BLOODBORNE PATHOGENS IN HEALTHCARE FACILITIES · The series includes programs on the following...

LEADER'S GUIDE

1486-LDG-E

BLOODBORNE PATHOGENS IN HEALTHCARE FACILITIES

Training for THE OSHA BLOODBORNE PATHOGENS STANDARD

Quality Safety and Health Products, for Today... and Tomorrow

106 Capitola Drive Durham, NC 27713

(P) 919-544-6663 (F) 919-544-5800 Trainingnetwork.com

THE REGULATORY COMPLIANCE KIT VIDEO SERIES

This education program is part of a comprehensive series of programs on important regulatory topics. Many of these programs have been created to meet employee training requirements of specific OSHA, EPA and DOT regulations. The series includes programs on the following regulations and topics:

- The Asbestos Standard. - The Bloodborne Pathogens Standard. - The Confined Space Entry Standard. - DOT Hazardous Materials Regulations (HMR). - Emergency Planning. - Forklifts/Powered Industrial Trucks Standard. - The "HAZWOPER" Standard (Hazardous Waste Operations and

Emergency Response). - Hearing Conservation and Safety. - Indoor Air Quality. - The Laboratory Standard. - The OSHA Lead Standard (Industrial and Construction versions). - Lock-Out/Tag-Out. - The OSHA Recordkeeping Standard. - The Personal Protective Equipment Standards (Industrial and

Construction versions). - The Respiratory Protection Standard. - Right-To-Know/The Hazard Communications Standard (Industrial

and Construction versions). - Supported Scaffold Safety (Industrial and Construction versions). - Suspended Scaffold Safety (Industrial and Construction versions). - The CDC Tuberculosis Prevention Guidelines.

Other products in the Regulatory Compliance Kit line include compliance manuals, employee booklets and posters which have been designed specifically to be used with the programs. These products can be used to satisfy OSHA, EPA and DOT compliance requirements for creating written compliance programs, as well as employee training.



WARRANTY/DISCLAIMER "This program has been created to assist companies that are endeavoring to educate their employees regarding exposure to, or contact with bloodborne pathogens. In addition to common information about bloodborne pathogens themselves, the program presents information concerning protective equipment, cleanup procedures and the like. The information contained in this program is the information available to the producers of the program at the time of its production. All information in this program should be reviewed for accuracy and appropriateness by companies using the program to assure that it conforms to their situation and recommended procedures, as well as to any state, federal or other laws and regulations governing their operations. There is no warranty, expressed or implied, that the information in this program is accurate or appropriate for any particular company's environment."

Copyright 2001, The MARCOM Group, Ltd.



TABLE OF CONTENTS 1 INTRODUCTION TO THE OSHA BLOODBORNE

PATHOGENS STANDARD - Background - Major compliance requirements

2 INTRODUCTION TO THE PROGRAM

- Structure and organization - Objectives - Reviewing the program

3 PREPARING FOR THE PRESENTATION

- Structuring the presentation - Preparing supplemental information - Setting up the class and classroom

4 CONDUCTING THE SESSION

- The initial steps - Showing the program - Presenting the supplemental information - Conducting the discussion - Concluding the presentation - Wrapping up the paperwork

5 OUTLINE OF MAJOR POINTS IN THE PROGRAM 6 ACCOMPANYING MATERIALS

- Scheduling and Attendance Form - Quiz - Training Certificate - Employee Training Log



INTRODUCTION TO THE OSHA BLOODBORNE PATHOGENS STANDARD

Background On December 6, 1991 the Occupational Safety and Health Administration (OSHA) published the Occupational Exposure to Bloodborne Pathogens Standard. The purpose of this regulation is to eliminate or minimize occupational exposure to Hepatitis B Virus (HBV), Human Immunodeficiency Virus (HIV) and other bloodborne pathogens. Other agencies of the Federal government have been involved with the issue of employee exposure to medically related infectious materials for some time. For instance, for a number of years the Department of Health and Human Service's has published a booklet entitled, "Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Healthcare and Public Safety Workers". Additionally, in 1989, the Environmental Protection Agency (EPA) published interim final rules on the Standards for Tracking and Management of Medical Wastes. The impetus behind this activity is varied. First, the publicity received in recent years regarding the Human Immunodeficiency Virus (HIV) and AIDS has sensitized the public and legislators alike regarding the transmission of infectious diseases. Additionally, increased emphasis on employee safety and health has elevated the concern regarding exposure to Hepatitis B, especially in healthcare facilities. OSHA initially became involved in this area in 1983, issuing a set of voluntary guidelines designed to reduce the risk of occupational exposure to Hepatitis B Virus.



In late 1986, the American Federation of State, County and Municipal Employees (AFSCME) petitioned OSHA to formally take action to reduce the risk to employees from exposure to various infectious agents. Later that same year, the Service Employees International Union, the National Union of Hospital and Healthcare Employees and other groups petitioned OSHA to create a standard to protect healthcare employees from the hazard posed by occupational exposure to the Hepatitis B Virus. It was these actions that prompted OSHA to begin work on the Bloodborne Pathogens Standard. This standard represents OSHA's first regulation of occupational exposure to biological hazards. This standard has also been changed several times over the years, including a recent update concerning the Exposure Control Plan that attempts to reduce sharps-related injuries. Major Compliance Requirements The requirements in OSHA's Bloodborne Pathogens Standard can be grouped into a number of major areas:

- Creating an Exposure Control Plan - This plan describes how the facility will comply with the Bloodborne Pathogens Standard and protect employees from hazards presented by bloodborne pathogens encountered in the workplace, and must be reevaluated at least once a year.

