The bloodborne pathogen standard finalPresentation Transcript
The Bloodborne Pathogen Standard:An OverviewIn 1990, the U.S. Occupational Safety and Health Administration (OSHA)estimated that occupational exposures to bloodborne pathogens causedmore than 200 deaths and 9,000 bloodborne infections every year. To helpprotect workers from this serious workplace hazard, OSHA published theOccupational Exposure to Bloodborne Pathogens Standard on December6, 1991. The purpose of this standard is to protect workers by limitingoccupational exposure to blood and other potentially infectious materials.In 2000, the Needlestick Safety and Prevention Act (Public Law 106-430)mandated that OSHA clarify and revise the Bloodborne PathogensStandard to address the implementation of safer needle devices. OSHApublished the revised standard, which included such new requirements asthe use of safer needle devices and maintaining a log of contaminatedneedlestick injuries, in the Federal Register in January 2001. The revisedstandard became effective in April 2001.The Bloodborne Pathogen standard is located in Title 29 of the Code ofFederal Regulations (29 CFR), Part 1910.1030.
Bloodborne pathogens aremicroorganisms that arepresent in human blood andcan infect and cause disease inpeople who are exposed toblood containing the pathogen.These microorganisms can betransmitted through contactwith contaminated blood andbody fluids.
Bloodborne pathogens include, but arenot limited to:• Human Immunodeficiency Virus (HIV)• Hepatitis B (HBV)• Hepatitis C (HCV)• Non A, Non B Hepatitis• Syphilis• Malaria
Human Immunodeficiency Virus (HIV)• HIV is passed from one person to another through blood- to-blood and sexual contact. Pregnant women infected with HIV can also pass the virus to their baby during pregnancy or delivery, and through breast-feeding.• People with HIV have what is called HIV infection. Most of these people will eventually develop AIDS as the result of their HIV infection. By killing or damaging cells of the bodys immune system, HIV progressively destroys the bodys ability to fight infections and certain cancers. People diagnosed with AIDS may get life-threatening diseases called opportunistic infections, which are caused by microbes such as viruses or bacteria that usually do not affect healthy people.
HIV• The symptoms of HIV infection range from an asymptomatic state to severe immunodeficiency and associated opportunistic infections, neoplasms, and other conditions. Initial infection can be followed by an acute flu-like illness, with such symptoms as: fever myalgia lymphadenopathy rash sweats sore throat• The risk of disease progression increases with the duration of the infection. Most studies show that less than 5% of HIV infected adults develop AIDS within 2 years of infection. Without therapy, approximately 20-25% of infected adults develop AIDS within 2 years of infection, and 50% within 10 years.
HepatitisAcute viral hepatitis is a common, sometimes serious infectionof the liver leading to inflammation and necrosis. There are atleast five distinct viral agents that cause acute viral hepatitis:• HAV (Hepatitis A)• HBV (Hepatitis B)• HDV (delta)• HCV (Hepatitis C)• HEV (an enterally transmitted non A, non B hepatitis agent)
Hepatitis B Virus (HBV)• An estimated 1.25 million Americans are chronically infected with the Hepatitis B virus, and about 20-30% of those infected acquired the infection during childhood. A Hepatitis B vaccine has been available since 1982, and routine Hepatitis B vaccinations have greatly reduced the rate of disease among children and adolescents.• About one-third of persons infected with HBV have no signs or symptoms. Symptoms can include: Jaundice Fatigue Abdominal pain Loss of appetite Nausea, vomiting Joint pain• Transmission of the Hepatitis B virus (HBV) occurs when an infected persons blood or body fluids enters the body of a person who is not immune.• The Bloodborne Pathogen standard requires employers to make the hepatitis B vaccine and vaccination series available to all employees that have occupational exposure to HBV. Employees who decline the vaccination must sign a statement indicating that they understand they are at continued risk for acquiring hepatitis B.
