Bloodborne Pathogens

1. Bloodborne Pathogens

2. TOSHA believes the information in this presentation
to be accurate and delivers this presentation as a
community service. As such, it is an academic
presentation which cannot apply to every specific
fact or situation; nor is it a substitute for any
provisions of 29 CFR Part 1910 and/or Part 1926
of the Occupational Safety and Health Standards
as adopted by the Tennessee Department of Labor
and Workforce Development or of the
Occupational Safety and Health Rules of the
Tennessee Department of Labor and Workforce
Development.

3. Bloodborne Pathogens
Pathogenic micro-
organisms present
in human blood that
can lead to diseases
Most common in US
– Human immuno-
deficiency virus (HIV)
– Hepatitis B (HBV)
– Hepatitis C (HCV)

4. Hepatitis
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Viruses which attacks the liver
Liver performs many functions vital to life
– Blood reservoir, blood filter, carbohydrate, fat,
protein metabolism, storage of vitamins, iron, etc.

5. Hepatitis A
Caused by infection with Hepatitis A virus (HAV)
Virus is found in the stool of infected persons
HAV is usually spread from person to person by
putting something in the mouth (even though it may
look clean) that has been contaminated with the stool
of a person with hepatitis A
Hepatitis A infection occurs in epidemics both
nationwide and in communities
Hepatitis A is NOT bloodborne and, therefore, is
NOT covered by the bloodborne pathogen
standard

6. Hepatitis A--Symptoms
Jaundice
Fatigue
Abdominal pain
Loss of appetite
Nausea
Diarrhea
Fever

7. Hepatitis A Prevention
Good personal hygiene and proper sanitation
can help prevent infection with the hepatitis A
virus
Always wash your hands with soap and water
after using the bathroom, changing a diaper,
and before preparing and eating food
Vaccine is available

8. Hepatitis B
Hepatitis B is a disease of the liver caused by
infection with the hepatitis B virus (HBV)
Infection occurs when blood or body fluids from an
infected person enters the body of a person who is
not immune
HBV is spread through:
– Sex with an infected person without using a condom (the
efficacy of latex condoms in preventing infection with
HBV is unknown, but their proper use may reduce
transmission)
– Sharing drugs, needles, or "works" when "shooting"
drugs
– Exposure to blood and body fluids on the job
– From an infected mother to her baby during birth

9. Hepatitis B
HBV can cause lifelong infection, cirrhosis
(scarring) of the liver, liver cancer, liver failure,
and death
Symptoms
– Jaundice
– Fatigue
– Abdominal pain
– Loss of appetite
– Nausea, vomiting
– Joint pain

10. Hepatitis B--Prevention
A safe and effective vaccine is available
Use latex condoms correctly and every time you have
sex
If you are pregnant, get a blood test for hepatitis B
Never share drugs, needles, syringes, or "works“
Do not share personal care items that might have
blood on them (razors, toothbrushes)
Do not come into contact with another person’s blood
or body fluids at work

11. Hepatitis C
Hepatitis C is a disease of the liver caused by
infection with the hepatitis C virus (HCV)
Infection occurs when blood or body fluids from an
infected person enters the body of a person who is
not infected
HCV is spread through
– Sharing needles or "works" when "shooting" drugs,
– Exposure to blood and body fluids on the job
– From an infected mother to her baby during birth
55%-85% of infected persons are chronically
infected
70% of chronically infected persons develop chronic
liver disease

12. Hepatitis C
Hepatitis C infection is the leading indication for
liver transplant
Symptoms
– Jaundice
– Fatigue
– Dark urine
– Abdominal pain
– Loss of appetite
– Nausea
80% of infected persons have no signs or symptoms

13. Hepatitis C--Prevention
There is no vaccine to prevent hepatitis C
Do not “shoot” drugs and never share needles,
syringes, or "works"
Do not share personal care items that might
have blood on them (razors, toothbrushes)
Do not come into contact with another
person’s blood or body fluids at work

14. Hepatitis D
Hepatitis D is a liver disease caused by infection
with the hepatitis D virus (HDV)
It is a defective virus that needs the hepatitis B
virus to exist

15. Hepatitis E
Hepatitis E is a liver disease caused infection with
the hepatitis E virus (HEV)
It is transmitted in much the same way as hepatitis
A virus through the fecal/oral route
Hepatitis E virus is NOT bloodborne and is
NOT covered by the bloodborne pathogen
standard
Hepatitis E virus does not occur often in the United
States

