Chapter 24

1. Chapter 24 Bloodborne pathogens in the workplace

2. Major Topics • AIDS in the workplace • Legal concerns • AIDS education • Counseling infected employees • Hepatitis B (HBV) and hepatitis C (HCV) in the workplace • OSHA’s standard on occupational exposure to bloodborne pathogens • Preventing and responding to needlestick injuries

3. AIDS • Acquired immunodeficiency syndrome (AIDS) has become one of the most difficult issues that safety and health professionals are likely to face today. • AIDS and various related conditions are caused when humans become infected with the human immunodeficiency virus (HIV). • This virus attacks the human immune system, rendering the body incapable of repelling disease causing microorganisms.

4. Symptoms of AIDS • Enlarged lymph nodes that persist • Persistent fevers • Involuntary weight loss • Fatigue • Diarrhea that does not respond to standard medication • Purplish spots or blotches on the skin or in the mouth • White, cheesy coating on the tongue • Night sweats • Forgetfulness

5. Known ways that AIDS is transmitted • Sexual contact • Blood contact • Mother to child during pregnancy or child birth

6. AIDS - high risk people • Homosexual men who do not take appropriate precautions • IV drug users who share needles • People with a history of multiple blood transfusions or blood product transfusions • Sexually promiscuous people who do not take appropriate precautions

7. Ways that AIDS is not transmitted • AIDS is a blood borne, primarily sexually transmitted disease. It is not spread by casual contact in schools, workplaces, public washrooms, or restaurants. It is not spread via handshakes, social kissing, coughs, sneezes, drinking fountains, swimming pools, toilet facilities, eating utensils, office equipment, or by being next to an infected person. • No cases of AIDS have been reported from food being either handled or served by an infected person in an eating establishment. • AIDS is not spread by giving blood. New needles and transfusion equipment are used for every donor. • AIDS is not spread by mosquitoes or other insects. • AIDS is not spread by sexual contact between uninfected individuals – whether homosexual or heterosexual – if an exclusive sexual relation has been maintained.

8. AIDS in the workplace • The first step in dealing with AIDS at the company level is to develop a comprehensive AIDS policy. • Employers are feeling the impact of AIDS in increased insurance premiums and health care costs, time on the job losses, and decreased productivity, AIDS related lawsuits, increased stress, and related problems that result from misconceptions about AIDS.

9. Minimum components of corporate AIDS policy • The starting point for dealing with AIDS in the workplace is the development of a company policy that covers AIDS and other blood borne pathogens. • The policy should cover the following areas at a minimum: • Employee rights: Treat HIV-positive employees compassionately, allowing them to work as long as they perform their jobs. Make reasonable allowances to accommodate the HIV-positive employee. Ensure that HIV-positive employees have access to private health insurance that covers the effect of AIDS. Include provisions for evaluating the work skills of employees to determine if there has been any degradation of ability caused by the disease. • Testing: presence of HIV antibodies means that a person has been infected with the virus. There is a growing body of support for mandatory testing. • Education: It is important to have an ongoing education program to keep employees up to date and knowledgeable. The primary purpose is to convey basic knowledge and eliminate unnecessary fear among coworkers.

10. Legal concerns: otherwise qualified, essential functions, and reasonable accommodation • Otherwise qualified: A person with a handicap is otherwise qualified when he or she can perform what the courts have described as essential functions of the job. • Essential functions: The supervisor’s knowledge of the various jobs in his or her unit is essential in helping company officials make a qualified decision. • Reasonable accommodation: In determining if a worker with a disability can perform the essential functions of a job, employers are required to make reasonable accommodations to help the worker. • What constitutes reasonable accommodation and otherwise qualified must be determined on a case by case basis.

11. AIDS testing • State Laws: Control of communicable diseases is typically considered to be the province of the individual state. Some states prohibit the use of pre-employment AIDS tests to deny employment to infected individuals. • Federal Laws and regulations: The laws protecting an individual’s right to privacy and due process apply to AIDS testing. • Civil suits: An employer cannot discriminate against an employee who has a communicable disease. • Company policy: Companies should have an AIDS policy that contains a testing component that includes a strong rationale, procedures to be followed, employee groups to be tested, the use and dissemination of results, and the circumstances under which the testing will be done. Safety and health professionals should be knowledgeable about their company’s policy and act in strict accordance with it. • The purpose of the screening must be ethically acceptable. • The means to be used in the screening program and the intended use of the information must be appropriate for accomplishing the purpose. • High quality lab services must be used. • Individuals must be notified that the screening will take place. • Individuals who are screened must have the right to be informed of the results. • Sensitive and support counseling programs must be available before and after screening to interpret the results, whether they be positive or negative. • The confidentiality of screened individuals must be maintained.

12. Most widely used HIV test • Ensuring the accuracy of an HIV antibody test requires two different tests, one for initial screening, and one for confirmation. • The screening test used is the ELISA (enzyme linked immunosorbent assay) test. • The confirmation test is the IFA (immuno-florescent) or the Western blot test. • The ELISA test is relatively accurate, bur is susceptible to both false positive and false negative tests.