Hepatitis C Virus (HCV)• The Hepatitis C virus (HCV) is a major cause of acute hepatitis and chronic liver disease, including cirrhosis and liver cancer. According to estimates from the Centers for Disease Control and Prevention, an estimated 3.9 million Americans (1.8%) have been infected with HCV, and 2.7 million are chronically infected. The number of new infections per year has declined from an average of 240,000 in the 1980s to about 30,000 in 2003. Illegal injection drug use is the primary cause of infection. Approximately 80% of the persons infected with Hepatitis C have no signs or symptoms. Those that have symptoms and signs may exhibit the following: Jaundice Fatigue Dark Urine Abdominal Pain Loss of Appetite Nausea• Chronic infections occur in 75-85% of infected persons, and chronic liver disease occurs in 70% of infected persons. There is no vaccine for Hepatitis C.
Transmission of Bloodborne Pathogens • Bloodborne pathogens are transmitted when contaminated blood or body fluids enter the body of another person. In the workplace setting, transmission is most likely to occur through: • An accidental puncture by a sharp object, such as a needle, broken glass, or other "sharps", contaminated with the pathogen. • Contact between broken or damaged skin and infected body fluids • Contact between mucous membranes and infected body fluids.
Transmission of Bloodborne Pathogens • Unbroken skin forms an impervious barrier against bloodborne pathogens. However, infected blood or body fluids can enter your system percutaneously through: Open sores Cuts Abrasions Acne • Any sort of damaged or broken skin such as sunburn or blisters • Bloodborne pathogens can also be transmitted through the mucous membranes of the eyes, nose, or mouth. For example, a splash of contaminated blood to your eye, nose, or mouth could result in transmission.
There are also many ways that bloodbornepathogens are not transmitted. Forexample, bloodborne pathogens are nottransmitted by:• touching an infected person• coughing or sneezing• using the same equipment, materials, toilets, water fountains or showers as an infected person.• It is important that you know which ways are viable means of transmission for the bloodborne pathogens in your workplace, and which are not.
Exposure Control PlanThe Bloodborne Pathogen Standard requires thatemployers develop an Exposure Control Plan and make itaccessible to all employees.• The Exposure Control Plan is a written plan that identifies the tasks and procedures, as well as job classifications, where occupational exposure to blood occurs--without regard to personal protective clothing and equipment.• The plan also establishes the schedule by which the employer will implement other provisions of the standard, and specifies the procedure for evaluating circumstances surrounding exposure incidents.
Exposure Control PlanEmployers must update their Exposure ControlPlan to include:• changes in technology that reduce/eliminate exposure• annual documentation of consideration and implementation of safer medical devices• solicitation of input from non-managerial employees
Methods of ComplianceThe Bloodborne Pathogen Standard specifiesmethods that are to be used to minimize thetransmission of bloodborne pathogens in the workplace. These methods include:• Universal Precautions• Engineering and Work Practice Controls• Personal Protective Equipment (PPE)• Appropriate Housekeeping Measures• Well take a more detailed look at each of these methods in the next few pages.
Universal Precautions• The Bloodborne Pathogen Standard requires that employers implement a standardized approach to infection control called Universal Precautions.• The concept of Universal Precautions is that all blood and potentially infectious materials must be treated as if they are known to contain HIV, HBV, or other bloodborne pathogens.
Body Substance IsolationBody Substance Isolation is an alternativeinfection control method in which all body fluidsand substances are defined as infectious.Workplaces that use BSI as an alternative toUniversal Precautions extend the coverage of theBloodborne Pathogen standard to include all bodysubstances. Such workplaces must also complywith the other provisions of the standard.