- Standard Precautions - A Standard Precautions program must be

observed throughout the facility to prevent contact with blood and other potentially infectious materials.

- Engineering and Work Controls - Controls must be implemented

to reduce employees' exposure to bloodborne pathogens. These include things such as:

- Sharps containers. - Hand washing facilities. - Equipment decontamination.



- Personal Protective Equipment - Employees must have access to all types of personal protective equipment that can be used to reduce or eliminate their exposure to bloodborne pathogens. This equipment must be available in their work areas. Procedures for collection, decontamination and disposal of this equipment must also be addressed.

- Housekeeping - Written cleaning schedules must be created to

clean and decontaminate work areas. Regulated Waste must be handled according to existing OSHA, EPA and state/local laws.

- HIV and HBV Research Laboratories and Production Facilities -

Special requirements exist for these types of facilities. Since most laboratories in healthcare settings are clinical and diagnostic in nature (which are not covered under these special requirements) this section of the standard does not apply to most healthcare institutions.

- Hepatitis B Vaccination - A free vaccination program must be

provided for employees who have occupational exposure to bloodborne pathogens.

- Post-Exposure Evaluation and Follow up - A defined process

must be put into place to provide employees with appropriate medical consultation and treatment if they experience an exposure incident involving bloodborne pathogens.

- Labels and Signs - Biohazard warning labels are required in a

number of situations including: - Regulated waste. - Storage/transport containers. - Contaminated equipment.



- Information and Training - Employees must be provided with information and training in areas including:

- The Bloodborne Pathogens Standard itself. - The epidemiology and symptoms of bloodborne

diseases. - Transmission of bloodborne diseases. - The facility's Exposure Control Plan. - An explanation of how to recognize tasks that may

involve exposure. - A review of methods that will prevent or reduce

exposure (such as engineering controls, work practices, personal protective equipment, etc.).

- How to select and use personal protective equipment. - The use of biohazard labels, signs and container color-

coding. - Information on the Hepatitis B vaccine, including

efficacy, safety and benefits. Also, information on the facility's free vaccination program.

- Actions to take in case of emergencies involving bloodborne pathogens.

- An explanation of the procedures to follow if an exposure incident occurs, including reporting and medical follow-up.

- Information on the post-exposure evaluation and follow-up that is provided to employees in case of an exposure incident.

This information and training must be provided annually to all employees who may have occupational exposure to bloodborne pathogens. Also, all new employees and employees who are transferred from one department or area to another must be given this training if their new position will expose them to bloodborne pathogens in new or different ways.



INTRODUCTION TO THE PROGRAM Structure and Organization Information in this program is presented in a definite order so that employees will see the relationships between the various groups of information and can retain them more easily. The sections included in the program are:

- The Bloodborne Pathogens Standard itself.

- The epidemiology and symptoms of bloodborne diseases.

- Transmission modes for bloodborne pathogens.

- The Exposure Control Plan.

- An explanation of how to recognize tasks that may involve exposure.

- A review of methods that will prevent or reduce exposure (such as engineering controls, work practices, use of personal protective equipment, etc.).

- How to select and use personal protective equipment.

- The use of biohazard labels, signs and alternative container color-

coding.

- Information on the Hepatitis B vaccine, including efficacy, safety and benefits. Also, information on the facility's free vaccination program.

- Actions to take in case of emergencies involving bloodborne

pathogens. - An explanation of the procedures to follow if an exposure incident

occurs, including reporting and medical follow-up.



- Information on the post-exposure evaluation and follow-up that is provided to employees in the case of an exposure incident.

These sections include examples and other references that will help employees to relate the information to their work environments. Objectives This training program is designed to present information on the nature of bloodborne diseases and help employees reduce or eliminate potential exposure to bloodborne pathogens in their work environments. Upon completion of the program, employees should:

- Have an overall understanding of the OSHA Bloodborne Pathogens Standard.

- Understand the general concepts behind potential exposure to

bloodborne pathogens in their workplace.

- Have a good understanding of the terms and language used in discussing bloodborne pathogens.

- Have a good knowledge of the methods that can be used to reduce

or eliminate potential exposure to bloodborne pathogens.

- Recognize the effectiveness of the Hepatitis B vaccine, and know about their facility's vaccination program.

- Know the procedure to be followed in case an exposure incident

involving bloodborne pathogens occurs, including persons to contact.

- Understand the facility's post-exposure evaluation and follow-up

process and how it benefits them.



Reviewing the Program As with any educational program, the presenter should go through the entire program at least once to become familiar with the content and make sure the program is consistent with company policy and directives. Additionally, because this program addresses a federal regulation, the presenter should check to make sure that the program's contents do not conflict with any of the regulations that the facility is subject to in this area. An outline of the points in the program is included in this Leader's Guide to help with this task and for general reference. As part of this review process, you should determine how you will conduct your session. The use of materials, such as handouts, charts, etc., that may be available to you needs to be well thought out and integrated into the overall program presentation.