13. AIDS education • A well planned AIDS education program can serve several purposes: • It can give management the facts needed to develop policy and make informed decisions with regard to AIDS • It can result in changes in behavior that will make employees less likely to contract or spread the disease • It can prepare management and employees to respond appropriately when a worker falls victim to the disease • It can decrease the likelihood of legal problems resulting from an inappropriate response to an AIDS related issue. • Consequently, safety and health professionals should be prepared to participate in developing AIDS education programs.

14. Counseling infected employees • The employee who learns that he or she has AIDS will be angry, frightened, and confused. Safety and health professionals who are faced with such an employee should proceed as follows: • Listen • Maintain a nonjudgmental attitude • Make the employee aware of the company’s policy on AIDS • Respond in accordance with the company’s policy

15. Easing employees’ fears about AIDS • Work with higher management to establish an AIDS education and awareness program that covers the following topics at a minimum: How HIV is transmitted, precautions that workers can take, and concerns about AIDS testing. • Conduct group round table discussions that allow employees to express their concerns. • Correct inaccuracies, rumors, and misinformation about AIDS as soon as they occur.

16. OSHA categorization of work tasks • OSHA guidelines for preventing exposure to HIV infection identify three categories of work related tasks: Categories I, II, and III. • Jobs that fall into Category I involve routine exposure to blood, body fluids, or tissues that may be HIV infected. • Category II jobs do not involve routine exposure to blood, body fluids, or tissues, but some aspects of the job may involve occasionally performing Category I tasks. • Category III jobs do not normally involve routine exposure to blood, body fluids, or tissues. • Most industrial occupations fall into Category III. However regardless of the category of their job, employees should know how to protect themselves, and safety and health professionals should be prepared to tell them how.

17. Guard against contracting AIDS • The U.S. Public Health Service recommends the following precautions for reducing the chances of contracting AIDS: • Abstain from sex or have a mutually monogamous marriage or relationship with an infection free partner. • Refrain from having sex with multiple partners or with a person who has multiple partners. The more partners one has, the greater the risk of infection. • Avoid sex with a person who has AIDS or who you think may be infected. However if you choose not to take this recommendation, the next logical course is to take precautions against contact with the infected person’s body fluids [blood, semen, urine, feces, saliva, and female genital secretions]. • Do not use intravenous drugs or if you do, do not share needles. • Safety and health professionals should make sure that all employees are aware of these common precautions. They should be included in the company sponsored AIDS education program.

18. CPR administered safely • It is not uncommon for an employee to be injured in a way that requires resuscitation. • The HIV virus has been found in human saliva. • Because CPR involves using your fingers to clear the airway and placing your mouth over the victim’s, there is concern about contracting AIDS while trying to resuscitate someone. • Because of this concern, disposable face masks and various other types of personal protective devices are now being manufactured. • Safety and health professionals should ensure that such devices are used in both training and live situations involving CPR. These devices should be readily available in many easily accessible locations throughout the company.

19. Hepatitis B Virus (HBV) • Although the spread of HIV receives more attention, a greater risk is from the spread of Hepatitis B. • The Hepatitis B virus can be transmitted by: contact with blood, body fluids including tears, saliva, and semen. • Persons infected with the HBV may contract chronic hepatitis, cirrhosis of the liver, and primary heptocellular carcinoma. • The symptoms of hepatitis B are varied but include: jaundice, joint pain, rash, and internal bleeding.

20. Preventing Hepatitis C Virus (HCV) • Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States, with approximately 36,000 new cases diagnosed every year. • Prevention and controlling HCV requires: • Primary prevention activities: screening and testing blood, plasma, organ tissue, and semen donors. Virus inactivation of plasma-derived products. Risk reduction counseling and services. Implementation and maintenance of infection control practices. • Secondary prevention activities: identification, counseling, and testing of persons at risk. Medical management of infected persons. • Education and training • Monitoring the effectiveness of prevention activities to develop improved prevention methods.

21. Needle-stick prevention program • The National Institute for Occupational Safety and Health [NIOSH] has a website http://www.cdc.gov/niosh/topics/bbp/safer that recommends a five step model for developing, establishing, and maintaining a needle-stick prevention program: • Form a needle-stick injury prevention team. • Identify priorities • Identify and screen safer medical devices. • Evaluate safer medical devices. • Institute and monitor the use of safer medical devices selected.

22. Summary • Symptoms of AIDS are persistent fevers, involuntary weight loss, fatigue, diarrhea, purplish spots or blotches, night sweats, and forgetfulness. • A corporate AIDS policy should have 3 components: employee rights, testing, and education. • An AIDS program may include: counseling, referral, classroom instruction, self paced instruction, group discussion, and printed materials. • When counseling AIDS infected employees, safety and health professionals should follow company policy. • Hepatitis B (HBV) is transmitted through tears, blood, saliva, and semen and is an even greater risk that HIV. • Hepatitis C (HCV) is the most common blood borne infection in the U.S. About 36,000 new cases are diagnosed each year primarily through exposure to blood. • For preventing needle stick injuries: evaluate safer devices and monitor their use.

23. Home work • Answer questions 7, 8, 12, and 14 on page 560. • 7. Briefly explain the minimum components of a corporate AIDS policy. • 8. Explain how the following legal concepts relate to AIDS: otherwise qualified, essential functions, and reasonable accommodation. • 12. How should a safety and health professional proceed when faced with an employee who thinks he or she has AIDS? • 14. Explain how OSHA categorizes work tasks relative to exposure to HIV infection.