Engineering and Work Practice Controls Employers must select and implement appropriate engineering and work practice controls in situations where occupational exposures to blood or other potentially infectious materials may occur. The objective of engineering controls and work practice controls is the same: to reduce or minimize employee exposure to bloodborne pathogens. The difference between the two types of controls is that one isolates or removes the hazard from the workplace, while the other reduces the risk of exposure by altering how tasks are performed. Definitions and examples of each type of control are:Engineering Controls Work Practice ControlsControls that isolate or remove the Controls that reduce the likelihood ofbloodborne pathogens hazard from the exposure by altering the manner in whichworkplace. a task is performed.Examples: sharps disposal containers, self-sheathing needles, safer medical devices, Example: Prohibiting recapping of needlessuch as sharps with engineered sharps by a two-handed technique.injury protections and needleless systems
Exposure DeterminationTo select the proper engineering and work practice controls toimplement in the workplace, the employer must make anexposure determination. This determination must contain:• A list of all job classifications in which all employees in those job classifications have occupational exposure;• A list of job classifications in which some employees have occupational exposure, and• A list of all tasks and procedures or groups of closely related task and procedures in which occupational exposure occurs and that are performed by employees in job classifications listed in accordance with the provisions of paragraph (c)(2)(i)(B) of this standard.• This exposure determination shall be made without regard to the use of personal protective equipment.
Needlestick SafetyTwo commonly used engineering controls areNeedleless Systems: devices that do not use a needle for:• Collection of bodily fluids• Administration of medication/fluids• Any other procedure with potential percutaneous exposure to a contaminated sharpSharps with Engineered Sharps Injury Protections (SESIP)• Non-needle sharp or a needle with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.
Work Practice Controls Hand washing is one of the simplest and most effective practices used to prevent the transmission of bloodborne pathogens. Hand washing keeps you from transferring contamination from your hands to other areas of your body, or to other surfaces you may contact later.
Hand washing tips• Thoroughly wash hands or other exposed skin with soap and water as soon as possible following an occupational exposure to blood or other potentially infectious materials.• Wash your hands with soap and water every time you remove your gloves. If your gloves are intact and you have had no occupational exposure to blood or other potentially infectious materials, antiseptic hand cleaners may be used as an appropriate hand washing practice. However, washing with soap and running water every time you remove your gloves is the recommended practice.• Use soft, antibacterial soap, if possible. Avoid harsh, abrasive soaps, as these may open fragile scabs or other sores.• If skin or mucous membranes come in direct contact with blood, wash or flush the area with water as soon as possible.• Where handwashing facilities are not available, use antiseptic hand cleansers or antiseptic towelettes. However, these should be used as a temporary measure only. You must still wash your hands with soap and running water as soon as you can.
Personal HygienePersonal hygiene involves using good judgment when working inareas with the potential for exposure. Examples of goodpersonal hygiene practices include:• Minimizing splashing, spraying, spattering and generation of droplets when attending to an injured person.• Refraining from eating, drinking, smoking, applying cosmetics or lip balms, or handling contact lenses where there is a reasonable likelihood of occupational exposure.• Keeping food or drink away from refrigerators, freezers, shelves cabinets or on countertops or bench tops where blood or other potentially infectious materials are present.• Refraining from mouth pipetting/suctioning of blood or other potentially infectious materials.
Personal Protective EquipmentThe type of protective equipment appropriate for your job orresearch varies with the task and the degree of exposure youanticipate. Equipment that protects you from contact with bloodor other potentially infectious materials (OPIM) may include:• Gloves• Eye Protection• Masks and Face Shields• Gowns, Aprons, and Other Protective Body ClothingAll Personal Protective Equipment can be found in Room 111 ofthe Health Center.
Gloves• Gloves should be made of latex, nitrile, rubber, or other water impervious materials. If gloves are particularly thin or flimsy, double gloving can provide an additional layer of protection. If you have cuts or sores on your hands, cover these with a bandage or similar protection as an additional precaution before donning your gloves.• Always inspect your gloves thoroughly before putting them on. Never use gloves that are damaged, such as torn or punctured.• Remove contaminated gloves carefully, avoiding touching the outside of the gloves with bare skin. Dispose of contaminated gloves in a proper container.