16. Viral Hepatitis - Overview
A B C D E
Source of
virus
feces blood/
blood-derived
body fluids
blood/
blood-derived
body fluids
blood/
blood-derived
body fluids
feces
Route of
transmission
fecal-oral percutaneous
permucosal
percutaneous
permucosal
percutaneous
permucosal
fecal-oral
Chronic
infection
no yes yes yes no
Prevention pre/post-
exposure
immunization
pre/post-
exposure
immunization
blood donor
screening;
risk behavior
modification
pre/post-
exposure
immunization;
risk behavior
modification
ensure safe
drinking
water
Type of Hepatitis

17. HIV
Human immunodeficiency virus
Infection occurs when blood or body fluids from an
infected person enters the body of a person who is
not infected
HIV is spread through:
– Sex with an infected person without using a condom (the efficacy of
latex condoms in preventing infection with HIV is unknown, but their
proper use may reduce transmission)
– Sharing drugs, needles, or "works" when "shooting" drugs
– Exposure to blood and body fluids on the job
– From an infected mother to her baby when she is pregnant, when she
delivers the baby, or if she breast-feeds her baby
Leads to the disease AIDS
Destroys the immune system

18. HIV/AIDS Symptoms
You cannot rely on symptoms to know whether or
not you are infected
The only way to know if you are infected is to be
tested for HIV infection
Many people who are infected with HIV do not have
any symptoms at all for 10 years or more
You also cannot rely on symptoms to establish that a
person has AIDS
The symptoms of AIDS are similar to the symptoms
of many other illnesses
AIDS is a medical diagnosis made by a doctor
based on specific criteria established by the CDC

19. HIV Prevention
Use latex condoms correctly and every time you
have sex
Don’t share, syringes, or “works” used to inject
drugs, steroids, vitamins, etc.
If you are pregnant or think you might be soon, talk
to a doctor or your local health department about
being tested for HIV. Drug treatments are available
to help you and reduce the chance of passing HIV to
your baby if you have it
Don’t share razors or toothbrushes because of the
possibility of contact with blood
Do not come into contact with another person’s
blood or body fluids at work

20. You Cannot “Catch” Hepatitis B, C,
or HIV
By working with or being around someone who has
the disease
From sweat, spit, tears, clothes, drinking fountains,
phones, toilet seats, or through everyday things like
sharing a meal
From insect bites or stings
From donating blood
From a closed-mouth kiss (but there is a very small
chance of getting it from open-mouthed or
"French" kissing with an infected person because of
possible blood contact)

21. Other Bloodborne Diseases
Syphilis
Malaria
Brucellosis
Babeosis
Leptospirosis
Arborviral Infections
Relapsing Fever
Creutzfeld-Jacobs Disease--Mad-cow
Viral Hemorrahgic Fever--Ebola

22. The Bloodborne Pathogen Standard
29 CFR 1910.1030
1. Written Exposure Control Program
2. Engineering Controls (safer medical devices) and work
practice controls
3. Personal Protective Equipment
4. Housekeeping
5. Hepatitis-B vaccine and antibody test
6. Confidential follow-up and evaluation of circumstances in
event of a needlestick or other exposure incident
7. Labeling
8. Initial and Annual training.
9. Sharps Injury Log
10. Recordkeeping

23. Scope of the Standard
Covers all employees with reasonable
anticipation of exposure to potentially
infectious materials (bloodborne pathogens)
Applies to general industry situations only
Does not apply to the construction industry
5.6 million workers in health care and
public safety occupations are covered

24. Potentially Infectious Materials--
Blood (human)
Semen
Vaginal secretions
Cerebrospinal fluid
Pleural fluid
Pericardial fluid
Peritoneal fluid
Amniotic fluid
Saliva in dental proc.
Any visibly
contaminated body
fluid
Any body fluid where
differentiation is
difficult
Any unfixed tissue or
organ
Aqueous and vitreous
humors in the eyes

25. Modes of Transmission
Stick or Cut
Splash to mucous membranes of the eyes,
nose, mouth
Non-intact skin exposure

26. Universal Precautions
Must be observed
All blood and body fluids are treated as if
known to be infected with HIV, HBV,
HCV, etc.
Key to Prevention of Infection
–Do not come into contact with
another person's blood or body
fluids