PREPARING FOR THE PRESENTATION Structuring the Presentation In conducting this education session, you should proceed with a friendly and helpful attitude. Remember that the trainees are looking to your experience and knowledge to help them relate to the situations shown in the program. It is important to let the trainees interact with you and each other during the training session. Stimulating conversation within the group is one of the best things you, as the presenter of the program, can do to help everyone get as much as possible from the session. Be alert for comments that could help in this area in future sessions and make note of them. As the presenter, you also should:

- Keep the session related to the topic of bloodborne pathogens.

- Relate discussions to your company’s operations, procedures, and responsibilities.

- Prevent any one person or small group of employees in the session

from doing all the talking.

- Get everyone involved. Ask questions of those who don't participate.

- Clarify comments by relating them to the key points in the program. Use the outline of the major points included in the program, as well as the information included in the quiz, as the basis for answering any questions. If you don't know the answer, say so. Tragic results may occur should you provide incorrect or inaccurate information. Remember, this is a positive program on working with bloodborne pathogens safely. Make sure your attitude and words reflect this and that the emphasis is always on providing the information needed by the attendees to reduce or eliminate exposure to bloodborne pathogens they may encounter in their jobs.



Preparing the Supplemental Information This program has been produced to be used as the core source of information concerning bloodborne pathogens and how to reduce or eliminate exposure. As such, it addresses the general things that an employee needs to know in these areas. The OSHA Bloodborne Pathogens Standard also requires that additional, site specific information be provided to employees. As part of the preparation for conducting this session, you need to accumulate this information and list it so that you can easily present it to your trainees. Examples of this type of site specific information include:

- The availability of your facility's Exposure Control Plan.

- The availability of a copy of the Bloodborne Pathogens Standard.

- The location of personal protective equipment in the employees' work areas.

- Specifics regarding your free Hepatitis B vaccination program.

- How to contact the appropriate facility personnel in case of a spill,

leak, or accident involving materials that may contain bloodborne pathogens.

Setting Up the Class and Classroom Remember, there are a number of things that must be done to set up the class as well as the classroom. These fall into several groups of activities, and include:



- Scheduling and Notification - Use the enclosed form to schedule employees into the

session. - Make sure that the session is scheduled so that it fits

into your attendees' work day. - Send out notification of the session well in advance, to

give people enough time to incorporate it into their schedule for that day.

- If possible, post a notification on bulletin boards in the affected employees' areas.

- The Classroom

- Schedule the room well in advance. - Make sure the room can accommodate the expected

number of attendees. - Check it again on the day of the program to make sure

there is no conflict. - Make sure the room can be darkened, and won't create

a glare on the television screen. - Locate the light controls and test them. - Make sure the power for the videotape or DVD player

you are using operates separately from the room light. - See if you can control the room temperature. - Know where the closest restrooms are located. - Assure that the room is free from distracting noises. - Make sure emergency exits are marked and known to

the attendees.

- Seating - Make sure everyone can see the screen from their seat. - Make sure everyone can hear both the videotape/DVD

and you (when you speak). - Check to see that seating is such that writing can be

done easily. - Make sure the seating arrangement allows eye contact

between attendees, and between you and attendees.



- Equipment and Materials - Make sure the videotape or DVD player, monitor, and all

appropriate cables and extension cords are available. - Make sure a stand or table is available and is of

appropriate height for all attendees to easily see the monitor.

- If you plan on using a chartpad, blackboard, or other writing board, make sure it is available, easy to see, and you have the proper writing instruments.

- Make sure you have 6" x 8" index cards or other materials to be used as name tents for attendees.

- Make sure you have made up a sufficient number of copies of the quiz as well as any other handouts you are using.

- Final Check

- Make sure equipment is in the room prior to the scheduled session.

- Check to see that the room is set up properly. - Check equipment prior to the presentation to assure

that it works. - Make sure extension cords, etc. are taped down, if need

be, to avoid tripping. - If you are using the videotape version of the program,

run the leader up to the point where the program begins.



CONDUCTING THE SESSION The Initial Steps In conducting the session remember the positive nature of this presentation. Everyone is attending in order to learn more about how to do things safely. Initially, you need to:

- Introduce yourself as the session leader.

- State the title of the program, Bloodborne Pathogens in Healthcare Facilities and the purpose of the session (to learn more about the OSHA Bloodborne Pathogens Standard and how to reduce or eliminate exposure to bloodborne pathogens the attendees may encounter in their jobs).

- Inform the attendees when there will be breaks (if you plan them) the

location of exits and restrooms and if water, coffee, or other refreshments will be available.

- Make sure all of the attendees have signed in on your Scheduling

and Attendance Sheet. Remember, it is very important to document peoples' attendance at the session.

Once this housekeeping is done, it is time to move to the meat of the session. First, the attendees need to be informed about the objectives of the session (this is where you can use a flip chart or board to list the objectives, which should be done prior to the class starting). This listing should be preceded with some introductory remarks. Your own words are always best, but the remarks should follow along the lines of the following:

"Today we are going to talk about the OSHA Bloodborne Pathogens Standard, and how we can work as safely as possible in an environment that brings us into potential contact with bloodborne pathogens."



