BLOODBORNE PATHOGENS Training

1. BLOODBORNE PATHOGENS Training THE OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) STANDARD Revised January 2011

2. INTRODUCTION • What is the bloodborne pathogens standard? • Who needs bloodborne pathogens (BBP) training? • What content needs to be included?

3. OSHA’s EXPECTATIONS • Employers Duties • identify job risks and classify • provide appropriate training • provide exposure plan • provide appropriate equipment • Compliance • Employees Duties • follow employer’s plan • know job classification • complete training • use equipment provided by employer • Compliance

4. OSHA REQUIRED INFORMATION • Documents • General explanation of bloodborne pathogens • Hepatitis B immunization • Explanation of tasks that may involve exposure

5. BLOODBORNE PATHOGENS DEFINED • Disease-causing microorganisms that may be present in human blood or other potentially infectious material (OPIM) • Viruses – Hepatitis B (HBV), Hepatitis C (HCV), HIV • Bacteria - Syphilis • Parasites - Malaria

6. MODES OF TRANSMISSION • Puncture wounds or cuts • Contact (touch, splash, or spray) with blood or OPIM on: • mucous membrane • non-intact skin • cuts, abrasions, burns • acne, rashes • paper cuts, hangnails • contaminated sharps

7. Objective • Objective of BBP standard is to minimize or eliminate the hazard posed by work that may expose one to blood or OPIM • Effectively treat employees involved in an exposure to BBP

8. RISKOF EXPOSURE • If an exposure occurs one should know: • Is there a way to prevent infection • What are signs & symptoms of infection • availability of counseling • availability of post-exposure treatment & follow-up

9. OCCUPATIONAL EXPOSURE INCIDENTS • Occupational contact with blood or OPIM is considered an exposure incident • If an exposure occurs: • wash with soap & water • report incident • document incident • seek “immediate” medical evaluation • follow employer’s exposure control plan

10. IMMEDIATE MEDICAL EVALUATION • “Immediate” means prompt medical evaluation and prophylaxis • An exact timeline cannot be stated • Time limits on effectiveness of prophylactic measures vary depending on the infection of concern

11. REPORTINGAN INCIDENT Minimal Information to Report • Date and time of incident • Job classification • Location in the worksite where incident occurred • Work practice being followed • Engineering controls in use • Procedure being performed • PPE in use

12. MEDICAL EVALUATION POST EXPOSURE • Entitled to confidential medical evaluation • Personal decision about blood testing • Blood may be tested only with consent • Blood may be stored for 90 days, while considering testing • Interpretation of any test results occurs with health care provider

13. BLOOD TESTING • Blood may be tested for antibodies to: • Human Immunodeficiency Virus (HIV) • Hepatitis C Virus (HCV) • Hepatitis B Virus (HBV) • Other disease-causing organisms • Source blood may also be tested with consent • Results of tests of source blood will be made known to exposed person

14. SPECIFIC BLOODBORNE PATHOGENS • Definition • Signs and symptoms • Course of infection • Prevention and control • Post-exposure prophylaxis and follow-up care

15. HBV DEFINED • HBV is Hepatitis B Virus • It is a virus which affects the liver • Highest rate of disease in persons 20-49 years of age • HBV carriers are people infected who never fully recovered. • 30-40% of people with acute HBV have no idea how or when the became infected • HBV very durable, can survive in dried blood for up to 7 days

16. SIGNS & SYMPTOMS OF HBV • Jaundice - yellow color to the skin and whites of eyes • Fatigue • Abdominal Pain • Loss of appetite • Nausea and vomiting • Joint pain • 30% of infected persons have no signs & symptoms

17. COURSE OF HBV INFECTION • Incubation period ranges from a few weeks to several months • Some cases of HBV resolve without complications • Chronic liver disease may occur in 6 to 7% of those infected with HBV

18. HBV PREVENTION • A vaccine does exist to prevent HBV infection • Employers are required to offer HBV vaccination to employees covered under BBP standard • Follow Universal Precautions any time you are dealing with blood or body fluids

