Bloodborne Pathogens

IntroductionIntroduction Approximately 5.6 million workers in health care Approximately 5.6 million workers in health care

and other facilities are at risk of exposure to and other facilities are at risk of exposure to bloodborne pathogens such as human bloodborne pathogens such as human immunodeficiency virus (HIV – the virus that immunodeficiency virus (HIV – the virus that causes AIDS), the hepatitis B virus (HBV), and the causes AIDS), the hepatitis B virus (HBV), and the hepatitis C virus (HCV) hepatitis C virus (HCV)

OSHA’s Bloodborne Pathogens standard prescribes OSHA’s Bloodborne Pathogens standard prescribes safeguards to protect workers against the health safeguards to protect workers against the health hazards from exposure to blood and other hazards from exposure to blood and other potentially infectious materials, and to reduce their potentially infectious materials, and to reduce their risk from this exposurerisk from this exposure

Who is covered by the standard?Who is covered by the standard? All employees who could be All employees who could be

“reasonably anticipated” as the result “reasonably anticipated” as the result of performing their job duties to face of performing their job duties to face contact with blood and other potentially contact with blood and other potentially infectious materialsinfectious materials

““Good Samaritan” acts such as Good Samaritan” acts such as assisting a co-worker with a nosebleed assisting a co-worker with a nosebleed would not be considered occupational would not be considered occupational exposureexposure

Some Workers Who are at RiskSome Workers Who are at Risk Physicians, nurses and emergency room personnelPhysicians, nurses and emergency room personnel Orderlies, housekeeping personnel, and laundry workersOrderlies, housekeeping personnel, and laundry workers Dentists and other dental workersDentists and other dental workers Laboratory and blood bank technologists and techniciansLaboratory and blood bank technologists and technicians Medical examinersMedical examiners MorticiansMorticians Law enforcement personnelLaw enforcement personnel FirefightersFirefighters Paramedics and emergency medical techniciansParamedics and emergency medical technicians Anyone providing first-response medical careAnyone providing first-response medical care Medical waste treatment employeesMedical waste treatment employees Home healthcare workersHome healthcare workers

How does exposure occur?How does exposure occur? Most common: needle sticksMost common: needle sticks Cuts from other contaminated sharps Cuts from other contaminated sharps

(scalpels, broken glass, etc.)(scalpels, broken glass, etc.) Contact of mucous membranes (for Contact of mucous membranes (for

example, the eye, nose, mouth) or example, the eye, nose, mouth) or broken (cut or abraded) skin with broken (cut or abraded) skin with contaminated bloodcontaminated blood

Exposure Control PlanExposure Control Plan Identifies jobs and tasks where occupational Identifies jobs and tasks where occupational

exposure to blood or other potentially exposure to blood or other potentially infectious material occurs infectious material occurs

Describes how the employer will:Describes how the employer will:• Use engineering and work practice controlsUse engineering and work practice controls• Ensure use of personal protective Ensure use of personal protective

equipmentequipment• Provide trainingProvide training• Provide medical surveillanceProvide medical surveillance• Provide hepatitis B vaccinationsProvide hepatitis B vaccinations• Use signs and labelsUse signs and labels

Exposure Control PlanExposure Control Plan Written plan required Written plan required Plan must be reviewed at least annually to reflect Plan must be reviewed at least annually to reflect

changes in:changes in:• tasks, procedures, or assignments which affect tasks, procedures, or assignments which affect

exposure, andexposure, and• technology that will eliminate or reduce exposuretechnology that will eliminate or reduce exposure

Annual review must document employer’s consideration Annual review must document employer’s consideration and implementation of safer medical devicesand implementation of safer medical devices

Must solicit input from potentially exposed employees in Must solicit input from potentially exposed employees in the identification, evaluation and selection of the identification, evaluation and selection of engineering and work practice controlsengineering and work practice controls

Plan must be accessible to employeesPlan must be accessible to employees

Universal PrecautionsUniversal Precautions Treat all human blood and certain body Treat all human blood and certain body

fluids as if they are infectious fluids as if they are infectious

Must be observed in all situations Must be observed in all situations where there is a potential for contact where there is a potential for contact with blood or other potentially with blood or other potentially infectious materialsinfectious materials

Engineering and Work Practice Engineering and Work Practice ControlsControls

These are the primary methods used to These are the primary methods used to control the transmission of HBV and HIVcontrol the transmission of HBV and HIV

When occupational exposure remains after When occupational exposure remains after engineering and work practice controls are engineering and work practice controls are put in place, personal protective put in place, personal protective equipment (PPE) must be usedequipment (PPE) must be used