"Our healthcare system is one of the best in the world. But in providing healthcare services we are constantly coming into contact with potentially hazardous situations. Contact with blood and other human body substances, and other materials that may be contaminated is one of these hazards."

"The government has passed a set of laws and regulations to make sure that facilities where these potential exposures occur do as much as possible to guard against infection from bloodborne pathogens."

"To help us understand these laws and learn how to reduce or eliminate potential exposure to bloodborne pathogens we need as much information as possible about their hazards and how to control them. Before we do anything else, let's take a look at what we want to accomplish in this session."

"We realize that the first step in protecting ourselves in these situations is to be able to recognize, as much as possible, situations where potential exposure can exist. And we realize that some situations in our facility can be potentially hazardous. We have tried to limit these hazards through the use of engineering controls, such as sharps containers, and by following good work practices. We also know that it is important to use appropriate personal protective equipment in many of our job duties. Additionally, for some time we have been practicing Standard Precautions, which is an integral part of this OSHA regulation."

"These are the type of things the regulation addresses. And learning more about these areas, as well as new requirements in the regulation, is the focus of this session. In order to do that, these are the things we would like to accomplish here today (verbally reference the Objectives list, provided in the preceding section of this manual or indicate to the board or chart where you have written them down)."



Once the objectives have been provided, you are ready to show the program. However, you need to let the attendees know that they will be taking a quiz at the end of the session (if you are using it). It needs to be emphasized that they are not being graded, but that the quiz is being used to see if the session is effectively transmitting information to them in a way they will remember. Showing the Program At this point, you need to introduce the title of the program once again, Bloodborne Pathogens in Healthcare Facilities, darken the lights if necessary, and begin the showing of the program. If you are using the DVD version of the course you have several options as to how you can move through the program and what employees see. T

he DVD menu has two selection bars:

- Play. - Contact Info.

To just play the program from beginning to end, select Play. If you would like information on other programs and products that are available from MARCOM you can select Contact Us for information about how to contact us. Presenting the Supplemental Information As we have said, this program is meant to provide the core educational information needed to comply with the OSHA Bloodborne Pathogens Standard. Around this core must go the additional, supplemental information that we mentioned earlier. This information should be provided to the attendees immediately after the program has been shown. In this way they will get all the information before any discussion is held. This will allow them to integrate both groups of information into a full, meaningful discussion of the entire subject of bloodborne pathogens and how to reduce or eliminate potential exposure as



much as possible. As you may recall, the supplemental information should contain things such as:

- The availability of your facility's Exposure Control Plan.

- The availability of a copy of the Bloodborne Pathogens Standard.

- The location of personal protective equipment in the employees' work areas.

- Specifics regarding your free Hepatitis B vaccination program. - How to contact the appropriate facility personnel in case of a spill,

leak, or accident involving the materials that may contain bloodborne pathogens.

Conducting the Discussion After the program has been shown, and the supplemental information given, it is time for the group discussion on the information contained in the session. Care must be taken to make sure that the discussion is kept to the general topic of the bloodborne pathogens, how to reduce or eliminate exposure as well as what to do in an exposure situation. There are several ways to conduct these iscussions. These include: d

- Calling for questions from the attendees and using these questions

as the basis for the discussion.

- Leading the discussion through the points covered in the program using statements such as:

- "One of the sections that we saw in the program was about selection and use of personal protective equipment. What types of personal protective equipment do we have available that we might be able to make better use of?"



- "We saw some interesting things about 'cleanup and disposal of spills or leaks of materials that may contain bloodborne pathogens'. Who can review for us the considerations in this area that we have just seen?"

You should use the discussion format that you are most comfortable with. The outline of the major points addressed in the program and the questions and answers in the master copy of the quiz should be used as a basis for this discussion, as well as the supplemental information that you have presented in this session. Remember, you have allocated a limited amount of time in which this discussion can take place. It is important to blend the attendees' questions and areas of obvious interest with the objective of trying to touch on each major area within the session in the discussion. By touching on each area, the attendees are much more likely to retain the information presented in the session. Concluding the Presentation Once discussion has concluded (whether naturally or you have had to bring the discussion to a close in order to complete the session within the time allowed), it is time to give the quiz (if you are using it). Again, remind the attendees that the quiz is only meant to help determine how effective the presentation of the information is, and that they will not be graded. Let them know that they have approximately five minutes to complete the quiz. At the end of the five minute period, remind the attendees to date and sign their quizzes and then collect them. The attendees should be thanked for attending the session and reminded of any other sessions in the educational program that they may be attending. They can then be dismissed to return to their normal activities. *(An alternative to this approach is to give the quiz immediately after showing the program, then use a review of the quiz as a basis for your group discussion.)



Wrapping Up the Paperwork Before much time has passed, and the subject matter is fresh in your mind, several areas of paperwork must be completed. First, check to make sure that all attendees signed the scheduling and attendance form. Next, make sure that you have a quiz from every attendee, dated and signed. Also, depending upon what you have decided to do, a copy of the attendance sheet and the quiz for each attendee should be either filed in your files, or turned over to the attendee's department manager (or the personnel office) so that this paperwork can be included in their personnel file. The training logs should also be updated, and each attendee should be given a filled out and signed training certificate, signifying that they have successfully completed the course. Remember, it is always a good idea to document information about an employee's attendance at these sessions, as well as the fact that the employee has come away from the session with some knowledge of where they may encounter bloodborne pathogens in healthcare facilities, how to reduce or eliminate exposure and what to do in an exposure situation.



