectemployees from physical contact with thecontents.

Q Are bandages and vaginal speculumsconsidered regulated waste?

ABandages that are not saturated to the pointof releasing blood or OPIM if compressed arenot considered regulated wastes. Similarly,vaginal speculums do not meet the criteria forregulated wastes as dened by the standard.

Q Are there special handling procedures forregulated waste?

AYes. Contaminated sharps must bedisposed in approved containers. Otherregulated waste must be placed in properlylabeled or red bags that contain all contentsand prevent leakage. The bags or containersmust be closed before removal. If a bag leaksor becomes contaminated on the outside, it

must be placed in a second labeled and/orred bag or container.

Q Are there requirements other than theOregon OSHA bloodborne pathogens

standard that govern biohazardous or reg-ulated waste?

AYes. The rule requires disposal of regu-lated waste in accordance with state, local, orfederal waste disposal standards. The Depart-ment of Human Services, Health Services

regulates storage and collection, the Depart-ment of Transportation regulates transporta-tion, and the Department of EnvironmentalQuality regulates disposal of biohazardouswastes.

Labeling

OAR 437-002-1910.1030(g)(1)

The standard requires that uorescent orange ororange-red warning labels be attached to containersof regulated waste; to refrigerators and freezerscontaining blood and other potentially infectiousmaterials; and to other containers used to store,

transport, or ship blood or other potentially infec-tious materials. (See Labeling requirements, Page19.) Labels are not required when: (1) red bags orred containers are used; (2) containers of blood,blood components, or blood products are labeledas to their contents and have been released fortransfusion or other clinical use; and (3) individualcontainers of blood or OPIM are placed in a labeledcontainer during storage, transport, shipment, ordisposal. The warning label must be uorescentorange or orange-red, must contain the biohazard

symbol and the word BIOHAZARD in a contrastingcolor, and must be attached to each object by string,wire, adhesive, or another method to prevent loss orremoval of the label.


21/3619

Labeling requirements

Item Biohazardlabel

Redcontainer

No labels required if universalprecautions are used andcontainers use is known toall employees.

*Alternative labeling or color coding is sufcient if it permits all employees to recognize containers asrequiring compliance with universal precautions.

and a label specifying wherethe contamination exists

Regulated waste container(e.g., contaminated sharpscontainers)

Reusable contaminated sharpscontainer (e.g., surgicalinstruments soaking in a tray)

Refrigerator/freezer holdingblood or other potentiallyinfectious material

Containers used for storage,transport, or shipping of blood

Blood/blood products forclinical use

Individual specimen contain-ers of blood or other potentiallyinfectious materials remaining infacility

Contaminated equipmentneeding service (e.g., dialysisequipment, suction apparatus)

Specimens and regulatedwaste shipped from theprimary facility to anotherfacility for service or disposal

Contaminated laundry

Contaminated laundry sent to

another facility that does notuse universal precautions

X or X

X or X

X

X or X

X

X or X or X

X

X or X

X * or X or X

X or X


22/3620

SECTION V

Exposure IncidentsOAR 437-002-1910.1030(f)(3)

The standard requires immediate post-exposure

medical evaluation and follow-up for employeeswho have had an exposure incident.

Q What is an occupational exposureincident?

AIts an employees exposure to or contactwith blood or OPIM through broken skin;through the eyes, nose, or mouth; or by meansof a wound such as a needlestick.

Q What must be done if an exposureincident occurs?

AAn evaluation and follow-up including thefollowing elements:

Documentation of the route of exposure andhow exposure occurred.

Identication of the source individual, unlessthe employer can establish that identication isinfeasible or prohibited by state or local law.

Obtain consentfrom the source individual.If consent is not obtained, the employer mustshow that legally required consent couldnot be obtained. Where consent is not re-quired by law, the source individuals blood,if available, should be tested and the resultsdocumented.

