1. Blood Borne PathogensOSHA 1910.130
Jeffrey S. Davin, M.D.
October 28, 2008
3. What are Blood Borne Pathogens ? HIV - The virus that causes AIDS.
Hepatitis B - Liver Infection
Hepatitis C - Liver Infection
4. Less common BBP’s Syphilis
5. Who are affected by BBP’s Health Care Workers
Hazardous Waste Workers
6. Significance of BBP’s Risk of transmission from skin penetrating trauma with HIV infected blood is 0.3% or 3 in 1000 (1 in 333).
Risk from mucous membrane exposure (mouth, nose, eyes) is 0.09% or 9 in 10,000.
Risk from non-intact skin exposure is estimated to be less than mucous membrane exposure.
7. Significance of BBP’s Average risk of skin penetrating trauma with Hepatitis C infected blood is 1.8% or 1.8 in 100 (range 0-7%).
Risk of skin penetrating trauma with Hepatitis B infected blood is up to 30% or up to 1 in 3 depending on source.
8. OSHA 1910.130Blood Borne Pathogens Applies to all employees who reasonably anticipate skin, eye, mouth, or mucous membrane or parenteral contact with blood or other potentially infectious material as a result from the performance of their duties.
9. OSHA BBP RegulationExposure Control Plan Key Elements Exposure determination
Eliminate or minimize exposure
Vaccination procedures (Hepatitis B only)
10. Hepatitis B Vaccination Must be offered to employees
Series of 3 injections
Immunity can be checked
Significant lack of seroconversion - additional boosters needed in 10-15%
Now given during infancy/childhood
11. Vaccine Non-responders3 shots don’t work
13. Vaccine Non-responders3 shots don’t work May still be immune
May convert with booster injections
Recommend repeat series
If non-responder, exposure to Hepatitis B requires treatment with HBIG as soon as possible (7 days max)
14. No Vaccine For Hepatitis C
No Vaccine For HIV
15. Hepatitis C Exposure Monitor for development of Hepatitis C
Monitor blood tests
Treatment available with Interferon
16. Exposure to HIV Prophylactic treatment available
Should be started within 1-2 hours of exposure
2 or 3 drugs for 4 weeks
Varying degrees of toxicity/side effects from treatment
Effectiveness is theoretical
17. Post- ExposureEvaluations
18. Exposure DeterminationWhat is Significant? Was the exposure unprotected?
Was the skin barrier penetrated?
Was there mucus membrane exposure?
Volume of material.
19. Potentially Infectious MaterialsProven to spread HIV Blood
Saliva in dental procedures
20. Potentially Infectious MaterialsKnown to contain HIV Cerebrospinal fluid
Unfixed tissues or organs
21. NOT INFECTIOUSas a Blood Borne Pathogen Tears
Unless Visible Blood Is Present
22. Modes of Transmission Percutaneous (sharps instruments)
Broken or non-intact skin
Mucous membranes (eyes, nose, mouth)
Transplacental (Mother to Fetus)
23. Exposure DeterminationFirst determine if unprotected exposure has actually occurred. If yes………. Determine “Source” status for HIV, Hepatitis B and C
Determine status of “Exposed” as a baseline for HIV, Hepatitis B and C
Determine “Exposed” immune status for Hepatitis B
24. Testing the “Source” of Exposure HIV antibody
Hepatitis B surface antigen
Hepatitis C antibody
Need consent to be tested, especially for HIV
May need legal help to obtain tests
Timing and follow-up issues
25. Testing the “Exposed” This is “Baseline Testing”
Same tests as “Source”
Test Hepatitis B antibody level if vaccinated
26. Source Known HIV Positive Start drugs within 2 hours of exposure
Consider up to 36 hours after exposure
If source status is unknown, consider treatment until results are available
If source is totally unknown treat case by case
27. Information to be Provided to theHealthcare Professional A copy of this regulation
A description of the exposed employee’s duties as the relate to the exposure incident
Route of exposure
Results of the source individual’s blood testing
All relevant record’s of the employee such as Hepatitis B vaccination records
29. Current Recommendation to Employers for Exposure follow-up Initial evaluation and blood work should be done at the Emergency room
Follow-up to review lab results, assess risk status and to establish need for additional testing at a Bethesda Care Center
30. Blood Borne Pathogens Use Universal Precautions at all times
Treat ALL Blood/Body Fluids as Infected