OUTLINE OF MAJOR PROGRAM POINTS The following outline summarizes the major points of information presented in the program. The outline can be used to review the program before conducting a classroom session, as well as in preparing to lead a class discussion about the program.

- Exposure to bloodborne diseases is a serious concern in the healthcare industry. Because of this, in 1991, OSHA created a regulation dealing with bloodborne pathogens.

- Pathogens are the disease-causing microorganisms found in human blood, as well as human blood components and products.

- Since the Centers for Disease Control's isolation precautions in

hospitals incorporate the concept of standard precautions, many of you will be already acquainted with some of the information in this program.

- For you, this will act as a refresher course. - However, this program will also point out new or

different requirements that appear in the regulation. - In addition, you will see how exposure to bloodborne

pathogens occurs so you can help protect you and your coworkers.

- You may want to read the regulation itself.

- Your course instructor will tell you where to find the nearest copy.

- While there are a number of bloodborne pathogens, those causing

Hepatitis B, Hepatitis C, and the Human Immunodeficiency Virus pose the greatest threat.



- Human Immunodeficiency Virus (HIV) is the newest of the bloodborne pathogens and is spreading rapidly.

- It is believed that over one million people in the U.S. have already been infected.

- Currently, no vaccine exists to prevent infection. - There is no known cure.

- Symptoms experienced at the onset of HIV infection can vary. They

include: - Weakness. - Fever. - Sore throat. - Nausea. - Headaches. - Diarrhea. - Other flu-like symptoms.

- However, many people with the HIV virus show no apparent

symptoms for years after their initial infection.

- Controlling the spread of HIV is very important. It is generally believe that those who contact the HIV virus will ultimately develop Acquired Immunodeficiency Syndrome (AIDS).

- AIDS results in a breakdown of the immune system, canceling out the body's ability to fight off other diseases.

- Hepatitis is a liver disease. It usually results in an inflammation of the

liver, and frequently progresses to more serious conditions including cirrhosis and cancer.

- Each year in the U.S., there are over 70,000 new cases of Hepatitis B.

- It is estimated that more than 3 million people in the U.S. are carrying the Hepatitis C virus.

- The prevalence of hepatitis is so widespread that it is quickly becoming a larger transmission hazard than HIV.



- Statistics show that healthcare workers are much more likely to contract hepatitis than the general population.

- It is estimated that there are as many as 18,000 new cases of hepatitis each year among healthcare workers, which result in 200 to 300 deaths.

- While there is no cure for Hepatitis B or Hepatitis C, a vaccine does exist that can prevent Hepatitis B infection.

- After exposure, it can take four weeks to six months for hepatitis to

develop. - Early detection is extremely important, since

vaccinations begun immediately after exposure to HBV can often prevent infection.

- The initial symptoms of both Hepatitis B and Hepatitis C resemble

those of a mild flu, including: - Fatigue. - Nausea. - Loss of appetite. - Possible stomach pain. - Jaundice (a distinct yellowing of the skin). - Darkening of the urine.

- However, as with HIV, people infected with Hepatitis will frequently

fail to show symptoms for weeks or even months.

- Bloodborne diseases are most often transmitted through parenteral exposure.

- This is where microorganisms enter the body through breaks in the skin or through mucous membranes.

- These exposures most often occur through:

- Punctures from infected needles. - Human bites. - Skin abrasions or cuts that come into contact with

potentially infectious material.



- Infectious material can include: - Blood. - Human tissue. - Vaginal secretions from discarded hygiene products. - Other bodily substances with blood in them.

- Cultures and body substances visibly contaminated with blood must

also be considered potentially infectious, as must any body substances and materials of unknown origin.

- Materials taken from infected lab substances may also carry bloodborne pathogens.

- Preventing parenteral exposures to these materials is one of the major parts of the OSHA regulation.

- The Exposure Control Plan spells out how your facility will address

the requirements of the regulation itself, and includes: - A determination of each employee's potential exposure

to bloodborne pathogens. - An examination of ways to limit or eliminate exposure.

- The Exposure Control Plan also deals with:

- Setting up a Hepatitis B vaccination program. - Procedures to be followed whenever an accidental

exposure occurs. - Warning signs and labels. - Employee training. - Recordkeeping for exposure, vaccination and training.

- The plan must also incorporate the use of Standard Precautions.

- Treating all human blood and other body substances as if they are known to be infectious.

- If you work in the healthcare industry, one of the most critical issues

the plan addresses is how to reduce the risk of needlesticks and other sharps injuries.

- The Centers for Disease Control estimates that there are over 500,000 injuries from contaminated sharps each year.



- When these injuries involve infectious agents such as hepatitis or HIV, the affected workers are at risk of contracting bloodborne diseases.

- One of the things OSHA has done to help combat the danger of

needlesticks is to mandate that Exposure Control Plans be reevaluated at least once a year.

- A major focus of these reviews is to make sure that your group is

using every means available to keep you safe, including: - Updated work practices. - The use of the latest needleless technologies.

- As a rule, the review must show that the Exposure Control Plan:

- Reflects changes in technology that can eliminate or reduce exposure.