Testing to determine HIV and HBV infectiv-ity as soon as possible after the incident anddocumentation of the source individuals

blood test results. If the source individualis known to be infected with either HIV or

HBV, testing need not be repeated. Provision of the source individuals test

results (if consent has been obtained) andinformation about disclosure and condenti-ality laws to the exposed employee.

Upon consent, testing of the exposedemployees blood for HBV and HIV sero-logical status as soon as feasible after theexposure incident.

If the employee does not give consent forHIV serological testing during the collectionof blood for baseline testing, preservation ofthe baseline blood sample for at least 90 days.

If, during this time, the exposed employeeelects to have the baseline sample tested, test-ing shall be done as soon as feasible.

Provision of HBV and HIV serological

testing, counseling, and safe and effectivepost-exposure prophylaxis according torecommendations of the U.S. Public HealthService.

The employer must give the health care professionalresponsible for the employees hepatitis B vaccina-tion, post-exposure evaluation, and follow-up a copyof the Oregon OSHA standard. The employer mustprovide the following to the health care professional:a description of the employees job duties relevant tothe exposure incident, documentation of the route(s)

of exposure, circumstances of exposure, results ofthe source individuals blood tests, if available, andall relevant employee medical records, includingvaccination status.

The health care professionals written opinion to theemployer for post-exposure evaluation must docu-ment that the employee has been informed of theresults of the medical evaluation and of any medicalconditions resulting from the exposure incident thatmay require further evaluation or treatment. Otherdiagnoses pertaining to the employee must remaincondential and not be included in the written report.The employer must provide a copy of this report tothe employee within 15 days of the evaluation.

The requirements for the medical and trainingrecords are discussed in the next section,Record Keeping.

Q If the employer is also the health careprofessional, how can the employermaintain post-exposure condentiality?

AThe employer is required to maintain re-quired medical records in a way that protectsthe employees identity and test results. Ifthe employer has contracted with a clinicor other health care facility to provide thefollow-up programs, condentiality require-ments must be included in the contract.


23/362

SECTION VI

Record KeepingOAR 437-002-1910.1030(h)

Employers must preserve and maintain for each em-

ployee an accurate record of occupational exposureaccording to Oregon OSHAs rule governing accessto employee exposure and medical records, 437-002-1910.1020.

Employers who must maintain an exposure-controlplan must also maintain a log of injuries from con-taminated sharps. This log must protect the con-dentiality of the injured employee and must includethe type and brand of the device, the department orwork area in which the injury occurred, and how theinjury occurred. This log must be maintained for

ve years.

Q What information is required to berecorded on the employee medical record?

AUnder the bloodborne pathogens standard,medical records must include the following:

Employees name; Social Security number;hepatitis B vaccination status, includingvaccination dates; and any medical recordsrelated to the employees ability to receive

vaccinations.

Results of examinations, medical testing,and post-exposure evaluation and follow-upprocedures.

A copy of the information provided to thehealth care professional and the health careprofessionals written opinion.

Q When is an employee exposure to bloodor OPIM required to be recorded on the

OSHA 300 form?

AAll contaminated sharps injuries must berecorded on the OSHA 300 log. All otherexposure incidents need only be recorded onthe OSHA 300 log when medical treatmentis initiated as part of the post-exposureevaluation. These incidents are recordedas injuries until or unless the employee is

diagnosed with an illness, such as hepatitisor HIV. If this occurs, the OSHA 300 logmust be updated to reect the incident as anillness, and the description of the incidentmust reect the new diagnosis.

All of these types of incidents are recordedas privacy-concern cases, in which the nameof the employee is kept condential. If you

have a privacy-concern case, do not enterthe employees name on the OSHA 300 log.Instead, enter privacy case in the spacenormally used for the employees name. Thiswill protect the privacy of the injured or illemployee when another employee, a formeremployee, or an authorized employee repre-sentative has access to the OSHA 300 log.You must keep a separate, condential list ofthe case numbers and employee names foryour privacy-concern cases so you can update

the cases and provide the information to thegovernment if asked to do so.

Q I own a janitorial company, and wehave an exposure control plan becausewe clean up blood spills. My employees

occasionally nd used syringes. Do I needto keep a sharps injury log?

