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Bloodborne Pathogens. Department of Labor and Industries Consultation & Education Services. Course Objectives. What are Bloodborne Pathogens? Why are they harmful? What must I do to protect my workers? What is, and how do I write an Exposure Control Plan?

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Bloodborne pathogens l.jpg

Bloodborne Pathogens

Department of Labor

and Industries

Consultation & Education

Services


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Course Objectives

  • What are Bloodborne Pathogens?

  • Why are they harmful?

  • What must I do to protect my workers?

  • What is, and how do I write an Exposure Control Plan?

  • What are the requirements of WAC 296-62-0800?


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Disease

PATHOGENS

  • Parasite

  • Bacteria

  • Fungi

  • Virus


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Disease

TRANSMISSION

  • Air

  • Fecal

  • Bloodborne


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What are Bloodborne Pathogens ?

  • How are they harmful ?

  • How are they contracted ?

  • Some facts and figures


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Definitions

Blood Bloodborne Pathogens


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Definitions

Other potential infectious materials

OPIM


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Hepatitis B or C Virus

  • Inflammation of the liver

  • Causes liver damage ranging from mild to fatal

  • Can live in a dry environment for at least 7 days


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HBV -Hepatitis B

  • Very infectious

    • 1/3 no symptoms, 1/3 flu-like, 1/3 severe

    • 6 to 10% of cases infectious for life (carrier state)

  • In the past, 140,000-300,000 new infections per year

    • 5,000-6,000 deaths/yr from chronic liver disease

  • Safe and effective vaccine is now available

    • Many HCW are not vaccinated


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HBV - Hepatitis B

Health Care Workers and HBV

  • Approximately 400 HCW infected annually

  • This is a decrease from 17, 000 in 1983 and 1,000 in 1994.

  • 25% of infected develop acute hepatitis

  • 10-30% of health/dental workers show evidence of past HBV infection


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HCV - Hepatitis C

  • Affects 4 times more people than HIV

  • 4 million Americans infected

  • Only 25% of those infected have been diagnosed

  • In 1995, estimated 560-1120 cases among HCW in U.S.


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HCV - Hepatitis C

  • Symptoms may or may not be present

  • Infection may lead to carrier state

  • Carrier state can develop with or without symptoms

  • Carrier state can lead to chronic liver disease, cirrhosis (10 year latency), or cancer (alcohol is strong co-factor)

  • Leading cause of liver transplant in U.S.


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HCV - Hepatitis C

  • 85% of Hepatitis C infections persist for life

  • 70% develop chronic liver disease

  • Signs and symptoms may not appear until 10 years after infection

  • Onset of symptoms may present with severe liver disease

  • No broadly effective treatment

  • No vaccine available


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HCV - Risk Factors

  • Blood transfusion prior to 1992

  • IV drug use

  • Unprotected sex (multiple sexual partners)

  • Occupational percutaneous exposure to blood with contaminated sharp

    • Risk is intermediate between Hepatitis B and HIV


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Human Immunodeficiency Virus (HIV)

  • Attacks the human immune system

  • Can live in a dry environment for only a few hours

  • > 1 million infections in U.S.

  • 56 documented cases among HCW;

  • 138 cases of possible occupational transmission


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AIDS

  • AIDS = Acquired Immunodeficiency Syndrome

  • Results from destruction of the human immune system from infection with HIV

  • Some have no symptoms, or less severe symptoms

  • No vaccine available yet


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HBV & HIV Compared

HBV HIV

  • HCW cases 400/yr. 56

  • Risk of infection

    • Needle stick 6-30/100 1/300

  • Vaccine available Yes No


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Hepatitis C

Infectivity: Low

Nucleic Acid: RNA

Carrier state: > 80%

Route: Blood

Hepatitis B

Very High

DNA

Variable {10-50%}

Blood

HBV & HCV Compared


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Control

Plan

Exposure Control Plan

“To eliminate or minimize employee exposure”

  • Exposure determination

  • Controls

    • Universal precautions (or equivalent system)

    • Engineering controls

    • Work practices

    • Personal protective equipment

    • Housekeeping


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Exposure Control Plan

  • Hepatitis B vaccination

  • Post exposure evaluation & follow-up

  • Communication and training

  • Recordkeeping


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Exposure Determination

  • Do we have job classifications where ...

    • All employees are occupationally exposed?

      • List the classifications

    • Some employees are occupationally exposed?

      • List the classifications

      • List the tasks with exposure

  • Determine exposure without regard for PPE the worker uses


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First Aid

First aid training

Good Samaritan

Collateral duty*

Designated responder

BBP standard

applies

Not covered by

BBP Standard

BBP standard applies

* if First-Aid response is an expected part of the job


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Universal Precautions

Treat as if known to be infectious

Certain human body fluids

All human blood

All human body fluids if they can’t be distinguished


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Engineering Controls

  • Isolate or remove the bloodborne pathogen hazard from the workplace

    • A physical guard

    • Barrier

    • Environmental controls

    • Other devices


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Engineering Controls

  • Annual evaluation and documentation

  • Solicit input from patient care providers

  • Implement commercially available, effective and appropriate devices

  • Document justifications for not using safer devices


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Physical Guard

Sharps disposal containers

  • Closable

  • Puncture resistant

  • Leakproof

  • Labeled


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Barriers


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Environmental Controls

Ventilation Hoods


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Other Devices

  • Avoid recapping

  • Use Safer Sharp Devices

    • needleless IV systems

    • retractable syringes and lancets

    • puncture-resistant capillary tubes


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Work Practice Controls

Safer steps to do the job!