- Documents investigation and implementation of new medical devices that are designed to reduce or eliminate exposure.

- Incorporates the opinions of frontline employees whose interactions with patients expose them to potentially contaminated sharps.

- If you would like to look at your facility's plan, see your training

instructor or supervisor.

- Labeling is the most visible requirement in the regulations. - Containers carrying any potentially infectious materials,

such as blood, must be marked with a biohazard label. - Labels must also appear on any equipment and

materials suspected of being contaminated.

- The word contaminated indicates the presence or anticipated presence of potentially infectious materials on an item or surface.



- Biohazard labels are fluorescent orange/red with the biohazard symbol in a contrasting color.

- The word Biohazard is also marked on the lower portion of the label.

- Red bags or red containers can substitute for these labels.

- There are several exceptions to these labeling requirements:

- Individual containers of blood do not have to be labeled if they are placed inside another labeled container for transport or storage.

- Facilities following Standard Precautions in handling all specimens do not have to use this type of labeling if the specimens are recognizable by the employees who normally handle them.

- Labeled blood products released for transfusion or other clinical use are also exempt if these specimens remain in the facility.

- Common places that you will see biohazard labels include:

- Refrigerators and freezers containing blood or other potentially infectious materials.

- Containers used to store, transport or ship materials. - Contaminated equipment awaiting cleaning. - Containers of regulated waste. - Potentially infectious materials such as blood. - Contaminated items such as bandages, bedding and

towels. - Contaminated sharps, including needles, scalpel blades

and broken glass. - Containers which may have infectious material in them.

- There are a number of ways that you can recognize activities that might involve exposure to bloodborne pathogens.

- The most obvious is to look for biohazard signs and labels.

- If you are not sure what materials need labeling, ask your supervisor.



- You should also be aware of all of the tasks that you perform which deal with:

- Blood. - Other body substances. - Tissues where blood could be present.

- Your employer has compiled lists of job classifications and activities

that may present risk of exposure. - These lists can be found in your facility's Exposure

Control Plan.

- There are many ways that you and your employer can work to reduce exposure to bloodborne pathogens. These include the use of:

- Standard precautions. - Engineering controls. - Work practice controls. - Personal protective equipment (PPE). - Good housekeeping practices.

- Engineering controls refer to equipment or machinery that minimize

exposure. Your facility uses many of these, such as: - Puncture resistant sharps containers. - Self-ventilating laboratory hoods. - Sharps with engineered injury protections such as self-

sheathing needles.

- Work practice controls reduce the potential for exposure by focusing on the safest ways to perform tasks.

- You are probably familiar with many of the practices on OSHA's list.

- Hand washing is one of the most important.

- If you have been involved in an exposure situation, OSHA requires that you wash your hands immediately after removing gloves and PPE.

- Remember to wipe the spigot with your towel when turning it off, to avoid recontamination.

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- You must wash your hands immediately. After contact with blood or other potentially infectious material, as well as rinse other areas with generous amounts of water:

- Eyes. - Nose. - Other mucous membranes.

- Other work practices are also addressed by OSHA:

- Minimize splashing, spraying or creation of droplets when dealing with potentially infectious samples.

- No mouth pipetting or suctioning is permitted.

- During handling or storage, specimens must be placed in appropriately labeled, leak-proof containers.

- Appropriately labeled, secondary containers must be used if the outside surface of the primary container is contaminated.

- If there is a danger that the specimen could puncture the primary container, the secondary container must be puncture-resistant as well as leak-proof.

- OSHA considers housekeeping practices to be very important to the

control of exposure situations. - Written cleaning schedules that specify methods of

decontamination must be maintained to keep all areas clean and sanitary.

- Equipment and surfaces must be cleaned and decontaminated after

contact with blood or other potentially infectious materials. - If they are obviously contaminated, work surfaces must

be cleaned immediately with disinfectant. - Otherwise, this should be done at the end of each work

shift. - Protective coverings on equipment such as plastic or

coated absorbents must also be replaced when decontaminated.



- There are several work practice control requirements that apply to contaminated needles and sharps:

- They must not be bent. - They can not be recapped or removed unless there is

no feasible alternative. - If they have to be recapped or removed, you must use a

one-handed technique or a mechanical device.

- Broken glass is not to be picked up by hand, but by using: - A brush and dustpan. - Tongs. - Other tools.

- Contaminated sharps must be discarded as soon as possible into

appropriately labeled containers that are: - Closeable. - Puncture-resistant. - Leak-proof.

- These containers should be easily assessable and must be:

- Left upright. - Replaced routinely. - Never overfilled. - Closed when handled. - Subject to the same secondary container requirements

as specimens.

- Rules also govern the handling of other regulated waste in your facility.

- It must be placed in appropriately labeled, closeable and leak-proof containers.

- Containers must be closed and secured during handling.

- The secondary containment rules that apply to specimen handling

also apply to regulated waste. - This waste must be disposed of in accordance with

existing federal and state regulations.



- Another part of the regulation concerns contaminated laundry. - It should be handled as little as possible and always

bagged appropriately. - It must never be sorted or rinsed at its originating

location.

- Labeled or color-coded bags are required to transport laundry. - Bags must be leak-proof if the laundry is wet. - All laundry must be handled with gloves and other

appropriate PPE.