AYes. The sharps injury log must be keptby all employers who must maintain an ex-posure control plan, regardless of whether ornot they use sharps in their normal duties.

Q I must also log injuries from contaminatedsharps on my 300 log. Can I just use thatas my sharps injury log?

AYes, as long as the information required tobe kept on the sharps injury log is recordedon the 300 log. Additionally, you must beable to easily separate the sharps injuryinformation from all of the other informa-

tion on the 300 log. For example, if you keepyour 300 log electronically in a database,you must be able to pull up a report of thesharps injuries with the required informa-tion. If you use the paper version of the300 log, you can comply by using a separatesheet for the sharps injuries.


24/3622

Q How long must an employer maintainmedical records?

AMedical records must be kept condentialand maintained for at least the duration ofemploymentplus 30 years.

The bloodborne pathogens standard alsorequires employers to keep accurate trainingrecords for three years. They must includetraining dates, contents or a summary ofthe training, names and qualications of thetrainer or trainers, and names and job titlesof trainees.

Upon request, both medical and trainingrecords must be made available to theNational Institute for Occupational Safetyand Health and to Oregon OSHA. Trainingrecords must be available to employees or

employee representatives upon request. Anemployees medical records can be obtainedby that employee or anyone having that em-ployees written consent.

Q What must I do if I decide to close mybusiness?

AIf an employer ceases to do business,medical and training records must be trans-ferred to the successive employer. If thereis no successive employer, the employer

must notify NIOSH, U.S. Department ofHealth and Human Services, for specicdirections regarding disposition of therecords at least three months prior toceasing company operations.


25/3623

Appendix A

Statement of Declination

The following statement must be signed by every employee who declines the hepatitis vaccine. Thestatement can only be signed by the employee after he or she has received training regarding hepatitis B,hepatitis B vaccination, and the method and benets of vaccination. Employees must be told that the

vaccine and vaccination are provided free of charge to the employee. The statement is not a waiver;employees can request and receive the hepatitis B vaccination at a later date if they remain occupationallyat risk for hepatitis B.

I understand that due to my occupational exposure to blood

or other potentially infectious materials, I may be at risk of

acquiring hepatitis B virus (HBV) infection. I have been given the

opportunity to be vaccinated with hepatitis B vaccine, at no charge

to myself. However, I decline hepatitis B vaccination at this time.

I understand that by declining this vaccine, I continue to be at

risk of acquiring hepatitis B, a serious disease. If in the future I

continue to have occupational exposure to blood or other potentially

infectious materials and I want to be vaccinated with hepatitis B

vaccine, I can receive the vaccination series at no charge to me.

__________________________________ _________________Employee signature Date


26/3624

Appendix B

ABC Precious Metals CompanyBloodborne Pathogens Exposure Control Plan

The following is an example of a basic exposurecontrol plan. It can be used as a guide to developyour organizations exposure plan, but your plan

ABC Precious Metals Company has made a

commitment to the prevention of incidents or

accidents that can result in employee injury or

illness. This exposure control plan is an element

of our safety and health program in compliance

with Oregon OSHABloodborne Pathogens,

1910.1030, requirements. The rst-aid-center

nurse has the authority and responsibility toensure that all elements of the exposure plan are

in place. A copy of this plan is available to all

employees at the rst-aid center.

Purpose

The purpose and goal(s) of this exposure plan

is to eliminate or minimize employee

occupational exposure to blood or other

potentially infectious materials (OPIM), identify

employees occupationally exposed to blood

or OPIM in the performance of their regular

job duties, provide information and training

to employees exposed to blood and OPIM,

and comply with Oregon OSHABloodborne

Pathogen standard, 1910.1030.

Exposure determination

Employees subject to the Oregon OSHA bloodborne

pathogens standard are those who are reasonably

expected to have skin, eye, mucous membrane, or

parenteral contact with blood and/or any body uids

that are contaminated with blood resulting from the

performance of their assigned job duties. Although

Good Samaritan acts are not covered under thebloodborne pathogen standard, it is our policy

to provide evaluation and treatment of employ-

ees who sustain exposure to blood or OPIM who

assist an injured employee but are not required to.

