This document discusses OSHA standards for preventing the spread of infectious diseases through occupational exposure to bloodborne pathogens. It defines bloodborne pathogens and outlines OSHA's Bloodborne Pathogens standard which aims to eliminate or minimize employee exposure to blood and other potentially infectious materials. The standard requires employers to conduct exposure determinations, offer hepatitis B vaccinations, ensure appropriate personal protective equipment is available and used, implement universal precautions, and provide related training to employees. Compliance with these measures helps protect both healthcare workers and patients from infectious diseases.

1. Bloodborne PathogensBloodborne Pathogens
Prevention of Spread of Infectious Diseases
OSHA Long Term Care Worker Protection Program

2.  Define bloodborne pathogens.
 Recognize OSHA standards related to
bloodborne pathogens.
 Identify employer responsibilities related to
compliance with OSHA standards.
 Recognize key strategies to control the spread of
infectious diseases.

3.  Bloodborne Pathogens
 Pathogens include but are not limited to:
Hepatitis B
HIV – human immunodeficiency virus
Pathogenic microorganisms that are present
in human blood or other potentially infectious
materials and can cause disease in humans.

4.  29 CFR 1910.1030, Occupational Exposure to
Bloodborne Pathogens
 Published December 1991
 Effective March 1992
 Scope
◦ ALL occupational exposure to blood and other
potentially infectious material (OPIM)

5. Hepatitis BHepatitis B
HIV/AIDSHIV/AIDS

6. What would you do?
and what would other employees do?

7.  …reasonably anticipated skin, eye, mucous membrane,
or parenteral contact with blood or other potentially
infectious materials that may result from the
performance of an employee’s duties.
 Duties may include:
◦ Direct Patient Care
◦ Phlebotomy/Laboratory
◦ Environmental Services
◦ Waste Management
◦ Other?

8. ◦ Exposure Determination
 all job classifications in which all employees
in those job classifications have occupational
exposure.
 job classifications in which some employees
have occupational exposure.
 all tasks and procedures…in which
occupational exposure occurs and that are
performed by the above listed employees.

9.  The schedule and method of implementation for:
◦ Methods of compliance.
◦ Hepatitis B vaccination and post-exposure
evaluation and follow-up for any exposure.
◦ Communication of hazards to employees.
◦ Recordkeeping.

10.  The procedure for the evaluation of
circumstances surrounding exposure incidents:
◦ Immediate availability for exposed employees
to confidential medical evaluation and follow-
up.
◦ Documentation of the route(s) of exposure,
and the circumstances under which the
exposure incident occurred.

11.  Standard (universal) Precautions
◦ …shall be observed to prevent contact with blood or
other potentially infectious materials.
◦ …all body fluids shall be considered potentially
infectious materials.

12. Purpose - to eliminate or minimize employee exposure:
◦ Readily accessible hand washing facilities.
◦ Contaminated sharps management.
◦ Keeping food and drink out of the work area.
◦ Procedures involving blood handling.
◦ Transport of specimens.
◦ Contaminated equipment.
◦ CFR 1910.1030 (d)(2)

13.  Teaching appropriate technique, make no
assumptions!
 Availability of materials.
 Reinforcing and reminding.
 Monitoring.

14.  Provide alcohol-based hand cleansers in multiple
locations.
 Monitor use by volume replacement and observation.
 When they should be used: if hands are not visibly dirty,
if soap and water are not available.
 Frequent use is recommended, good amount, rubbing
into all surfaces of hands until dry.
 Washing with soap and water: careful technique, 20-30
seconds, if hands are dirty, and after direct contact with
potentially infectious material, after toileting, and when
caring for a patient with a C. Difficile infection.

15. Let’s Take on the Challenge!

16.  Shall be used where exposure remains after
institution of engineering and work practice
controls.
 Employer shall provide appropriate PPE at no cost
to employee.
 May include: gloves, gowns, laboratory coats, face
shields or masks, eye protection, mouthpieces,
resuscitation bags, pocket masks, or other
ventilation devices.

17.  Use
 Accessibility
 Cleaning, laundering, and disposal
 Repair and replacement
 Garment penetration
 PPE removal prior to leaving work area

18.  Worksite maintained in clean and sanitary
condition.
 Cleaning and decontamination of items.
 Safe disposal.

19.  Contaminated sharps discarding and containment:
◦ Approved sharp containers
 Easily accessible
 Upright
 Not allowed to overfill
◦ Container removal
 Close immediately prior to removal
 Place in secondary container if leakage is possible
◦ Reusable containers
 Should NOT be opened, emptied, or cleaned manually

20.  Other regulated waste containment:
◦ Closeable, constructed to contain all contents, labeled or
color-coded, closed prior to removal.
◦ If outside contamination of the container occurs, it shall
be placed in a second container.
 Disposal of all regulated waste shall be in
accordance with applicable regulations.