- Never eat, drink or smoke in work areas where exposure may occur. - Never apply cosmetics, lip balm or contact lenses in

these areas. - Food and drink should never be stored in laboratory

refrigerators or freezers.

- The last type of workplace control the regulation addresses concerns equipment.

- Before any piece of equipment is serviced or shipped it must be inspected for contamination with body substances.

- Any required disinfection should be completed as soon as possible.

- If the equipment can not be totally decontaminated, it must remain labeled as a biohazard.

- All employees or service personnel who may come in contact with the equipment must be notified of the location and type of contamination.

- The use of PPE is another important part of the Bloodborne

Pathogens Regulation. - It must be worn whenever there is a chance of exposure

to blood or other potentially infectious material. - Gloves are mandatory in these situations.



- Disposable gloves should be replaced as soon as possible after becoming contaminated.

- Never attempt to decontaminate and reuse them. - Replace disposables immediately when they are torn or

otherwise damaged. - Removing rings before putting on gloves will help keep

them from tearing.

- Utility gloves, usually rubber or vinyl, are heavier and can be reused after decontamination.

- However, they must be discarded if they are cracked, peeling or damaged.

- You must change gloves and wash your hands after each exposure.

- If you are sensitive to latex, talk to your supervisor. - Non-latex PPE will be made available to workers with

documented latex allergies.

- Masks and eye protection should be worn whenever there is a chance that fluids may splash or splatter.

- Standard safety glasses protect the eyes from direct exposure from the front.

- Side shields provide added coverage. - Safety goggles fit snugly and provide complete eye

protection.

- Face shields protect not only the eyes, but the rest of your face as well.

- However, you may also need to wear goggles or safety glasses if there is a threat that splashing or spraying could occur up under the shield.

- Pocket and other face masks are designed to protect the mouth and

lip area. - They should be worn whenever eye protection is used.



- Lab coats and other protective clothing provide protection for much of the body.

- They should be selected based on the degree and circumstance of anticipated exposure.

- They must effectively prevent the pass-through of fluids and materials.

- Gowns with total frontal coverage do the best job of protecting street clothes from contamination.

- Surgical caps and hoods should be worn whenever gross

contamination is anticipated, such as during: - Autopsies. - Orthopedic surgery.

- Shoe covers should also be worn in these situations, as well as

when cleaning up spills of significant size.

- Your facility has PPE available for you in your work area. - If you are unsure of its location, ask your supervisor.

- Be aware of your facility's procedures for handling PPE once it has been worn.

- Know the location of collection and disposal points and use them.

- You must take off your PPE before leaving the work area.

- Good work practices and the use of PPE can substantially reduce

the risk of exposure.

- Vaccination, however, can be the first line of defense against infection. While there is no vaccine for HIV or Hepatitis C, a vaccine for Hepatitis B has been available for some time.

- The vaccine is administered in three injections, given several months apart.

- Hepatitis B vaccines are safe. There is no possibility of infection through the vaccine itself.

- Over the years, vaccination has proven to be very effective in preventing Hepatitis B infection.



- Your employer has set up a free Hepatitis B vaccination program for all employees who are at risk of exposure.

- Your training instructor can give you more information. - If you are at risk, it is important that you be vaccinated. - It is so important that OSHA requires you to sign a form

if you decline the vaccination.

- If you are accidentally exposed to Hepatitis B infected blood and have not been vaccinated, your employer will offer you an accelerated vaccination series at no cost.

- This after the fact vaccination will not always prevent the disease.

- However, many forms of Hepatitis B are slow to develop.

- Given in time, a vaccination may prevent the infection.

- As careful as we may be, needlesticks, blood leakage and spills can occur.

- You need to know what to do in case of such an emergency.

- First, if you come into contact with any potentially contaminated

material, you should wash the affected area with soap and water as quickly as possible.

- If the incident involves a spill or leakage, you should soak up the

material or contain it using absorbent barriers.

- Then immediately take the following steps: - The area should be cleaned with your facility's approved

disinfecting solution, such as diluted bleach. - Once the spill or leak has been cleaned, any

contaminated materials should be disposed of in an approved waste disposal container.

- Discard any contaminated PPE. - Reusable equipment should be recycled for

decontamination.



- A number of people will need to be notified about the incident, including:

- Your supervisor. - Your environmental services department. - The infection control group.

- You may also need to complete an Incident Report.

- If the injury was caused by a contaminated sharp, your facility will

record it in a special Sharps Injury Log. - This log is specifically set up to keep track of

percutaneous injuries from contaminated sharps.

- Every entry into the log must include the following information: - The type and brand of device involved in the incident. - The department or work area where the accident took

place. - An explanation of what happened.

- Immediately following the exposure, your employer will give you a

written description summarizing: - The routes of exposure that you experienced. - The circumstances under which the exposure occurred.

- If possible, the identity of the individual from whom the potentially

infectious material originated will be established. - Your employer will also try to determine if the source

individual's blood is infected with Hepatitis B, Hepatitis C or HIV.

- An appointment will be arranged for you with a healthcare

professional to review the medical ramifications of what took place. Your employer will provide the healthcare professional with information such as:

- The type of work you were doing when the incident occurred.