The Employees at riskchart lists job classica-

tions and associated tasks identifying employees at

risk of exposure to blood or other potentially infec-

tious materials (OPIM). Exposure determinations are

made without regard to use of PPE.

must reect your employees job responsibilities andspecic exposures or potential exposures to blood-borne pathogens.

Page 1

Task or procedure

Blood drawingProcess and package of blood and other biological specimens for shippingCleanse and bandage of cuts, burns, and other open woundsEmergency treatment of traumatic woundsCardiopulmonary resuscitationClean up spilled blood or OPIMDecontamination of work surfaces and reusable equipment

Cleanse and bandage of cuts, burns, and other open woundsEmergency treatment of traumatic woundsCardiopulmonary resuscitationClean up spilled blood or OPIMDecontamination of work surfaces and reusable equipment

Job Classifcation

Nurse(First-aid center)

Supervisors(Assigned to provide frst-aidassistance as part of their job duties)

Employees at risk


27/3625

Compliance methods

Universal precautionsUniversal precautions is an approach to infection

control in which all human blood and other

potentially infectious materials are handled as if

they were known to be infectious for bloodborne

pathogens. Consider difcult- or impossible-to-

identify body uids as potentially infectious.

Engineering and work practices controls

Use the following controls to eliminate or

minimize occupational exposure.

Sharp containers

Place contaminated needles, blood-

contaminated test tubes, and other sharp objects

in a sharps container. Replace containers rou-

tinely and do not allow overlling. Place reusable

sharps in metal trays for decontamination. When

moving containers of contaminated sharps from

the area of use, close containers to prevent spill-

age or protrusion of contents.

Safe medical devicesPurchase and use safe medical devices whenever

possible. Evaluate devices annually to determine

appropriateness of the device and to investigate

new and safer options.

Work practicesClean up blood spills or body uids as soon as

possible. Use disposable absorptive materials,

such as paper towels or gauze pads, to soak up the

uids. Clean the area with chemical germicides or

a 1:10 solution of liquid bleach. Place absorptive

towels, pads, and other material used to mop

up spills in plastic bags or designated, labeled

containers and treat as biohazardous waste.

Employees must wash their hands upon removal of

gloves and other protective gear. In an emergency,

if soap and water are not immediately available,

use disposable antiseptic towelettes or germicidal

gels to clean hands after removing gloves.

Employees must wash their hands with soap and

water as soon as possible.

Employees may not eat, drink, smoke, apply

cosmetics or lip balm, or handle contact lenses

where occupational exposure can occur. Do

not store food or beverages in refrigerators and

freezers and other sites used to store blood or other

biohazardous material. Place biohazard labels on

refrigerators or freezers used to store biohazardous

material.

Page 2

The following is a list of job classications and tasks in which some employees may have occupationalexposures to blood or OPIM:

Employees who may be at risk

Task or procedure

Clean up spilled blood or OPIM

Empty biological trash cans

Job Classifcation

Janitors


28/3626

Page 3

Use resuscitation devices, which minimize contact

with mucous membranes, to perform cardiopulmo-

nary resuscitation.

Remove used personal protective equipment at the

exposure location or as soon as feasible to avoid con-

tamination of other work areas. Place in a biohazard

container or in a plastic bag with a biohazard label.

PPE must not be taken from the work site.

Housekeeping

Maintain the rst-aid center in a clean and sanitary

condition. Employees who have received bloodborne

pathogen training and who have been included

under the exposure plan can clean up spills and worksurfaces such as bench tops and blood processing

areas.

Clean and decontaminate all equipment and working

surfaces after completion of procedures in which

blood or body uids contaminated with blood are

handled and immediately, or as soon as feasible,

when surfaces are overtly contaminated with blood

and at the end of the work shift if the surface may

have been contaminated since the last cleaning.

