Bloodborne Pathogens

Department of Labor Department of Labor

and Industriesand Industries

Consultation & Education Consultation & Education

ServicesServices

Course Objectives

What are Bloodborne Pathogens?What are Bloodborne Pathogens?

Why are they harmful?Why are they harmful?

What must I do to protect my workers?What must I do to protect my workers?

What is, and how do I write an Exposure Control What is, and how do I write an Exposure Control

Plan?Plan?

What are the requirements of WAC 296-62-0800?What are the requirements of WAC 296-62-0800?

Disease

PATHOGENSPATHOGENS

ParasiteParasite

BacteriaBacteria

FungiFungi

VirusVirus

Disease

TRANSMISSIONTRANSMISSION

AirAir

FecalFecal

BloodborneBloodborne

What are Bloodborne Pathogens ?

How are they harmful ?How are they harmful ?

How are they contracted ?How are they contracted ?

Some facts and figuresSome facts and figures

DefinitionsDefinitions

Blood Bloodborne Blood Bloodborne Pathogens Pathogens

Definitions

Other potential infectious materialsOther potential infectious materials

OPIMOPIM

Hepatitis B or C Virus

Inflammation of the liverInflammation of the liver

Causes liver damage ranging from mild to fatalCauses liver damage ranging from mild to fatal

Can live in a dry environment for at least 7 daysCan live in a dry environment for at least 7 days

HBV -Hepatitis B

Very infectiousVery infectious

– 1/3 no symptoms, 1/3 flu-like, 1/3 severe1/3 no symptoms, 1/3 flu-like, 1/3 severe

– 6 to 10% of cases infectious for life (carrier state)6 to 10% of cases infectious for life (carrier state)

In the past, 140,000-300,000 new infections per year In the past, 140,000-300,000 new infections per year

– 5,000-6,000 deaths/yr from chronic liver disease5,000-6,000 deaths/yr from chronic liver disease

Safe and effective vaccine is now available Safe and effective vaccine is now available

– Many HCW are not vaccinatedMany HCW are not vaccinated

HBV - Hepatitis B

Health Care Workers and HBVHealth Care Workers and HBV

Approximately 400 HCW infected annuallyApproximately 400 HCW infected annually

This is a decrease from 17, 000 in 1983 and This is a decrease from 17, 000 in 1983 and 1,000 in 1994.1,000 in 1994.

25% of infected develop acute hepatitis25% of infected develop acute hepatitis

10-30% of health/dental workers show 10-30% of health/dental workers show evidence of past HBV infectionevidence of past HBV infection

HCV - Hepatitis C

Affects 4 times more people than HIVAffects 4 times more people than HIV 4 million Americans infected4 million Americans infected Only 25% of those infected have been Only 25% of those infected have been

diagnoseddiagnosed In 1995, estimated 560-1120 cases among In 1995, estimated 560-1120 cases among

HCW in U.S.HCW in U.S.

HCV - Hepatitis C

Symptoms may or may not be presentSymptoms may or may not be present Infection may lead to carrier stateInfection may lead to carrier state Carrier state can develop with or without Carrier state can develop with or without

symptomssymptoms Carrier state can lead to chronic liver disease, Carrier state can lead to chronic liver disease,

cirrhosis (10 year latency), or cancer (alcohol cirrhosis (10 year latency), or cancer (alcohol is strong co-factor)is strong co-factor)

Leading cause of liver transplant in U.S.Leading cause of liver transplant in U.S.