These controls reduce employee exposure by either removing the hazard or isolating the worker. Examples:

Engineering ControlsEngineering Controls

Sharps disposal containersSharps disposal containers Self-sheathing needlesSelf-sheathing needles Safer medical devicesSafer medical devices

• Needleless systemsNeedleless systems• Sharps with engineered sharps injury Sharps with engineered sharps injury

protectionsprotections

Safer Medical DevicesSafer Medical Devices Needless Systems:Needless Systems: a device that does not use a device that does not use

needles for the collection or withdrawal of body needles for the collection or withdrawal of body fluids, or for the administration of medication or fluids, or for the administration of medication or fluidsfluids

Sharps with Engineered Sharps Injury Protections: Sharps with Engineered Sharps Injury Protections: a non-needle sharp or a needle device used for a non-needle sharp or a needle device used for withdrawing body fluids, accessing a vein or artery, withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a or administering medications or other fluids, with a built-in safety feature or mechanism that built-in safety feature or mechanism that effectively reduces the risk of an exposure incidenteffectively reduces the risk of an exposure incident

Work Practice ControlsWork Practice Controls

Wash hands after Wash hands after removing gloves and as removing gloves and as soon as possible after soon as possible after exposureexposure

Do not bend or break Do not bend or break sharpssharps

No food or smoking in No food or smoking in work areaswork areas

These controls reduce the likelihood of exposure by altering how a task is performed. Examples:

Personal Protective EquipmentPersonal Protective Equipment Specialized clothing or Specialized clothing or

equipment worn by an equipment worn by an employee for protection employee for protection against infectious materialsagainst infectious materials

Must be properly cleaned, Must be properly cleaned, laundered, repaired, and laundered, repaired, and disposed of at no cost to disposed of at no cost to employeesemployees

Must be removed when Must be removed when leaving area or upon leaving area or upon contaminationcontamination

Examples of PPEExamples of PPE GlovesGloves GownsGowns Face shieldsFace shields Eye protectionEye protection Mouthpieces and Mouthpieces and

resuscitation resuscitation devicesdevices

HousekeepingHousekeeping

Location within the facilityLocation within the facility Type of surface to be cleanedType of surface to be cleaned Type of soil presentType of soil present Tasks or procedures being Tasks or procedures being

performedperformed

Must develop a written schedule for cleaning and decontamination at the work site based on the:

Housekeeping Housekeeping (cont’d)(cont’d)

After completion of After completion of procedures, procedures,

When surfaces are When surfaces are contaminated, andcontaminated, and

At the end of the work At the end of the work shiftshift

Work surfaces must be decontaminated with an appropriate disinfectant:

Regulated WasteRegulated Waste

Must be placed in closeable, leak-proof containers built to contain all contents during handling, storing, transporting or shipping and be appropriately labeled or color-coded.

LaundryLaundry Handle contaminated Handle contaminated

laundry as little as possible laundry as little as possible and use PPEand use PPE

Must be bagged or Must be bagged or containerized at location containerized at location where usedwhere used

No sorting or rinsing at No sorting or rinsing at location where usedlocation where used

Must be placed and Must be placed and transported in labeled or transported in labeled or color-coded containerscolor-coded containers

Hepatitis B Vaccination RequirementsHepatitis B Vaccination Requirements Must make available, free of charge Must make available, free of charge

at a reasonable time and place, to all at a reasonable time and place, to all employees at risk of exposure within employees at risk of exposure within 10 working days of initial assignment 10 working days of initial assignment unless:unless:• employee has had the vaccinationemployee has had the vaccination• antibody testing reveals immunityantibody testing reveals immunity

The vaccination must be performed The vaccination must be performed by a licensed healthcare professionalby a licensed healthcare professional

Hepatitis B Vaccination Requirements Hepatitis B Vaccination Requirements (cont’d)(cont’d)

Must be provided even if employee initially Must be provided even if employee initially declines but later decides to accept the declines but later decides to accept the vaccinationvaccination

Employees who decline the vaccination must sign Employees who decline the vaccination must sign a declination forma declination form

Employees are not required to participate in Employees are not required to participate in antibody prescreening program to receive antibody prescreening program to receive vaccination seriesvaccination series

Vaccination booster doses must be provided if Vaccination booster doses must be provided if recommended by the U.S. Public Health Service recommended by the U.S. Public Health Service