Inspect all biohazardous waste receptacles anddecontaminate weekly or immediately upon visible

contamination.

Use chemical germicides or solutions of 5.25 percent

sodium hypochlorite (liquid bleach) diluted 1:10 with

water for cleaning. Chemical germicides approved

for use as hospital disinfectants and effective against

HIV can also be used.

Broken glassware or glass items must not be picked

up directly with the hands. Use a mechanical means,such as a brush and dust pan, tongs, or forceps.

Handle as a biohazardous waste. Decontaminate

equipment used to pick up glassware with a 1:10

bleach solution or an approved germicide.

Personal protective equipment (PPE)

PPE is provided at no cost to employees. Employ-

ees receive training in its use, maintenance, and

disposal annually.

Storage area

The rst-aid center stores and maintains an inven-

tory of sufcient bloodborne protective gear. Take

supplies, including PPE, as needed, to the location

of the injured person. Supplies include dispos-

able gloves; face shields; impervious disposable

coveralls and booties; resuscitation devices; large,

heavy-duty plastic bags and ties; sharps contain-

ers; biohazard signs or labels; absorbent pressure

dressings for wounds; antiseptic towelettes; dispos-

able absorptive material for cleaning up spilled

blood; rubber gloves; and bleach

solutions or germicides.

PPE use and disposal

Employees engaging in activities that may involve

direct contact with blood, OPIM, contaminated

objects, mucous membranes, or open wounds must

wear disposable gloves made of vinyl or

latex. Use reusable rubber gloves (inspected andfree of apparent defects) or disposable gloves to

clean up spill areas. Disinfect reusable gloves with

diluted liquid bleach or germicides after use.

Wear face shields or goggles with disposable

surgical masks whenever splashes, spray, or

spatters of blood droplets or OPIM may be

generated and eye, nose, or mouth contamination

can be reasonably anticipated.

Use laboratory coats or scrubs at the rst-aid

center to prevent contamination of employee streetclothing. Wear impermeable disposable coveralls

and booties whenever contamination of skin not

protected by gloves or face shields is anticipated,

such as a traumatic injury with signicant blood

loss.


29/3627

Page 4

Contaminated laundry

Handle nondisposable linen, such as laboratory

coats or scrubs, or any other clothing visibly

contaminated with blood using disposable gloves.

Minimize the time spent handling laundry. Bag

laundry as close as possible to the location where

it was used. Place laundry in a bag that prevents

soak-through and/or leakage of uids to the

exterior; place a biohazard label on the bag.

Employees are not to take contaminated items

home to launder. Center Street Laundry currently

holds the contract to pick up, clean, and return

laundered items. The laundry facility has a

bloodborne pathogen program in place.

Regulated waste

Medical Waste Removal Transportation Inc. has

been contracted to pick up regulated waste for

disposal. Place regulated waste in containers that

are closable, constructed to contain all contents

and prevent leakage, appropriately labeled or color-

coded, and closed prior to removal to prevent

spillage or protrusion of contents during handling.

Labels and signs

Afx warning labels to laundry bags, containers

of regulated waste, refrigerator units and

containers used to store, transport, or ship blood

or OPIM. Red bags or red containers can be used

instead of labels.

Hepatitis B vaccine

The hepatitis B vaccine is offered, at no cost, to

employees that were determined to have occupa-

tional exposure, within 10 working days of initial

assignment. Employees who have potential expo-

sure to bloodborne pathogens but decline to take

the vaccination must sign a declination statement.

Employees who initially decline can still receive

the vaccination should they decide at a later date

to accept. Previously vaccinated new hires must

provide a vaccination record that includes the vac-

cination dates. Employees must sign a declination

statement if the vaccination record is not available

and revaccination is declined or not appropriate.

The rst-aid center nurse will coordinate with the

Northwest Health Occupational Clinic employee

vaccinations. The rst-aid center nurse retains

vaccination records in the employee medical

record le.