21.  Public Law 106-430
 Signed into law November 2000 – enacted in
2001 – part of OSHA standards
 “Needlestick Safety and Prevention Act”
 Why? In 2000, it was estimated that over
300,000 percutaneous injuries would occur
involving contaminated sharps.

22.  Requires that organizations use safer medical
devices with injury protection or needleless
systems.
 Need to reflect the changes in technology that
can eliminate or reduce exposure to blood borne
pathogens.
 Must document annually the consideration and
implementation of safer devices.

23.  Must maintain a Sharps Injury Log.
 List for each incident the type and brand of device
involved, department/work area, and how the
incident happened.
 Must “solicit input” from non-managerial staff in
the identification, evaluation, and selection of
effective engineering and work practice controls
and shall document this input process in the
Exposure Control Plan.

25.  Shall be handled as little as possible:
◦ Bagged or containerized at the location where it was
used.
◦ Containers labeled or color-coded.
◦ Leak proof bags or containers.
 Employer shall ensure that employees who have
contact with contaminated laundry wear protective
gloves and other appropriate PPE.
 Shipping to an off-site facility.

26.  The employer shall make available the Hep B vaccine
& appropriate medication…to all employees who have
occupational exposure.
 Post-exposure evaluation & follow-up care to all
employees who have had an exposure incident:
◦ No cost to the employee
◦ At a reasonable time
◦ Licensed physician or healthcare professional
◦ According to recommendations of the US Public Health
Service
◦ All lab tests are conducted by an accredited lab at no cost to
employee

27.  Yes
 Must have them complete the Declination
Statement and keep that document.
1910.1030 Appendix A (mandatory)
Individuals can change their mind at any time and
receive the vaccinations.

28.  Documentation of the route(s) of exposure.
 Identification and documentation of the source individual.
 Collection and testing of blood for HBV and HIV.
 Post-exposure prophylaxis and care.
 Counseling.
 Evaluation of reported illnesses.

29. Labels and Signs
Information and Education
•At the time of initial assignment
•At least annually
•When changes occur
•Content and vocabulary appropriate
to educational level,
literacy, and language of employees

30.  Provided to all employees who may be at risk for
exposure.
 At no cost.
 Minimum requirements
◦ CFR 1910.1030 (g)(2)(vii) lists all training
program requirements.

31.  Medical Records
◦ Shall be maintained for duration of employment plus 30
years.
 Training Records
◦ Shall be maintained for 3 years from the date of training.

32.  Lack of training
 Busy, hectic, rushing
 Decreased awareness of hazards
 “won’t happen to me….”

33.  What strategies can we use that are really
effective?
 What types of infectious diseases?
 Who is accountable?

34. • Engineering controls involve making changes to the
work environment to reduce work-related hazards.
• Work practice controls are procedures for safe and
proper work that are used to reduce the duration,
frequency or intensity of exposure to a hazard.
• Administrative controls include controlling
employees' exposure by scheduling their work tasks
in ways that minimize their exposure levels.
• Personal Protective Equipment (PPE) includes all
clothing and other work accessories designed to
create a barrier against workplace hazards.
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35. Keys to success with all of these strategies:
* Consistency
* Individual accountability
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36.  Current challenge with this: improper and
infrequent hand-washing or use of alcohol-based
cleansers.
 Strategies to encourage:
* Demonstrate proper technique
* Make the materials/supplies/facilities easy to
access, close to all work areas.
* Monitor compliance
* Role modeling
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37.  Encouraging this with all employees and
customers, family members/visitors.
 Consistent messages!
 Providing adequate facilities and materials.
 Monitor use and consistency of practices.
*** We all need to practice this every day.
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38. “Specialized clothing or equipment, worn by an
employee for protection against infectious or
other hazardous materials/objects.
Remember: PPE is the last resort to addressing
worker hazard. (Hierarchy of Controls)

39.  PPE for eyes, face, hand, extremities,
protective clothing, respiratory devices,
protective shields and barriers:
* Shall be provided, used, and maintained in a
sanitary and reliable condition,
* Wherever it is necessary by reason
of hazards or processes or environment.

40.  Must provide PPE at no cost to employee.
 Must assess all work environments for potential
hazards.
 Must provide training to any employee who uses
any PPE.
 Must pay for replacement of any required PPE,
unless the employee has lost or intentionally
damaged the item.

41. Chemical
Radiological
Thermal
Mechanical
Noise
Blood and OPIM (other potential infectious
material)
Encountered by an employee in a manner capable
of causing injury or impairment in any
function/body part through absorption, inhalation,
or physical contact.

42.  Employer shall assess the workplace to
determine if hazards are present that require
the use of PPE.
 Communicate presence of hazards to
employees.
 Select the appropriate PPE – must fit each
employee.

43.  Engage supervisors and employees in the
process.
 Assess in all work locations: support service
areas, patient care areas, specialty areas,
facility management areas, external areas, etc.
 Need to have a written certification that identifies
what was evaluated, who did it, the date.
 Reassess when appropriate - if services
change, locations change.