  • Prohibit two-handed needle recapping

  • Do not bend, break or remove needles (incl. phlebotomy)

  • Wash hands between glove use

  • Flush body parts with water after contact with blood or OPIM

  • Remove PPE before leaving work area


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Examples of Work Practice Controls

  • Lab coat removal Handwashing


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Personal Protective Equipment PPE

Provided at no cost to employee

  • Gloves

  • Gowns

  • Face shields and/or masks

  • Eye protection

  • Resuscitation devices

  • Lab coats


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PPE

Gloves

  • Latex

  • Nitrile

  • Vinyl

  • Utility


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PPE

Gowns


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PPE

Eye - Face protection and masks


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PPE

Resuscitation devices


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Housekeeping

Maintain a clean and sanitary workplace

  • Written cleaning and decontamination schedule

  • Contaminated waste disposal methods

  • Laundry

DISINFECTANT


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Regulated Waste

  • Blood or OPIM

    • Liquid

    • Semi-Liquid

    • Contaminated sharps

    • Lab or medical waste

  • Other items caked with dried blood or OPIM


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Regulated Waste Containers

  • Easily accessible

  • Leakproof

  • Maintained upright

  • Labeled or color coded

  • Replaced routinely ( no overfill!!!)

  • Disposal

    • County or City Health Dept.. Regulations


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Regulated Waste Handling

  • When moving containers:

    • Close immediately

    • If leaking, place in secondary container

    • If reusable, clean in a manner that will not expose employees.


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Laundry

  • Handle as little as possible!

    • Bag/containerize where used

    • Don’t sort or rinse where used

    • Labeled or color coded containers

    • Leak-proof containers if leaks are likely

  • Employees must wear proper PPE!!!


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Hepatitis B Vaccine

  • 3 shot series

  • Effective for 95% of adults

  • Post-vaccination titers for high risk HCW

  • Exposure without vaccination

    • Immune globulin ASAP after exposure

    • BeginVaccination series


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Hepatitis B Vaccination

  • Make Hepatitis B vaccination available

    • Declination statement required

    • Available at later date if desired

  • No cost to employees

  • Reasonable time and place

  • If series is interrupted, continue at any time rather than restart series


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Exposure Incident

Contact with blood or OPIM via:

  • Cuts, puncture, needle sticks

  • Mucous membrane

  • Eye

  • Non-intact skin


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Post Exposure Evaluation

Employer Responsibility:

  • Provide medical evaluation ASAP

    • Testing for HBV, HCV, HIV

    • HIV/HBV PEP when indicated

  • Identify source individual, if possible

    • Obtain consent for blood test

  • Provide information to healthcare provider

    • Routes of entry

    • Employee’s job duties

    • Copy of the regulation


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Post Exposure Evaluation

  • Insure that the healthcare provider provides to exposed employee:

    • Results of the source individuals test (if legal)

    • Results of exposed employee’s test

    • Post exposure treatment as needed

  • Provided at no cost to employee


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Medical Evaluation and Follow-up

Healthcare Provider’s Responsibility:

  • Provide in writing to employer:

    • Employee has been informed of the results

    • Employee has been informed of any medical conditions resulting from exposure

  • All specific findings or diagnoses are confidential to employee


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Communication

  • Signs and labels

    • Regulated waste

    • Containers with blood or OPIM

    • Laundry

    • Biohazard symbol


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Training

  • Provided to occupationally exposed employees:

    • At time of initial assignment

    • At least annually thereafter

    • Cover specific required elements

    • Interactive

    • Qualified trainers


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Recordkeeping

  • Medical records

    • HBV vaccination status

    • Written medical opinion of exposure incidents

    • Exposure incident details

    • Maintain for length of employment + 30 years


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Recordkeeping

  • Training records

    • Dates

    • Content summary

    • Trainer name & qualifications

    • Attendee’s names & job titles

    • Maintain for 3 years


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Sharps Log

  • Maintain a separate sharps injury log

  • Document sharps injuries on the OSHA 300 or equivalent form per 296-27 WAC

  • Recorded as confidentiality case

  • Must contain:

    • Type and brand of device involved

    • Department or work area where exposure occurred

    • An explanation of how the incident occurred


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Plan Evaluation

  • Review and/or update annually

  • Whenever necessary to reflect changes that affect occupational exposure, including improved safety devices


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Summary

Summary

  • What Bloodborne Pathogens are

  • Why they are Harmful

  • Employer Responsibilities

  • Written Exposure Control Plan

  • Understand the Requirements of WAC 296-62-0800


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Thank you for attending!

Now it is your turn!

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