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MIOSHA Part 554 Bloodborne Infectious Diseases Train the Trainer Program Module 1. Presented By: Consultation Education & Training (CET) Division Michigan Occupational Safety & Health Administration Michigan Department of Energy, Labor & Economic Growth www.michigan.gov/miosha

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Miosha part 554 bloodborne infectious diseases train the trainer program module 1

MIOSHAPart 554 Bloodborne Infectious DiseasesTrain the Trainer ProgramModule 1

Presented By:

Consultation Education & Training (CET) Division

Michigan Occupational Safety & Health Administration Michigan Department of Energy, Labor & Economic Growth

www.michigan.gov/miosha

(517) 322-1809


Welcome
Welcome

Welcome to the MIOSHA Bloodborne Infectious Diseases Online Training Program.

This program is designed to provide an overview of the MIOSHA bloodborne standard.

It does NOT fullfill all the training requirements in the Bloodborne Standard nor is it intended to replace facility specific training.


Intended use train the trainer
Intended Use: “Train the Trainer”

  • Provide bloodborne infectious diseases information to those who provide training to employees who are at risk of occupational exposure.

  • Provide additional resources to assist trainers in becoming more knowledgeable in topics related to bloodborne infectious diseases.


Module 1will provide an overview of the MIOSHA Bloodborne Infectious Diseases Standard Rules 1-9.


Overview of the bloodborne standard

Rule 1 Scope Infectious Diseases Standard Rules 1-9.

Rule 2 Definitions

Rule 3 Exposure determination

Rule 4 Exposure control plan

Rule 5 Universal precautions

Rule 6 Engineering controls

Rule 7 Work practices

Rule 8 Protective work clothing and equipment

Rule 9 Housekeeping

Rule 10 Regulated waste

Rule 11 Laundry

Rule 12 HIV and HBV research laboratories and production facilities

Rule 13 Vaccinations and postexposure follow-up

Rule 14 Communication of hazards to employees

Rule 15 Recordkeeping

Rule 16 Information and training

Appendices

Overview of the Bloodborne Standard

Module 1:

Module 2:


Rule 1 scope
Rule 1 Scope Infectious Diseases Standard Rules 1-9.

These rules apply to all employers that have employees with occupational exposure to blood and other potentially infectious materials.


Rule 2 definitions
Rule 2 Definitions Infectious Diseases Standard Rules 1-9.

  • Bloodborne Pathogens: pathogenic microorganisms present in human blood including HBV, HIV and [HCV].

  • Contaminated: presence or the reasonably anticipated presence of blood or other potentially infectious materials (OPIM).


Rule 2 definitions continued
Rule 2 Definitions Infectious Diseases Standard Rules 1-9.Continued

Other Potentially Infectious Materials (OPIM)

  • Materials included:

  • Semen

  • Vaginal secretions

  • Amniotic fluid

  • Synovial fluid

  • Saliva in dental procedures

  • *NOT included:

    • Vomit

    • Urine

    • Feces

    • Sweat

    • Tears

    • Spit

*Unless visually contaminated

with blood or OPIM


Rule 2 definitions continued1
Rule 2 Definitions Infectious Diseases Standard Rules 1-9.Continued

Contaminated Sharps: contaminated object that can penetrate the skin, including:

  • Needles

  • Scalpels

  • Broken glass

  • Broken capillary tubes

  • Exposed ends of dental wires


Rule 2 definitions continued2
Rule 2 Definitions Infectious Diseases Standard Rules 1-9.Continued

Engineering Controls: controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogen hazard from the workplace.


Rule 2 definitions continued3
Rule 2 Definitions Infectious Diseases Standard Rules 1-9.Continued

  • Exposure: reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or [OPIM] that may result from the performance of an employee’s duties.

  • Exposure Incident: specific eye, mouth, other mucous membrane, nonintact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties.*

    *Does not include incidental exposures which may take place on the job, which are neither reasonable nor routinely expected


Assessing risk
Assessing Risk Infectious Diseases Standard Rules 1-9.

  • Exposed person without HBV immunity (vaccine) via needlestick from confirmed HBV source:

    • 6-30% acquire HBV if no post-exposure follow-up

    • Post-exposure administration of Hepatitis B immune globulin and vaccine is >90% effective in preventing HBV infection.