HCV - Hepatitis C

85% of Hepatitis C infections persist for life85% of Hepatitis C infections persist for life 70% develop chronic liver disease70% develop chronic liver disease Signs and symptoms may not appear until 10 Signs and symptoms may not appear until 10

years after infectionyears after infection Onset of symptoms may present with severe liver Onset of symptoms may present with severe liver

diseasedisease No broadly effective treatmentNo broadly effective treatment No vaccine availableNo vaccine available

HCV - Risk Factors

Blood transfusion prior to 1992Blood transfusion prior to 1992 IV drug useIV drug use Unprotected sex (multiple sexual partners)Unprotected sex (multiple sexual partners) Occupational percutaneous exposure to Occupational percutaneous exposure to

blood with contaminated sharpblood with contaminated sharp

–Risk is intermediate between Risk is intermediate between Hepatitis B and HIVHepatitis B and HIV

Human Immunodeficiency Virus (HIV)

Attacks the human immune systemAttacks the human immune system Can live in a dry environment for only a few Can live in a dry environment for only a few

hourshours > 1 million infections in U.S.> 1 million infections in U.S. 56 documented cases among HCW; 56 documented cases among HCW; 138 cases of possible occupational 138 cases of possible occupational

transmission transmission

AIDS

AIDS = Acquired Immunodeficiency AIDS = Acquired Immunodeficiency SyndromeSyndrome

Results from destruction of the human Results from destruction of the human immune system from infection with HIVimmune system from infection with HIV

Some have no symptoms, or less severe Some have no symptoms, or less severe symptomssymptoms

No vaccine available yet No vaccine available yet

HBV & HIV Compared

HBVHBV HIV HIV

HCW casesHCW cases 400/yr. 56 400/yr. 56

Risk of infectionRisk of infection– Needle stickNeedle stick 6-30/100 1/300 6-30/100 1/300

Vaccine availableVaccine available Yes Yes No No

HBV & HCV Compared

Hepatitis Hepatitis CC

Infectivity: LowInfectivity: Low Nucleic Acid: RNANucleic Acid: RNA Carrier state: > 80%Carrier state: > 80% Route: Blood Route: Blood

Hepatitis BHepatitis B

Very HighVery High

DNADNA

Variable {10-50%}Variable {10-50%}

BloodBlood

““To eliminate or minimize employee exposure”To eliminate or minimize employee exposure” Exposure determinationExposure determination ControlsControls

– Universal precautions (or equivalent system)Universal precautions (or equivalent system)

– Engineering controlsEngineering controls

– Work practicesWork practices

– Personal protective equipmentPersonal protective equipment

– HousekeepingHousekeeping

Exposure Control Plan

Control

Plan

Exposure Control Plan

Hepatitis B vaccinationHepatitis B vaccination

Post exposure evaluation & follow-upPost exposure evaluation & follow-up

Communication and trainingCommunication and training

RecordkeepingRecordkeeping

Exposure Determination

Do we have job classifications where ...Do we have job classifications where ... AllAll employees are occupationally exposed? employees are occupationally exposed?

» List the classificationsList the classifications SomeSome employees are occupationally employees are occupationally

exposed?exposed?» List the classificationsList the classifications» List the tasks with exposureList the tasks with exposure

Determine exposure without regard for Determine exposure without regard for PPE the worker usesPPE the worker uses

First Aid

First aid training

Good Samaritan Collateral duty* Designated responder

Not covered by BBP Standard

BBP standard applies

* if First-Aid response is an expected part of the job

BBP standard applies

Universal Precautions

Treat as if known to be infectious

All human blood

Certain human body fluids

All human body fluids if they can’t be distinguishedAll human body fluids if they can’t be distinguished

Engineering Controls

Isolate or remove the bloodborne pathogen Isolate or remove the bloodborne pathogen hazard from the workplacehazard from the workplace

» A physical guardA physical guard

» BarrierBarrier

» Environmental controls Environmental controls

» Other devicesOther devices

Engineering Controls

Annual evaluation and documentationAnnual evaluation and documentation Solicit input from patient care Solicit input from patient care

providersproviders Implement commercially available, Implement commercially available,

effective and appropriate deviceseffective and appropriate devices Document justifications for not using Document justifications for not using

safer devicessafer devices

Physical Guard

Sharps disposal containersSharps disposal containers

ClosableClosable

Puncture resistantPuncture resistant

LeakproofLeakproof

Labeled Labeled

Barriers

Environmental Controls

Ventilation Hoods

Other Devices

Avoid recappingAvoid recapping

Use Safer Sharp Use Safer Sharp Devices Devices

» needleless IV systemsneedleless IV systems

» retractable syringes retractable syringes and lancetsand lancets

» puncture-resistant puncture-resistant capillary tubescapillary tubes

Work Practice Controls

Safer steps to do the job!Safer steps to do the job!