19. HBV POST-EXPOSURE PROPHYLAXIS & FOLLOW-UP • No cure for HBV infection • Post-exposure prophylaxis should begin within 24 hours; no later than 7 days after exposure • Unvaccinated exposed person should receive HBV vaccine • Treatment requires health care provider • OSHA requires treatment meet CDC’s most recent guidelines • HBV infection treatment may require liver transplant

20. HBV IMMUNIZATION • Employees with routine occupational exposure to blood/OPIM have the right to Hepatitis B vaccination at no personal expense • Employee refusal established by signing Hepatitis B vaccination declination form • Must be made available within 10 working days of initial assignment to job

21. HBV VACCINATION SCHEDULE • Vaccine given in 3 dose series over 6 months • 1st - on initial assignment • 2nd - 30 days later • 3rd - 6 months after 1st dose • CDC recommends HBVantibody testing 1 to 2 months following 3rd dose • Employer cannot require employee to use health insurance to cover test cost • Pre-screening is not required • HBV is declining because of vaccine use!

22. HCV DEFINED • HCV is Hepatitis C Virus • There is no vaccine to prevent HCV • It infects liver cells resulting in acute & chronic liver disease • An estimated 3.9 million Americans have been infected with HCV • Up to 10,000 people per year die from HCV

23. SIGNS & SYMPTOMS OF HCV • Jaundice - yellow color to skin and whites of eyes • Fatigue • Dark Urine • Abdominal Pain • Loss of appetite • Nausea

24. COURSE OF HCV INFECTION • Incubation period averages 6 to7 weeks • Chronic liver disease may occur in 70% of those infected with HCV • Transmission occurs when blood or body fluids from an infected person enters the body of a non -infected person • HCV is spread through sharing needles when using drugs, needle sticks or sharps exposures on the job or from an infected mother to baby during birth

25. HCV PREVENTION • Please note: there is NO vaccine available to prevent HCV infection • HCV infection in workers is best prevented by following Universal Precautions • Do not shoot drugs • HCV may be spread by sex, but this is rare • Do not share personal care items • Toothbrushes • Razors • Nail clippers

26. HCV POST-EXPOSURE PROPHYLAXIS & FOLLOW-UP • No cure for HCV • No post-exposure pro-phylaxis recommended • Tests for HCV anti-bodies & liver function recommended at time of exposure • Tests should be repeated 4-6 months post exposure • Treatment of HCV requires a health care provider • OSHA requires treatment that meets most recent CDC guidelines • HCV infection treatment may include liver transplant

27. HIV DEFINED • HIV is Human Immunodeficiency Virus • HIV can cause acquired immune deficiency syndrome (AIDS) • Risk of HIV infection from a puncture injury or cut exposure to HIV infected blood is very low - 0.3% (1/300 ) • Stated another way, 99.7% of needlestick/cut exposures do not lead to infection

28. SIGNS & SYMPTOMS OF HIV • Signs and symptoms include: • Weight loss • Night sweats or fever • Gland swelling or pain • Muscle and/or joint pain • Flu-like symptoms • Cannot rely on signs and symptoms to confirm if one is infected

29. COURSE OF INFECTION WITH HIV • HIV infection progresses in stages • Course of infection varies from person to person • Acute seroconversion may occur 6-12 weeks after exposure • Progressive disease in untreated persons is characterized by a steady decline in specific white blood cell counts • Increased susceptibility to infections

30. HIVPREVENTION • NOTE : There is NO vaccine to prevent HIV infections • HIV infection in workers is best prevented through following Universal Precautions • Post-exposure prophylaxis with anti-viral medication can reduce risk of infection

31. HIV POST-EXPOSURE PROPHYLAXIS & FOLLOW-UP • No cure for HIV infection • Testing schedule for HIV antibodies • at time of exposure • at 3 months • at 6 months • HIV antibodies usually become detectable within 3 months of infection • Treatment requires health care provider • OSHA requires treatment that meets most recent CDC guidelines • Treatment may include antiviral medications and a protease inhibitor