  • HIV exposure via needlestick from positive source is average of 0.3% become HIV +

    *NIOSH Alert Publication No. 2000-108 Preventing Needlestick Injuries in Health Care Settings (External link)


Rule 2 definitions continued4
Rule 2 Definitions Infectious Diseases Standard Rules 1-9.Continued

  • Needleless Systems: means a device that does not use needles for:

    • Collection or withdrawal of bodily fluids

    • Administration of medication or fluids

    • Other procedure involving potential for occupational exposure

  • Sharps with engineered sharps injury protections: [devices that have] built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.


Examples of Safer syringes Infectious Diseases Standard Rules 1-9.

Self-Sheathing

Retractable

Attached to syringe needle


Attached to blood tube holder Infectious Diseases Standard Rules 1-9.

Examples of Phlebotomy Safer Devices


Before During After Infectious Diseases Standard Rules 1-9.

Before During After

In use After use

Examples of Retracting lancets with safety features


Rule 2 definitions continued5
Rule 2 Definitions Infectious Diseases Standard Rules 1-9.Continued

Regulated Waste:

  • Liquid or semiliquid blood or [OPIM]

  • Contaminated items that would release blood or [OPIM] if compressed.

  • Items which are caked with dried blood or [OPIM]

  • Contaminated sharps

  • Pathological and microbiological waste that contains blood or [OPIM]

    Note: If material is dripping or caked (with dried blood), it must be disposed as regulated waste.


The next slide will provide questions to assist with reviewing the Bloodborne Infectious Diseases Standard Rule 2 Definitions


Rule 2 definitions questions and answers

True or False: reviewing the Bloodborne Infectious Diseases Standard Rule 2 Definitions

Hepatitis C is a bloodborne pathogen.

True

Blood exposure on intact skin is considered an exposure incident.

False. Rule 2 (o) Definition for exposure incident includes nonintact skin.

Fecal material is classified as an “other potentially infectious material.”

False, unless visually contaminated with blood. Rule 2(s)(J)

Rule 2 Definitions Questions and Answers:

Questions and answers will appear below. There will be delays to allow time to answer the questions.


Rule 3 exposure determination
Rule 3 Exposure Determination reviewing the Bloodborne Infectious Diseases Standard Rule 2 Definitions

  • Evaluate routine and reasonably anticipated tasks to determine employee exposure to blood or [OPIM]

  • Classify employees as either category A or B


Rule 3 exposure determination1
Rule 3 Exposure Determination reviewing the Bloodborne Infectious Diseases Standard Rule 2 Definitions

  • Category “A” involves exposure or reasonably anticipated exposure during routine and nonroutine required tasks. Includes emergency/1st aid responders.

  • Category “B” do not require tasks that involve exposure to blood or other potentially infectious material.

  • Determine without regard to protective equipment.

  • Determine/document rationale.

  • Maintain list of all “A” job classifications.


Rule 4 exposure control plan
Rule 4 Exposure Control Plan reviewing the Bloodborne Infectious Diseases Standard Rule 2 Definitions

  • Exposure Determination (Category A or B)

  • Summary of the training program.

  • Procedures for evaluating exposure incidents

  • Task specific Standard Operating Procedures (SOPs) to include:

    • Employee recognition of exposure

    • Personal Protective Equipment (PPE) selection, use, maintenance,

      and disposal

    • Contingency Plans

  • Task-specific SOPs for management of inadvertent exposures such as needlesticks


Rule 4 exposure control plan continued
Rule 4 Exposure Control Plan reviewing the Bloodborne Infectious Diseases Standard Rule 2 DefinitionsContinued

Review at least annually:

  • Tasks and procedures

  • Changes in technology that eliminate or reduce exposure

  • Document consideration and implementation of medical devices that are:

    • Appropriate: does not cause death, injury or illness in the patient

    • Commercially available

    • Effective: reduces or eliminates potential for employee exposure to blood and OPIM


Rule 4 exposure control plan1
Rule 4 Exposure Control Plan reviewing the Bloodborne Infectious Diseases Standard Rule 2 Definitions

Employer shall solicit input from non-managerial employees involved in direct patient care in the:

  • Identification;

  • Evaluation; and,

  • Selection of effective engineering and work practice controls. Must document in the plan


The next slide will provide questions to assist with reviewing the Bloodborne Infectious Diseases Standard:

Rule 3 Exposure Determination

Rule 4 Exposure Control Plan


Rule 4 exposure control plan questions and answers
Rule 4 Exposure Control Plan reviewing the Bloodborne Infectious Diseases Standard: Questions and Answers:

Questions and answers will appear below. There will be delays to allow time to answer the questions.

True or False:

  • Annual review of the exposure control plan is required.

    True. Rule 4(d)

  • Non-managerial employees are to be involve in the selection of effective engineering controls.