Prohibit two-handed needle recapping Prohibit two-handed needle recapping

Do not bend, break or remove needles (incl. phlebotomy)Do not bend, break or remove needles (incl. phlebotomy)

Wash hands between glove useWash hands between glove use

Flush body parts with water after contact with blood or Flush body parts with water after contact with blood or OPIMOPIM

Remove PPE before leaving work areaRemove PPE before leaving work area

Examples of Work Practice Controls

Lab coat removal HandwashingLab coat removal Handwashing

Personal Protective Equipment PPE

Provided at no cost to employeeProvided at no cost to employee

» GlovesGloves

» GownsGowns

» Face shields and/or masksFace shields and/or masks

» Eye protectionEye protection

» Resuscitation devicesResuscitation devices

» Lab coatsLab coats

PPE

GlovesGloves

LatexLatex

Nitrile Nitrile

VinylVinyl

UtilityUtility

PPE

Gowns

PPE

Eye - Face protection and masks

PPE

Resuscitation devices

Housekeeping

Maintain a clean and sanitary workplaceMaintain a clean and sanitary workplace

Written cleaning and decontamination Written cleaning and decontamination scheduleschedule

Contaminated waste disposal methodsContaminated waste disposal methods

LaundryLaundry DISINFECTANT

Regulated Waste

Blood or OPIMBlood or OPIM

» LiquidLiquid

» Semi-LiquidSemi-Liquid

» Contaminated sharpsContaminated sharps

» Lab or medical wasteLab or medical waste

Other items caked with dried blood or OPIMOther items caked with dried blood or OPIM

Regulated Waste Containers

Easily accessibleEasily accessible

LeakproofLeakproof

Maintained uprightMaintained upright

Labeled or color codedLabeled or color coded

Replaced routinely ( no overfill!!!) Replaced routinely ( no overfill!!!)

DisposalDisposal

» County or City Health Dept.. County or City Health Dept.. RegulationsRegulations

Regulated Waste Handling

When moving containers:When moving containers:

» Close immediatelyClose immediately

» If leaking, place in If leaking, place in secondary containersecondary container

» If reusable, clean in a If reusable, clean in a manner that will not expose manner that will not expose employees.employees.

Laundry

Handle as little as possible! Handle as little as possible! » Bag/containerize where usedBag/containerize where used

» Don’t sort or rinse where usedDon’t sort or rinse where used

» Labeled or color coded containersLabeled or color coded containers

» Leak-proof containers if leaks are Leak-proof containers if leaks are likelylikely

Employees must wear proper Employees must wear proper PPE!!!PPE!!!

Hepatitis B Vaccine

3 shot series 3 shot series

Effective for 95% of adultsEffective for 95% of adults

Post-vaccination titers for high risk HCWPost-vaccination titers for high risk HCW

Exposure without vaccinationExposure without vaccination» Immune globulin ASAP after exposure Immune globulin ASAP after exposure

» BeginVaccination series BeginVaccination series

Hepatitis B Vaccination

Make Hepatitis B vaccination available Make Hepatitis B vaccination available

» Declination statement requiredDeclination statement required

» Available at later date if desiredAvailable at later date if desired

No cost to employeesNo cost to employees

Reasonable time and placeReasonable time and place

If series is interrupted, continue at any time If series is interrupted, continue at any time rather than restart seriesrather than restart series

Exposure Incident

Contact with blood or OPIM via:Contact with blood or OPIM via:

Cuts, puncture, needle sticks Cuts, puncture, needle sticks

Mucous membraneMucous membrane

EyeEye

Non-intact skinNon-intact skin

Post Exposure Evaluation

• Provide medical evaluation ASAP Provide medical evaluation ASAP » Testing for HBV, HCV, HIVTesting for HBV, HCV, HIV» HIV/HBV PEP when indicatedHIV/HBV PEP when indicated

• Identify source individual, if possibleIdentify source individual, if possible» Obtain consent for blood testObtain consent for blood test

• Provide information to healthcare providerProvide information to healthcare provider» Routes of entryRoutes of entry» Employee’s job dutiesEmployee’s job duties» Copy of the regulationCopy of the regulation

Employer Responsibility:

Post Exposure Evaluation

• Insure that the healthcare provider Insure that the healthcare provider provides to exposed employee:provides to exposed employee:

» Results of the source individuals test Results of the source individuals test (if legal)(if legal)

» Results of exposed employee’s testResults of exposed employee’s test

» Post exposure treatment as neededPost exposure treatment as needed

• Provided at no cost to employeeProvided at no cost to employee

Medical Evaluation and Follow-up

• Provide in writing to employer: Provide in writing to employer:

» Employee has been informed of the results Employee has been informed of the results

» Employee has been informed of any medical Employee has been informed of any medical conditions resulting from exposureconditions resulting from exposure

• All specific findings or diagnoses are All specific findings or diagnoses are confidential to employee confidential to employee

Healthcare Provider’s Responsibility:

Communication

Signs and labelsSigns and labels

» Regulated wasteRegulated waste

» Containers with blood or OPIMContainers with blood or OPIM

» LaundryLaundry

» Biohazard symbolBiohazard symbol

Training

Provided to occupationally exposed employees:Provided to occupationally exposed employees:

» At time of initial assignmentAt time of initial assignment

» At least annually thereafterAt least annually thereafter

» Cover specific required elementsCover specific required elements

» Interactive Interactive

» Qualified trainersQualified trainers

Recordkeeping

Medical recordsMedical records

» HBV vaccination statusHBV vaccination status

» Written medical opinion of exposure Written medical opinion of exposure incidentsincidents

» Exposure incident detailsExposure incident details

» Maintain for length of employment + Maintain for length of employment + 30 years30 years

Recordkeeping

Training recordsTraining records

» DatesDates

» Content summaryContent summary

» Trainer name & qualificationsTrainer name & qualifications

» Attendee’s names & job titlesAttendee’s names & job titles

» Maintain for 3 yearsMaintain for 3 years

Sharps Log

Maintain a separate sharps injury logMaintain a separate sharps injury log Document sharps injuries on the OSHA 300 or Document sharps injuries on the OSHA 300 or

equivalent form per 296-27 WAC equivalent form per 296-27 WAC (schools are (schools are exempt from OSHA 300 reporting but must keep exempt from OSHA 300 reporting but must keep an equivalent sharps log.)an equivalent sharps log.)

Recorded as confidentiality caseRecorded as confidentiality case Must contain:Must contain:

– Type and brand of device involvedType and brand of device involved– Department or work area where exposure Department or work area where exposure

occurredoccurred– An explanation of how the incident occurredAn explanation of how the incident occurred

Plan Evaluation

Review and/or update annuallyReview and/or update annually

Whenever necessary to reflect Whenever necessary to reflect

changes that affect occupational changes that affect occupational

exposure, including improved safety exposure, including improved safety

devicesdevices

Summary

What Bloodborne Pathogens are What Bloodborne Pathogens are

Why they are HarmfulWhy they are Harmful

Employer ResponsibilitiesEmployer Responsibilities

Written Exposure Control PlanWritten Exposure Control Plan

Understand the Requirements of Understand the Requirements of WAC 296-62-0800WAC 296-62-0800

Summary

Thank you for Thank you for attending!attending!

Now it is your turn!Now it is your turn!

Please complete the Please complete the evaluation form.evaluation form.