Eye ProtectionBloodborne pathogens can betransmitted through the mucousmembranes of the eye.Consequently, you should use eyeprotection whenever there is arisk of splashing or vaporization ofcontaminated fluid, such as whilecleaning up spills or during certainlaboratory procedures.
Masks and Face ShieldsMasks and face shields provide additionalprotection for tasks that may generatesplashes, spray, spatter, or droplets of blood orother potentially infectious materials, andeye, nose, or mouth contamination can bereasonably anticipated. Masks and face shields arenot a substitute for eye protection, and must beused in combination with suitable eye protection.•
Protective Body ClothingAppropriate protectiveclothing such as, but notlimitedto, gowns, aprons, labcoats, clinic jackets, orsimilar outer garmentsshall be worn inoccupational exposuresituations. The type andcharacteristics will dependupon the task and degreeof exposure anticipated.
General Guidelines for Personal Protective Equipment Use• Persons should be trained to use the equipment properly.• The equipment should be appropriate for the task and should fit properly, especially gloves.• The equipment should be free from physical flaws that could compromise safety.• Persons must use appropriate protective equipment each time they perform a task involving potentially infectious materials.• The employer should issue PPE or make it readily accessible in the work area.• The employer should maintain, replace or dispose of any PPE at no cost to employees.• Persons should remove all PPE prior to leaving the work area.• Persons should place removed PPE in an appropriately designated area or container for storage, washing, decontamination or disposal.• Persons should remove garments such as lab coats or aprons that are penetrated by blood or other potentially infectious materials immediately or as soon as feasible.
Signs, Labels & Color CodingSigns and labels in the workplace communicatebloodborne pathogen hazards to employees. Thewarning label must include the universalbiohazard symbol and the term "biohazard" in acolor that contrasts with the fluorescentorange, orange-red background, as illustrated tothe right:Warning labels must be affixed to containers of regulatedwaste, refrigerators and freezers containing blood or otherpotentially infectious material, and other containers used tostore, transport, or ship blood or other potentially infectiousmaterials. Red bags or red containers can be substituted forlabels.Contaminated equipment which is to be serviced or shippedmust also have a warning label and a statement regarding whichportions of the equipment remain contaminated.
Signs, Labels & Color CodingSome common exceptions to the labeling requirements are:• Containers of blood, blood components, and blood products bearing an FDA required label that have been released for transfusion or other clinical uses.• Individual containers of blood or OPIM that are placed in secondary labeled containers during storage, transport, shipment, or disposal.• Specimen containers, if the facility uses Universal Precautions when handling all specimens, the containers are recognizable as containing specimens, and the containers remain within the facility.• Regulated waste that has been decontaminated.
Response to Emergencies InvolvingBlood or Body FluidsIf you are faced with a spill of blood or body fluids, here are some keypoints to keep in mind:• Wear appropriate Personal Protective Equipment (PPE).• Carefully cover the spill with an absorbent material, such as paper towels, to prevent splashing.• Decontaminate the area of the spill using an appropriate disinfectant, such as a solution of one part bleach to ten parts water. When pouring disinfectant over the area always pour gently and work from the edge of the spill towards the center to prevent the contamination from spreading out.• Wait 10 minutes to ensure adequate decontamination, and then carefully wipe up the spilled material. Be very alert for broken glass or sharps in or around the spill.• Disinfect all mops and cleaning tools after the job is done.• Dispose of all contaminated materials appropriately.• Wash your hands thoroughly with soap and water immediately after the clean up is complete.
