BLOODBORNE PATHOGENS

THE OCCUPATIONAL SAFETY AND HEALTH

ADMINISTRATION STANDARD

INTRODUCTION

•What is the bloodborne pathogens standard?

•Who needs bloodborne pathogens (BBP) training?

•What content needs to be covered?

OSHA’S EXPECTATIONS

• Duties of Employers– provide a plan– identify job types

and classifications– provide appropriate

training– provide appropriate

equipment

• Compliance

• Duties of Employees– to follow the

employer’s plan– to use equipment

provided by the employer

• Compliance

OSHA REQUIRED INFORMATION

• Documents• General

explanation of bloodborne pathogens

• Hepatitis B immunization

• Explanation of tasks that may involve exposure

BLOODBORNE PATHOGENS DEFINED

• Disease-causing microorganisms that may be present in human blood or OPIM (other potentially infectious material)– Viruses– Bacteria– Parasites

MODES OF TRANSMISSION

• Puncture wounds or cuts

• Contact (Touch, Splash, or Spray) with blood or OPIM on:– mucous membrane– non-tact skin

• cuts, abrasions burns• acne, rashes• papercuts, hangnails

– contaminated sharps

RISK OF EXPOSURE• The objective of

the BBP standard is to minimize or eliminate the hazard posed by work that may expose you to blood or OPIM

RISK OF EXPOSURE• If a risk of

exposure exists, you must know:– if there is a way to

prevent infection– the symptoms and

course of infection– that counseling is

available– that post-exposure

treatment & follow-up are available

OCCUPATIONAL EXPOSURE INCIDENTS

• Occupational contact with blood or OPIM is considered an exposure incident

• If an exposure occurs:– wash with soap & water– report the incident– document the incident– seek “immediate” medical

evaluation– follow employer’s exposure

control plan

IMMEDIATE MEDICAL EVALUATION

• Immediate means prompt medical evaluation and prophylaxis

• An exact time cannot be stated• Time limits on the effectiveness of

prophylactic measures vary depending on the infection of concern

REPORTING AN INCIDENT• Date and time

of the incident• Job classification• Location in the

worksite where the incident occurred

• Work practice being followed

• Engineering controls in use

• Procedure being performed

• PPE in useMinimal information to report

Medical Evaluation After an Exposure Incident

• Entitled to confidential medical evaluation

• Personal decision about blood testing• Blood may be tested only with consent• Blood may be stored for 90 days, while

considering testing• Interpretation of any test results

occurs with the health care provider

BLOOD TESTING• Blood may be tested for

antibodies to:– Human Immunodeficiency Virus

(HIV)– Hepatitis C Virus (HCV)– Hepatitis B Virus (HBV)– Other disease-causing organisms

• Source blood may also be tested with consent

• The results of the tests of source blood will be made known to you

SPECIFIC BLOODBORNE PATHOGENS

• Definition• Signs and Symptoms• Course of infection• Prevention and

control• Post-exposure

prophylaxis and follow-up care

HIV DEFINED• HIV is the Human

Immunodeficiency Virus• HIV causes acquired immune

deficiency syndrome (AIDS)• Risk of HIV infection from a

puncture injury exposure to HIV infected blood is very low -- 0.3%

SIGNS & SYMPTOMS OF HIV

• Signs and symptoms include:– Weight loss– Night Sweats or fever– Gland Swelling or pain– Muscle and/or joint pain