Exposure incident and post-exposureevaluation and follow-up

An exposure incident to bloodborne pathogens

is dened as an eye, mouth, other mucousmembrane, non-intact skin, or parenteral contact

with blood or other potentially infectious materials

that results from the performance of an employees

duties. It is our policy to include Good Samaritan

acts performed by an employee at the work site.

Whenever an exposure occurs, wash the

contaminated skin immediately with soap and

water. Immediately ush contaminated eyes or

mucous membranes with copious amounts of

water. Medically evaluate exposed employeesas soon as possible after the exposure incident

in order that post-exposure prophylaxis, if

recommended, can be initiated promptly.


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Page 5

Health care professionals written opinion

The rst-aid center nurse will provide the

employee with a copy of the health care

professionals written opinion within 15 days after

completion of the evaluation.

Limit the health care professionals written

opinion(s) for the hepatitis B vaccination to

whether the vaccination is indicated and whether

the employee has received the vaccination.

Limit the health care professionals written opinion

for the post-exposure evaluation to the following

information:

Whether the employee was informed of the eval-uation results

Whether the employee was told about any medi-

cal conditions resulting from exposure to blood

or OPIM that may require further evaluation or

treatment

Training and training records

All employees who have occupational exposure

to bloodborne pathogens receive training on

the epidemiology, symptoms, and mode oftransmission of bloodborne pathogen diseases.

In addition, the training program will include the

following topics:

An explanation of activities and tasks that may

involve exposure to blood and OPIM

How appropriate engineering controls, work

practices, and PPE will prevent or reduce expo-

sure

The basis for the selection of PPE; the types,

use, location, removal, handling, decontamina-

tion, and disposal procedures

Hepatitis B vaccine information including that

the vaccine is provided at no cost, the benets of

being vaccinated and methods of administration

The medical evaluation is to include the

route(s) of exposure and the exposure incident

circumstances; identication and documentation

of the source individual, where feasible; exposedemployee blood collection and testing of blood for

HBV and HIV serological status; post-exposure

prophylaxis, where indicated; counseling; and

evaluation of reported illnesses. Source test

results and identity will be disclosed to the

exposed employee according to applicable laws

and regulations concerning disclosure

and condentiality.

The Northwest Health Occupational Clinic

provides hepatitis B vaccinations and medical

evaluations and post-exposure follow-up after

an exposure incident. The Northwest Health

Occupational Clinic is open 24 hours a day; the

telephone number is 503-123-9876. A copy of the

bloodborne pathogen standard has

been provided to the clinic.

Information provided to the healthcare professional

The rst-aid center nurse is responsible to ensurethat the Northwest Health Occupational Clinic

health care professional evaluating the employee

after an exposure incident receives the following

information:

A description of the employees

duties as they relate to the exposure incident

Documentation of the route(s) and circumstanc-

es of the exposure

The results of the source individuals blood

testing, if available

All medical records relevant to the appropriate

treatment of the employee, including vaccina-

tion status


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Page 6

Employer responsibilities for post-exposure

evaluation and medical follow-up; how and

who to contact should an exposure incident oc-

cur

An explanation of the signs and hazard labels

How to review or obtain a copy of the expo-

sure control plan and the standard

The rst-aid center nurse trains employees

prior to initial assignment to tasks in which

occupational exposure may occur. Training

is repeated every 12 months or sooner when

there are new tasks or changes to the existing

procedures/tasks. Training records are maintainedat the center for three years and include the

date(s) and content of the training program, name

and qualications of the trainer(s), and names and

job titles of the attendees.

Record keeping

Medical records for employees with occupational

exposure to bloodborne pathogens include the

employees name, Social Security number, and

hepatitis B vaccination status, including dates

of hepatitis B vaccination and any medical

records relative to the employees ability to

receive the vaccination. Medical records are

kept for the duration of employment plus 30

years in accordance with Oregon OSHAs

Access to Employee Exposure and Medical

Records standard, 1910.1020. Medical records

are condential. Employees must sign a written

consent for disclosure.

In the event of an exposure incident, the following

records will be kept at the rst-aid center in the

employees medical le:

1. The results of any examination, medical test-

ing, and follow-up procedures.