44.  Locations/situations in where this is
needed?
 Must ensure that each affected employee
uses eye protection that provides front
and side protection from flying
objects/materials.
 If they wear prescription lenses, the eye
protection can incorporate the prescription
in the design, or be worn over the
prescription lenses – must not disturb the
prescription lenses or the protective
lenses.

45.  Does everyone who should wear this, do so,
every time?
 Are they fit properly?
 Are they checked to be sure they are in good
condition?
 What could we do differently?

46.  First Priority: Engineering Controls.
 Includes: enclosure or confinement, general or
local ventilation, or substitution of less toxic
materials.
 When engineering controls are not adequate or
feasible:
Face masks or Respirators should be used!
CFR 1910.134

47.  Provided by the employer.
 Must be applicable and suitable for the purpose
and potential hazards involved.
 Must establish and maintain a respiratory
protection program.

48.  Identify when and where respiratory PPE needs to be
used by employees and what type.
 Provide Medical evaluations prior to fit-testing and use.
 Follow standards on fit-testing procedure.
 Documentation requirements!
 N95 or higher NIOSH certified
respirators.

49.  Employer must select and provide appropriate
hand protection for employees that are exposed
to hazards:
* skin absorption of harmful substances
* severe cuts, lacerations, or abrasions
* punctures
* chemical or thermal burns
* harmful temperature extremes

50.  When and where: patient care, environmental
services, engineering, other areas.
 Glove material: vinyl, latex, nitrile, other.
 Sterile and nonsterile.
 Single use or reusable.
 Critical to train employees on appropriate use,
putting on, and taking off of gloves.

51.  Gown first
 Mask or respirator
 Goggles or face shield
 Gloves
 Combination of PPE will affect sequence – be
practical !

53. • Select a fit tested respirator
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with elastic
• Adjust to fit
• Perform a fit check –
– Inhale – respirator should collapse
– Exhale – check for leakage around face

54.  Gloves
 Face Shield or goggles
 Gown
 Mask or respirator
 And always wash hands thoroughly after removal
of PPE!

55.  Must train before they use the PPE.
 Need to know at least the following:
* when PPE is necessary
* what PPE is necessary
* How to properly put on, take off, adjust,
and wear PPE
* the limitations of the PPE
* proper care, maintenance, useful life,
and disposal of PPE
Resources available: OSHA and CDC/NIOSH

56.  Before using any PPE.
 Document training.
 Do not make assumptions about prior
knowledge of the use of PPE!

57.  When do you want employees to use hand
protection?
 What are some of the most important
“engineering controls” we need to provide?
 Gloves/all PPE must be easily accessible, in good
condition, good fit for every employee.
 Monitoring practices.
 Current state of our art?

58.  Monitoring
 Reminders – examples?
 Easy access
 Good role models/teachers

59.  Careful housekeeping procedures.
 Clear procedures for cleaning of items used by
patients.
 Control of waste materials.
 Annual flu vaccinations for staff and patients.
(now that is a challenge!)

60.  Encourage all employees to get the annual flu
vaccine.
 Encourage employees who are at risk for
complications due to the flu such as those over 50
or with a chronic health condition such as asthma
to get the pneumonia vaccine.
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61.  Seasonal Influenza:
1. VACCINATION!!
* This is the primary prevention strategy.
* Developed each year with the best knowledge
of circulating viral strains included.
* Available in intranasal form (live attenuated)
and injectable form (inactive attenuated).
2. Adherence to good daily hygiene practices.
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62.  Seasonal Flu vaccine is widely available most
years.
 Many healthcare organizations offer it free or at
minimal cost to employees.
 Available at community clinics, pharmacies,
doctor’s offices, etc.
 Current statistics: approximately 30% of US
citizens get the flu vaccine. And healthcare
workers?
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63.  History – I have never had the flu!
 Beliefs in stories of the past.
 One experience (misinterpreted) may decide the
future for an individual!
 I don’t like needles.
 Availability – timing, access, simplicity of the
process.
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64. 64
Flu.gov, April 20, 2010

65.  Sharing the facts.
 Making the vaccine easily available.
 Enlisting the aid of other employees, employee
health staff to talk with employees.
 Assuring that patients and visitors receive the
factual information about the vaccine.
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66.  Hazard awareness in healthcare.
 Must control contact with blood and OPIM.
 Provide hand, eye, face, full body protection –
easily accessible and good fit.
 Teach employees how to use, when to use, how
to put on and take off, how to dispose.
 Prevent the spread of infections whenever
possible!

67.  To improve employee safety.
 To enhance our care of patients, keeping
them and their families safe.

68.  Definition and scope.
 OSHA standards relating to Bloodborne
Pathogens and Personal Protective Equipment.
 Employer responsibilities.
 Employee accountability.