27. Exposure Control Plan
Employer's plan describing how compliance with
the standard is achieved
Describes what employees are covered
Describes tasks that are covered
Describes post-exposure follow-up procedures
Must be reviewed and updated annually
Must be accessible to employees
– Each employee should know the procedure to
follow to obtain a copy

28. Exposure Control Plan
Safer Medical Devices
– The Exposure Control Plan must be updated every
12 months to reflect evaluation, consideration, and
selection of appropriate devices
– Document in the plan the devises evaluated and
those currently used
– Front line employees must be involved in the
selection of devices and their involvement must be
documented

29. Handwashing
The single most important aspect of
infection control
Wash hands when contaminated with
blood or body fluids and after removing
personal protective equipment
Use antiseptic hand cleaner clean
paper/cloth towels or antiseptic
towelettes when "in the field"
Wash hands with soap and water asap

30. Use sharps with sharps injury prevention or needleless
systems for all procedures involving sharps
Place in puncture resistant, labeled, leak-proof containers for
transport, storage, and/or disposal
Keep the container closed
Do not bend, break, recap, or remove needles
Do not pick up contaminated broken glass directly with the
hands
Do not reach by hand into containers where contaminated
sharps are placed
Do not overfill sharps containers
Needles/Sharp Objects

31. Eating/Drinking
Do not eat or drink in
areas where there is
exposure to blood or
body fluids
Do not store food in
refrigerators, freezers,
cabinets, on shelves or
countertops where blood
or other body fluids are
present

32. Personal Protective Equipment
(PPE)
Wear PPE to prevent blood or body fluids
from getting on your clothes, skin,
underclothes, etc.
Must be provided at no cost to the
employees
Must be accessible to the employees
Employer must enforce the use
Must be removed prior to leaving the work
area and placed in designated area

33. PPE
Parental exposure
– stick or cut
Mucous membrane
– splash
Non-intact skin
– spill or splash
Gloves
– patient care and utility
gowns
glasses/
goggles/faceshields
masks
pocket masks
shoe covers

34. Decontamination
Written decontamination schedule must be
part of the exposure control plan
Clean and decontaminate all equipment and
environmental and working surfaces after
contact with blood and/or body fluids
Decontaminate with appropriate disinfectant
– EPA registered tuberculocidal disinfectant
– EPA registered disinfectant with label stating it is
effective against HIV and HBV
– Household bleach, diluted 1:10-1:100, made fresh
daily

35. Contaminated Laundry
Remove contaminated clothing when it
becomes contaminated
Place immediately in bag or container that
is labeled
Prevent leakage

36. Regulated Waste
Sharps containers
– Needles
– Blades
– Broken glass
Red bags
– Liquid or semi-liquid blood or
OPIM
– Items caked with dried blood or
OPIM
– Items that could release blood or
OPIM
– Pathological waste
– Microbiological waste

37. Hepatitis B Vaccination
The employer must offer the HBV vaccination to
exposed employees after they have received training
and within 10 working days of job assignment
– At no cost to the employee
– Provided by PLHCP (see next slide)
– According to US Public Health Service most current
recommendations
• “Immunization of Health Care Workers: Recommendations of
ACIP and HICPAC,” MMWR, Vol. 46, No. RR-18

38. What is a PLHCP?
PLHCP = Physician or Other Licensed
Health Care Professional
In Tennessee, licensing boards have
determined a PLHCP is a:
– Physician
– Physician’s Assistant
– Advanced Practice Nurse

39. HBV Vaccination
Must be offered to all exposed employees
Exposed employees may decline to take the
shots, but must sign a declination statement
Highly recommended and safe
Few contraindications
Three-shot series—titer 1-2 months after
last shot
No booster currently recommended

40. Health Care Professional’s
Written Opinion for Hepatitis B
Vaccination
A PLHCP must determine if the shots are
appropriate for each employee
The PLHCP must provide to the employer a
Health Care Professional’s Written Opinion for
each employee who takes the shots
– A copy must be provided to the employee within 15
days of completion of the evaluation
Employee can decline now, take the shots later