2. A copy of the treating physicians written

opinion to the employer.

3. A copy of all information provided by the em-

ployer to the health care professional regard-

ing the exposure incident.

Record any needle stick, mucous membrane,

or skin contact with blood or body uids

contaminated with blood or OPIM requiringmedical treatment (e.g., gamma globulin, hepatitis

B immune globulin, hepatitis B vaccine, etc.)

in the OSHA 300 log. In addition, record any

contaminated- sharp injuries, including needle

sticks on the sharps injury log. Retain these

records for ve years.

Plan evaluation and review

Review the exposure control plan and update at

least annually and whenever necessary to reectnew or modied tasks and procedures that affect

occupational exposure. The rst-aid center nurse

is responsible for the annual review. Sign and date

this exposure plan when the review has taken

place.

Signature: _______________________________

Date: ___________________________________


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Oregon OSHAServicesOregon OSHA offers a wide variety of safety and health services to employers and employees:

Appeals503-947-7426; 800-922-2689; [email protected]

Provides the opportunity for employers to hold informal meetings with Oregon OSHA on concerns aboutworkplace safety and health.

DiscussesOregonOSHAsrequirementsandclariesworkplacesafetyorhealthviolations.

Discusses abatement dates and negotiates settlement agreements to resolve disputed citations.Conferences

503-378-3272; 888-292-5247, Option 1; [email protected]

Co-hosts conferences throughout Oregon that enable employees and employers to learn and share ideas withlocal and nationally recognized safety and health professionals.

Consultative Services

503-378-3272; 800-922-2689; [email protected]

Offers no-cost, on-site safety and health assistance to help Oregon employers recognize and correctworkplace safety and health problems.

Provides consultations in the areas of safety, industrial hygiene, ergonomics, occupational safety and healthprograms, assistance to new businesses, the Safety and Health Achievement Recognition Program (SHARP),

and the Voluntary Protection Program (VPP).

Enforcement

503-378-3272; 800-922-2689; [email protected]

Offers pre-job conferences for mobile employers in industries such as logging and construction.

Inspects places of employment for occupational safety and health hazards and investigates workplacecomplaints and accidents.

Provides abatement assistance to employers who have received citations and provides compliance andtechnical assistance by phone.

Public Education

503-947-7443; 888-292-5247, Option 2; [email protected]

Provides workshops and materials covering management of basic safety and health programs, safetycommittees, accident investigation, technical topics, and job safety analysis.

Standards and Technical Resources

503-378-3272; 800-922-2689; [email protected]

Develops, interprets, and gives technical advice on Oregon OSHAs safety and health rules.

Publishes safe-practices guides, pamphlets, and other materials for employers and employees

Manages the Oregon OSHA Resource Center, which offers safety videos, books, periodicals, and researchassistance for employers and employees.

Need more information? Call your nearest Oregon OSHA ofce.

Salem Central Ofce350 Winter St. NE, Rm. 430

Salem, OR 97301-3882

Phone: 503-378-3272

Toll-free: 800-922-2689

Fax: 503-947-7461

en Espaol: 800-843-8086

Website: www.orosha.org

Bend

Red Oaks Square1230 NE Third St.,Ste. A-115Bend, OR 97701-4374541-388-6066Consultation: 541-388-6068

Eugene1140 Willagillespie, Ste. 42Eugene, OR 97401-2101541-686-7562Consultation: 541-686-7913

Medford

1840 Barnett Road, Ste. DMedford, OR 97504-8250541-776-6030Consultation: 541-776-6016

Pendleton200 SE Hailey Ave.Pendleton, OR 97801-3056541-276-9175Consultation: 541-276-2353

Portland

1750 NW Naito Parkway,Ste. 112Portland, OR 97209-2533503-229-5910Consultation: 503-229-6193

Salem1340 Tandem Ave. NE,Ste. 160Salem, OR 97301503-378-3274Consultation: 503-373-7819


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blood born pathogen q&a

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