Spill Kit• The Spill Kit is located in Room 111 at the Health Center.• All items contained in this kit are for one-time use only. Once used, they should be placed in the disposal bag provided and disposed of properly. These items should not be worn outside the contaminated area. ASSUME ALL BLOOD AND BODY FLUID SPILLS ARE CONTAMINATED AND POTENTIALLY HAZARDOUS TO YOUR HEALTH
Housekeeping and Waste DisposalKeeping the worksite clean and sanitary is anecessary part of controlling worker exposure tobloodborne pathogens. Cleaning schedules anddecontamination methods depend on the type ofsurface to be cleaned, the type of soil that ispresent, and the particular tasks or proceduresthat are being performed.
General housekeeping guidelines are:• Clean and decontaminate all equipment and working surfaces after contact with blood or other potentially infectious materials• Contaminated work surfaces, such as counters, fume hoods, or biosafety cabinets, should be decontaminated with an appropriate disinfectant as follows: • after completing procedures • immediately or as soon as feasible if they are heavily contaminated or if there has been a spill of blood or other potentially infectious materials • at the end of the work shift if the surface may have become contaminated since the last cleaning.• Inspect and decontaminate bins, pails, cans, and similar receptacles intended for reuse which have a reasonable likelihood for becoming contaminated with blood or other potentially infectious substances on a regularly scheduled basis.• Clean and decontaminate receptacles immediately or as soon as feasible upon visible contamination.
Handling Contaminated LaundrySoiled laundry in a non-healthcare setting is not generally covered by theBloodborne Pathogens Standard. However, employees handling laundry that issoiled or contaminated with blood or other potentially infectious materialsshould follow the recommendations of the standard, which include:• Handle soiled linen as little as possible and with minimum agitations, to prevent exposure to the handler• Facilities that use Universal Precautions for handling all soiled laundry may mark laundry bags or containers, containing contaminated laundry, with an alternative label or color-code provided all employees recognize the containers as requiring compliance with Universal Precautions. If the contaminated laundry is sent off-site for cleaning to a facility which does not use Universal Precautions in the handling of all soiled laundry, it must be placed in a bag or container which is red in color or labeled with the biohazard label.• When sending soiled linen to an off-site facility for laundering, place and transport the linen in specially marked, leak-proof bags.• If laundry is washed on-site, ensure individuals performing the laundering are trained and use universal precautions. Wash laundry in accordance with decontamination practices recommended by the Centers for Disease Control (CDC).
Waste DisposalRegulated waste refers to:• Any liquid or semi-liquid blood or other potentially infectious materials• Contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed• Items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling• Contaminated sharps• Pathological and microbiological wastes containing blood or other potentially infectious materials
RecordkeepingMedical records must be kept for each employee with occupationalexposure for the duration of employment plus 30 years, must beconfidential and must include name and social security number;hepatitis B vaccination status (including dates); results of anyexaminations, medical testing and follow-up procedures; a copy ofthe healthcare professionals written opinion; and a copy ofinformation provided to the healthcare professional.Training records must be maintained for three years and mustinclude dates, contents of the training program or asummary, trainers name and qualifications, names and job titles ofall persons attending the sessions.Medical records must be made available to the subjectemployee, and anyone with written consent of the employee, butthey are not to be available to the employer.
Exposure IncidentsEven the most comprehensive infection controlprogram cannot guarantee that no accidentalexposures to bloodborne pathogens will occur.Human error or an unexpected circumstance canresult in a sudden needlestick injury or a splash ofblood in an employees eyes. For thisreason, postexposure management must be anintegral component of a complete program toprevent infection following bloodborne pathogenexposure.
Exposure incidentAn exposure incident is an event resulting from the performanceof an employees duties in which there has been:• A percutaneous injury involving a potentially contaminated needle or other sharp• A splash of blood or other potentially infectious materials to the eyes, mouth, or mucous membranes• Blood or other potentially infectious materials contacting broken skin• An occupational exposure should always be considered an urgent medical concern to ensure timely postexposure management and administration of hepatitis B immune globulin (HBIG), hepatitis B vaccine, and/or HIV post-exposure prophylaxis (PEP).