What to do if an exposure occurs?What to do if an exposure occurs? Wash exposed area with soap and waterWash exposed area with soap and water Flush splashes to nose, mouth, or skin with Flush splashes to nose, mouth, or skin with

waterwater Irrigate eyes with water or salineIrrigate eyes with water or saline Report the exposureReport the exposure Direct the worker to a healthcare Direct the worker to a healthcare

professionalprofessional

Post-Exposure Follow-UpPost-Exposure Follow-Up Document routes of exposure and how exposure Document routes of exposure and how exposure

occurredoccurred Record injuries from contaminated sharps in a sharps Record injuries from contaminated sharps in a sharps

injury log, if requiredinjury log, if required Obtain consent from the source individual and the Obtain consent from the source individual and the

exposed employee and test blood as soon as possible exposed employee and test blood as soon as possible after the exposure incidentafter the exposure incident

Provide risk counseling and offer post-exposure Provide risk counseling and offer post-exposure protective treatment for disease when medically protective treatment for disease when medically indicated in accordance with current U.S. Public Health indicated in accordance with current U.S. Public Health Service guidelinesService guidelines

Provide written opinion of findings to employer and Provide written opinion of findings to employer and copy to employee within 15 days of the evaluationcopy to employee within 15 days of the evaluation

Biohazard Warning LabelsBiohazard Warning Labels Warning labels required on:Warning labels required on:

• Containers of regulated wasteContainers of regulated waste• Refrigerators and freezers Refrigerators and freezers

containing blood and other containing blood and other potentially infectious materialspotentially infectious materials

• Other containers used to store, Other containers used to store, transport, or ship blood or other transport, or ship blood or other potentially infectious materialspotentially infectious materials

Red bags or containers may be Red bags or containers may be substituted for labelssubstituted for labels

Training RequirementsTraining Requirements Provide at no cost to employees Provide at no cost to employees

during working hours during working hours Provide at time of initial Provide at time of initial

assignment to a job with assignment to a job with occupational exposure and at least occupational exposure and at least annually thereafterannually thereafter

Additional training needed when Additional training needed when existing tasks are modified or new existing tasks are modified or new tasks are required which affect the tasks are required which affect the worker’s occupational exposureworker’s occupational exposure

Maintain training records for 3 Maintain training records for 3 yearsyears

Training ElementsTraining Elements Copy of the standardCopy of the standard Modes of transmissionModes of transmission Site-specific exposure control planSite-specific exposure control plan Hazard recognitionHazard recognition Use of engineering controls, work Use of engineering controls, work

practices and PPEpractices and PPE Live question and answer sessionsLive question and answer sessions

Medical Recordkeeping RequirementsMedical Recordkeeping Requirements Employee’s name and social security numberEmployee’s name and social security number Employee’s hepatitis B vaccination statusEmployee’s hepatitis B vaccination status Results of examinations, medical testing, and post-Results of examinations, medical testing, and post-

exposure evaluation and follow-up proceduresexposure evaluation and follow-up procedures Health care professional’s written opinionHealth care professional’s written opinion Information provided to the health care professionalInformation provided to the health care professional Employee medical records must be kept confidential Employee medical records must be kept confidential

and not disclosed or reported without the employee’s and not disclosed or reported without the employee’s written consent (unless required by law)written consent (unless required by law)

Medical records must be maintained for duration of Medical records must be maintained for duration of employment plus 30 years according to OSHA’s rule employment plus 30 years according to OSHA’s rule governing access to employee exposure and medical governing access to employee exposure and medical recordsrecords

Sharps Injury LogSharps Injury Log Employers must maintain a sharps injury log for Employers must maintain a sharps injury log for

the recording of injuries from contaminated the recording of injuries from contaminated sharpssharps

The log must be maintained in a way that The log must be maintained in a way that ensures employee privacy and must contain, at a ensures employee privacy and must contain, at a minimum:minimum:• Type and brand of device involved in the Type and brand of device involved in the

incidentincident• Location of the incidentLocation of the incident• Description of the incidentDescription of the incident

SummarySummary OSHA’s Bloodborne Pathogens standard OSHA’s Bloodborne Pathogens standard

prescribes safeguards to protect workers prescribes safeguards to protect workers against the health hazards from exposure to against the health hazards from exposure to blood and other potentially infectious materials, blood and other potentially infectious materials, and to reduce their risk from this exposureand to reduce their risk from this exposure

Implementation of this standard not only will Implementation of this standard not only will prevent hepatitis B cases, but also will prevent hepatitis B cases, but also will significantly reduce the risk of workers significantly reduce the risk of workers contracting AIDS, Hepatitis C, or other contracting AIDS, Hepatitis C, or other bloodborne diseasesbloodborne diseases