32. Transmission RatesNot all BBPs have the same transmission rate, risk is affected by frequency of the virus, environmental viability and the amount of organism in body fluid Average Risk from a single needle stick • HBV: 30% (unless vaccinated) • HCV: 1-3% • HIV: 0.3% Average risk from mucous membrane exposure • HBV: 10% (unless vaccinated) • HCV: 1% • HIV: 0.1%

33. PREVENTION • Engineering Controls • Work Practice Controls • Personal Protective Equipment • Universal Precautions

34. ENGINEERING CONTROLS • Design safety into work tools and work space organization • Engineering controls can: • Decrease risk of exposure to hazards • Eliminate hazards • Isolate hazards

35. EXAMPLES OFENGINEERING CONTROLS • Hand and eye washing facilities • Sharps container use • Biohazard labeling • Self-sheathing needles • Needleless IV systems

36. LABELING REGULATED WASTE • Label liquid or semi-liquid blood or OPIM • Label item(s) contaminated with blood or OPIM • Label sharps contaminated with blood or OPIM • Label containers holding contaminated equipment for storage, handling and transport

37. SHARPS CONTAINERS MUST BE: • closable and puncture resistant • leak proof • labeled or color coded • functional • sufficient in number • easily accessible and maintained in upright position • replaced per agency policy • NOT be overfilled

38. SHARPS INJURY PROTECTION • Reusable sharps require proper handling (mechanical means) and decontamination • Retractable needles • Needleless systems

39. WORK PRACTICE CONTROLS • Behaviors using engineering controls safely and effectively • Work Practice Controls include: • using sharps containers • using an eyewash station • WASHING HANDS after using PPE • cleaning work surfaces • proper laundering

40. PROHIBITED WORK PRACTICESDO NOT • break, shear, bend or recap needles • reach into used sharps containers • pick up contaminated items, such as broken glass with bare hands • use a vacuum cleaner to clean up contaminated items • open or empty sharps containers • pipette or mouth suction blood or OPIM • store beverages or food in refrigerators, freezers, or cabinets where blood or OPIM are present • eat, drink, smoke, apply cosmetics, or handle contact lenses in areas of potential occupational exposure

41. HANDWASHING • Readily available facilities • Washing after removing PPE • Using antiseptic hand cleanser when a sink isn’t readily available

42. HANDWASHING • First roll out paper towel or have towel readily available so as not to touch other surfaces to reach it

43. HANDWASHING • Turn on tap water and adjust temperature • Use plenty of soap

44. HANDWASHING • Wash hands using friction on all surfaces for at least 30 seconds • Sing happy birthday to yourself twice = 30 seconds

45. HANDWASHING • Dry hands thoroughly • DO NOT turn off the water yet

46. HANDWASHING • Turn off tap with a dry part of the towel • DO NOT touch surfaces with clean hands

47. CLEANING • Clean work surfaces according to employer’s exposure control plan • Use PPE and EPA-approved solution • 10% bleach and water must be replaced weekly • Place contaminated laundry in color-coded laundry bag, use PPE, and handle as little as possible • DO NOT take contaminated materials home to launder

48. PERSONAL PROTECTIVE EQUIPMENT (PPE) • Specialized clothing/equipment used for protection when risk of exposure exists • Must prevent blood or OPIM from contaminating clothing or skin • Must be available at no cost to employee • Must be in appropriate sizes • Must be in good working condition • Must be properly maintained • Employee must be trained in proper use

49. TYPES OF PERSONAL PROTECTIVE EQUIPMENT • Gloves • Masks • Eye shields • Gowns/aprons • Resuscitation devices

50. LATEX GLOVES • Medical products containing latex must be labeled • Allergies to latex are increasing • Substitutes for latex-containing materials mustbe made available