- The result of the source individual's blood test. - Any of your medical records which are relevant to

possible treatment. 106 Capitola Drive

Durham, NC 27713 (P) 919-544-6663 (F) 919-544-5800

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- With your permission, your blood will also be tested to determine if an infection has occurred.

- Your situation will then be evaluated and discussed with you.

- If appropriate, medical treatment may then be recommended.

- If Hepatitis B vaccination is called for, it will be provided by your employer at no cost to you.

- The healthcare professional is also required to verify four things with

your employer: - That you have been informed of the results of their

evaluation. - That they have discussed any medical condition

resulting from the exposure which would require follow up with you.

- Whether Hepatitis B vaccination is recommended. - Whether you have received the first part of the

vaccination series.

- All other information that results from your medical evaluation will remain confidential.

- Bloodborne pathogens are dangerous.

- But by combining engineering controls, good work practices, Hepatitis B vaccinations, and the use of PPE, we can protect ourselves, and others, from exposure!



ACCOMPANYING MATERIALS In order to assist you in complying with as many facets of your training requirements as possible, we have provided a number of specific materials that can be used with this program. Some of these materials have been furnished in master form. This will enable you to make as many copies of these forms as you need. If you have colored paper available to you, it is often useful to put each form on a different color. This enables you to easily differentiate between the materials. The materials enclosed with this guide include: Scheduling and Attendance Form This form is provided so you can easily schedule your attendees into each session of the program. It is important that you have each attendee sign-in on the appropriate form, thereby documenting their attendance at the session. Typically, a copy of this attendance/sign-in form is filed in the employee's personnel file. Quiz The quiz is normally given after viewing the program. However, if you want an indication of the increase in the attendees' knowledge about bloodborne pathogens, you can give the quiz both before and after the program is shown. You can also use the quiz as the basis for class discussion. If you have decided to give the quiz both before and after the attendees view the program, it is often interesting to have the attendees compare their before and after answers as part of the session. Typically, the quiz is filed in the employee's personnel file.



Training Certificate This form allows you to give each employee their own certificate of completion showing that they have attended the course and taken the quiz. Space is provided to insert the employee's name, the course instructor and the date of completion. Employee Training Log This log helps you to keep track of when each employee has taken this course, as well as associated courses or training. Space is provided to list pertinent data about the employee, as well as information such as the date the course was taken, and the instructor conducting the course. A copy of this form should be kept in each employee's training or personnel file.



SCHEDULING AND ATTENDANCE FORM


TRAINING SESSION SCHEDULE

ATTENDEE DATE TIME SIGNATURE

106 Capitola Drive

Durham, NC 27713 (P) 919-544-6663 (F) 919-544-5800

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QUIZ


Name: Date:

1. Which of the following are the two most prevalent bloodborne diseases in the

United States? Hepatitis B. HIV. Tuberculosis. Mononucleosis.

2. Approximately how many new cases of Hepatitis B occur in the United States

each year? 70,000. 300,000. 3 million.

3. True or False... Vaccines do exist that can prevent infection from Hepatitis C and

HIV? True False

4. What is the most important personal hygiene practice for preventing infection

from bloodborne diseases? Cleaning fingernails daily. Hand washing. Gargling with disinfectant.

5. What color must be used as the background on biohazard warning labels?

Yellow. Red/orange. Black.

6. True or False... All types of gloves can be reused after an exposure incident if

they are decontaminated? True False

7. True or False... Personal protective equipment can help guard against infection

by bloodborne pathogens? True False





QUIZ


PRESENTER'S COPY WITH ANSWERS

1. Which of the following are the two most prevalent bloodborne diseases in the

United States? X Hepatitis B. X HIV. Tuberculosis. Mononucleosis.

2. Approximately how many new cases of Hepatitis B occur in the United States

each year? X 70,000. 300,000. 3 million.

3. True or False... Vaccines do exist that can prevent infection from Hepatitis C and

HIV? True X False

4. What is the most important personal hygiene practice for preventing infection

from bloodborne diseases? Cleaning fingernails daily. X Hand washing. Gargling with disinfectant.

5. What color must be used as the background on biohazard warning labels?

Yellow. X Red/orange. Black.

6. True or False... All types of gloves can be reused after an exposure incident if

they are decontaminated? True X False

7. True or False... Personal protective equipment can help guard against infection

by bloodborne pathogens? X True False



EMPLOYEE TRAINING LOG

BLOODBORNE PATHOGENS IN HEALTHCARE FACILITIES Employee: Employee #: Social Security #: Department: Date of Next Required Training:

DATE

TYPE OF TRAINING

OR COURSE DESCRIPTION LOCATION OF COURSE MATERIALS

INSTRUCTOR'S NAME AND ADDRESS/DEPARTMENT

CERTIFICATION OF TRAINING AND TESTING

(Instructor's Signature)



TRAINING CERTIFICATE TRAINING CERTIFICATE

This is to certify that _____________________________________ has

completed the course Bloodborne Pathogens in Healthcare Facilities and

has been tested on the contents of the course, as required. This training, as

well as the associated testing was conducted by

___________________________ and was completed on _________.

This is to certify that _____________________________________ has

completed the course Bloodborne Pathogens in Healthcare Facilities and

has been tested on the contents of the course, as required. This training, as

well as the associated testing was conducted by

___________________________ and was completed on _________.

_____________________________ ____________ _____________________________ ____________

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