41. Post-Exposure Follow-up
After exposure incident
– Stick or cut
– Splash
– Non-intact skin exposure
At no cost to the employee
Begin ASAP after exposure incident
Report exposure incidents to your
supervisor or designated personnel
immediately

42. Post-Exposure Follow-up
The employer must:
– Investigate the incident
– ID source individual, obtain consent, and test
his/her blood to determine HBV, HCV, and
HIV infectivity ASAP, if possible
– Give the results of source individual's test to the
exposed employee
– Obtain and test exposed employee's blood for
HBV, HCV, and HIV serological status

43. Post-Exposure Follow-up
Provide post-exposure prophylaxis to the exposed
employee as indicated by the CDC
– “Updated U.S. Public Health Service Guidelines for the
Management of Occupational Exposures to HBV, HCV, and
HIV and Recommendations for Postexposure Prophylaxis,”
June 29, 2001, Vol 50, No. RR-11
– “Updated U.S. Public Health Service Guidelines for the
Management of Occupational Exposures to HIV and
Recommendations for Postexposure Prophylaxis,”
September 30, 2005, Vol 54, RR-09
Provide counseling to the exposed employee
Provide evaluation of illness reported by the employee
HIV
Hepatitis

44. Health Care Professional’s Written
Opinion for Post-Exposure Follow-Up
The post–exposure follow-up must be provided by
or under the supervision of a PLHCP
The PLHCP must provide to the employer a
Health Care Professional’s Written Opinion for
each employee who has a post-exposure follow-up
– The employee must be provided a copy of the Health
Care Professional's Written Opinion for Post-Exposure
Follow-up within 15 days of completion of the
evaluation

46. Labels
On refrigerators,
freezers, and other
containers with
contaminated items
Can substitute red
containers

47. Training
For all employees listed in the Exposure
Determination
At no cost to employees
During working hours
At the time of initial assignment
Annually--within 12 months of last training date
Must be an opportunity for interactive questions
and answers
Train employees on adopted safer needle devices
before implementation

48. How TOSHA Evaluates
Employee Training
Recall
– Employees must be able to answer simple
questions about bloodborne pathogens, the
bloodborne pathogen standard, and other
material as specified in 29 CFR 1910.1030,
paragraph (g)(2)(vii).

49. Recall Questions
Five Easy Questions
– What is universal precautions?
– What do you do when there is a blood spill?
• Personal protection
• Clean-up and disposal procedures
• Disinfection (hazard communication applies)
– What do you do with contaminated sharps and
laundry?
– Have you been offered the HBV vaccination free
of charge?
– Where is the Exposure Control Plan?

50. Additional Training
Copy of the BBP standard, 29 CFR 1910.1030,
must be accessible to employees
Epidemiology, symptoms, and modes of
transmission of bloodborne diseases
Engineering and work practice controls in practice
Explanation of methods of recognizing tasks that
may involve exposure to blood and/or body fluids
Information on types, use, location, removal,
handling, decontamination, and disposal of personal
protective equipment (ppe)

51. Additional Training
Basis of selection of PPE
Information on hepatitis B vaccine
Explanation of the labeling system
Actions to take and persons to contact in a
bloodborne emergency
Procedure to follow if exposure incident
occurs
Opportunity for interactive Q & A

52. Records
Medical records
– Name and social security number
– Hepatitis B vaccination status
– Dates of hepatitis B vaccination
– Results of exposure incident follow-up
– Health care professional's written opinions
– Info provided to health care professional
– Confidential

53. Records
Training
– Dates
– Contents
– Names and qualifications of trainers
– Names and titles of persons attending

54. Records
Sharps Injury Log
– Per the Tennessee Sharps Injury
Prevention law
– Employer must keep a log of all sharps
injuries with
• Type and brand of device involved in the
incident
• Department or work area where the incident
occurred
• Explanation of how the incident occurred

55. Call TOSHA
Memphis Office 901-543-7259
Jackson Office 731-423-5641
Nashville Office 615-741-2793
1-800-249-8510
Knoxville Office 865-594-6180
Kingsport Office 423-224-2042
Chattanooga 423-634-6424
Consultative Services 1-800-325-9901

56. Web Resources
Federal OSHA
• www.osha.gov
TOSHA
• www.tennessee.gov/labor-wfd/tosha
Centers for Disease Control
• www.cdc.gov
National Institute of Occupational Safety and
Health
• www.cdc.gov/niosh