• Cannot rely on signs and symptoms to know if you are infected

COURSE OF INFECTION OF HIV

•Incubation period from HIV infection to AIDS may be 8 to 10 years

•Varies greatly among individuals

HIV PREVENTION

•There is no vaccine to prevent HIV infection

•Follow Universal Precautions

HIV Post-exposure Prophylaxis & Follow-up

• There is no cure for HIV infection

• Testing for HIV antibodies– at time of exposure– at 3 months– at 6 months

• HIV antibodies usually become detectable within 3 months of infection

• Treatment of HIV requires visits with your health care provider

• OSHA requires recommended treatment meet the most recent CDC guidelines

• Treatment can include antiviral medications and a protease inhibitor

HCV Defined• HCV is Hepatitis C Virus• It affects the liver• It is the most common chronic bloodborne

infection in the United States• Needlestick injury is the only occupational

risk factor that has been associated with HCV

• Risk of HCV infection after exposure to HCV infected blood is 1.8%

• 70 to 75% of those with acute HCV infection have no symptoms

SIGNS & SYMPTOMS OF HCV

• Jaundice - a yellow color to the skin

• Fatique• Headache• Abdominal Pain• Loss of appetite• Nausea & Vomiting

COURSE OF HCV INFECTION

•Incubation period averages 7 weeks

•Chronic liver disease may occur in 70% of those infected with HCV

HCV PREVENTION

•There is no vaccine to prevent HCV infection

•Follow Universal Precautions

HCV Post-exposure Prophylaxis & Follow-up

• There is no cure for HCV infection

• No recommendation for post-exposure prophylaxis

• Tests for HCV antibodies & liver function tests should be done at time of exposure

• Tests should be repeated 4 to 6 months after exposure

• Treatment of HCV requires visits with your health care provider

• OSHA requires recommended treatment meet the most recent CDC guidelines

• HCV infection may require liver transplantation for treatment

HBV DEFINED

•HBV is the Hepatitis B Virus•It affects the liver•The prevalence of HBV

infection among healthcare workers is 10 times greater than HCV infection

SIGNS & SYMPTOMS OF HBV

• Jaundice - a yellow color to the skin

• Fatique• Headache• Abdominal Pain• Loss of appetite• Nausea & Vomiting

COURSE OF HBV INFECTION

• Incubation period averages 12 weeks

• Most cases of HBV resolve without further complication

• Chronic liver disease may occur in 6 to 7% of those infected with HBV

HBV PREVENTION

• There is a vaccine to prevent HBV infection

• It is required to be offered to anyone covered by the BBP standard

• Follow Universal Precautions

HBV Post-exposure Prophylaxis & Follow-up

• There is no cure for HBV infection

• Post-exposure prophylaxis should begin within 24 hours and no later than 7 days after exposure

• If not previously vaccinated, the person should receive the HBV vaccine

• Treatment of HBV infection requires visits with your health care provider

• OSHA requires recommended treatment meet the CDC’s most recent guidelines

• Chronic HBV infection may require liver transplantation for treatment

HBV IMMUNIZATION• All people with routine occupational

exposure to blood or OPIM have the right to receive the HBV vaccine at no personal expense

• Refusal requires signing the Hepatitis B Vaccination declination form

• Vaccine is Recombivax HB or Energix - B• Vaccine is prepared from recombinant

yeast cultures• Must be made available within 10

working days of initial assignment to job

HBV VACCINATION SCHEDULE

• Vaccine is given in 3 doses over 6 months– 1st on initial assignment– 2nd one month later– 3rd five months after 2nd dose

• CDC recommends Hepatitis B antibody testing 1 to 2 months following the 3rd dose

• Employer cannot require you use your health insurance to cover the cost

• Pre-screening is not required• HBV is declining because of vaccine use!

PREVENTION• Engineering

Controls• Work Practice

Controls• Personal

Protective Equipment

• Universal Precautions

ENGINEERING CONTROLS

• Design safety into the tools and work space organization

• Engineering controls can:– Remove the risk of exposure to

the hazard– Eliminate the hazard– Isolate the hazard

EXAMPLES OF ENGINEERING CONTROLS

•Hand and eyewashing facilities

•Sharps containers•Labeling•Self-sheathing needles•Needleless IV systems

LABELING REGULATED WASTE

• Label liquid or semi-liquid blood or OPIM

• Label item(s) covered with blood or OPIM

• Label sharps contaminated with blood or OPIM

• Labels are necessary for containers, storage, equipment that is contaminated

• exception is certain blood or blood products that have been screened

SHARPS CONTAINERS MUST BE:

• closable• puncture resistant• leakproof• labeled or color-coded• functional• sufficient in number• easily accessible• maintained in an upright

position• replaced per policy• NOT be overfilled

SHARPS INJURY PROTECTION

• Reusable sharps require proper handling (mechanical means) and decontamination

• Retractable needles

• Needleless systems

WORK PRACTICE CONTROLS

• Behaviors necessary to use engineering controls safely & effectively

• Work Practice Controls include:– using sharps containers– using an eyewash station– WASHING HANDS after using PPE– cleaning work surfaces– proper laundering

PROHIBITED WORK PRACTICES

• Do not break, shear, bend or recap needles

• Do not reach into containers of contaminated sharps

• Do not pick up contaminated items, such as broken glass, with your bare hands

• Do not use a vacuum cleaner to clean up contaminated items

• Do not open, empty or clean sharps containers

• Do not pipette or mouth suction blood or OPIM

• Do not eat, drink, smoke, apply cosmetics, or handle contact lenses in areas of possible occupational exposure

• Do not store food or beverages in refrigerators, freezers, shelves, or cabinets where blood or OPIM are present

HANDWASHING• Facilities readily available

• Wash after removing PPE

• Use antiseptic hand cleanser when necessary (such as when a sink isn’t handy)

HANDWASHING• First roll out

your paper towel or have the towel readily available (so you don’t touch other surfaces to get it)

HANDWASHING• Turn on

the tap water and adjust temperature

• Use plenty of soap

HANDWASHING• Wash your

hands using friction on all surfaces for at least 30 seconds

HANDWASHING• Dry your

hands thoroughly

• DON’T turn off the water yet

HANDWASHING• Turn off the

tap with a dry part of the towel

• Don’t touch surfaces with your hands

CLEANING• Clean work surfaces according to the

employer’s exposure control plan• Use PPE and EPA-approved solution• 10% bleach and water, if used must be

made daily• Place contaminated laundry in color-

coded laundry bag, use PPE, and handle as little as possible

• DO NOT take home to launder!

PERSONAL PROTECTIVE EQUIPMENT (PPE)

• Specialized clothing or equipment used for protection when risk of exposure exists

• Must prevent blood or OPIM from contaminating clothing or skin

• Must be readily available at no cost to employee

• Must be in appropriate sizes• Must be in good working condition• Must be properly maintained• Must be trained in proper use

TYPES OF PERSONAL PROTECTIVE EQUIPMENT

• Gloves• Mask• Eye shields• Gowns/

Aprons• Resuscitatio

n devices

LATEX GLOVES

• Medical products containing latex must be labeled

• Allergies to latex have been on the rise

• Substitutes to latex-containing materials must be available

UNIVERSAL PRECAUTIONS

•Infection Control approach that treats all human blood and certain body fluids as if they are known to contain bloodborne pathogens

MATERIALS THAT REQUIRE PRECAUTIONS

• Blood• Semen• Vaginal Secretions• Cerebrospinal, synovial, or

pleural fluid• Body fluids with visible blood• Any unidentifiable body fluid• Saliva from dental

procedures

MATERIALS THAT DO NOT REQUIRE PRECAUTIONS

• Universal Precautions do not apply to these fluids UNLESS blood is visible:

•feces•nasal secretions•sputum•sweat•tears•urine•vomitus

BODY SUBSTANCE ISOLATION (BSI)

•An acceptable alternative to Universal Precautions

•Treats ALL body fluids and substances as infectious

EXPOSURE CONTROL PLAN• Site specific plan provided by employers for

the protection of employees working where the potential for occupational exposure exists

• Lists job classifications and tasks in which exposure may occur

• Identifies engineering controls, work practice controls, PPE, and Universal Precautions

• Identifies who will be trained and who will do the training

• Includes record keeping provisions and is reviewed annually

QUESTIONS?