    True. Rule 4(h)

  • The exposure control plan must include task specific standard operating procedures.

    True. Rule 4(b)(v)


Rule 6 engineering controls
Rule 6 Engineering Controls reviewing the Bloodborne Infectious Diseases Standard:

  • SHALL be used in combination with work practice controls to minimize or eliminate employee exposure

  • Provide hand washing facilities which are readily accessible to employees… [or] appropriate antiseptic hand cleanser with clean cloth


Rule 7 work practices
Rule 7 Work Practices reviewing the Bloodborne Infectious Diseases Standard:

  • PPE shall be removed before leaving the work area

  • Garment penetrated with blood or [OPIM] shall be removed immediately

  • Wash hands immediately after removing gloves or other protective clothing*

  • Wash hands after contact with blood or [OPIM]

*If blood or OPIM are present, hands must be washed. If no contact with blood or OPIM, waterless cleansers may be used. See Federal OSHA

documentation (External link).


Rule 7 work practices continued
Rule 7 Work Practices reviewing the Bloodborne Infectious Diseases Standard: Continued

  • Needles shall not be sheared, bent or broken, recapped, resheathed or *removed unless no alternative is feasible

  • Eating, drinking, smoking, applying cosmetics or lip balm, or handling contact lenses is prohibited where there is reasonable anticipation for exposure.

    *Reuse of tube holders is prohibited. See Federal OSHA document (External link).


Rule 7 work practices continued1
Rule 7 Work Practices reviewing the Bloodborne Infectious Diseases Standard: Continued

  • Food and drink shall not be stored in refrigerators, freezers, shelves….or in areas of possible contamination

  • All procedures shall be performed in a manner that minimizes splashing, spraying and aerosolization of blood or [OPIM]

  • Mouth pipetting is prohibited.


The next slide will provide questions to assist with reviewing the Bloodborne Infectious Diseases Standard:

Rule 6 Engineering Controls

Rule 7 Work Practices


Rule 6 7 engineering and work practice controls questions and answers
Rule 6-7 Engineering and Work Practice Controls Questions and Answers:

Questions and answers will appear below. There will be delays to allow time to answer the questions.

True or False:

  • Use of engineering controls is optional.

    False. Rule 6 (1) states that engineering controls shall be used.

  • Employees are required to wash hands following exposure to blood.

    True. Rule 7(2)(d)

  • Blood collection needles may be removed from blood collection tube holders before disposal.

    False. Review Rule 7 and Federal OSHA Document (External link)


Rule 8 protective work clothing and equipment
Rule 8 Protective work clothing and equipment and Answers:

  • PPE shall be provided and used

  • Employer shall ensure that an employee uses PPE

  • Assure appropriate PPE readily accessible at no cost

  • Provide for cleaning, laundering, or disposal of PPE

  • Repair or replacement of PPE

  • Gloves shall be worn


Rule 9 housekeeping
Rule 9 Housekeeping and Answers:

  • An employer shall assure that the worksite is maintained in a clean and sanitary condition.

  • Work surfaces

  • Coverings

  • Equipment

  • Bins, pails, etc

  • Broken glassware

  • Specimens

  • Reusable items


Appropriate Disinfectants and Answers:

  • One to ten through one to one hundred concentration of household bleach to water (made fresh within 24 hours & not stored in glass containers)

  • Environmental Protection Agency (EPA) registered disinfectants effective against Mycobacterium spp. (Tuberculocides)


EPA Lists and Answers:

All on the following EPA lists are appropriate:

  • List A: Sterilants

  • List B: Tuberculocides

  • List D: Against HBV & HIV-1

  • List E: TB, HIV-1 and HBV

    NOT LIST C (Effective against HIV-1 only)

    EPA Approved Disinfectants (External Link)


The next slide will provide questions to assist with reviewing the Bloodborne Infectious Diseases Standard:

Rule 8 Protective work clothing and equipment

Rule 9 Housekeeping


Rule 8 9 ppe and housekeeping questions and answers
Rule 8-9 PPE and Housekeeping reviewing the Bloodborne Infectious Diseases Standard: Questions and Answers:

Questions and answers will appear below. There will be delays to allow time to answer the questions.

  • The employer is required to ensure employees wear personal protective equipment.

    True. Rule 8(1)(b)

  • Bleach is the only appropriate disinfectant.

    False. Rule 9 (1)(a) states that an appropriate disinfectant be used. EPA registered disinfectants at least effective against HIV and HBV are appropriate.


Contact MIOSHA for Additional Information reviewing the Bloodborne Infectious Diseases Standard:

  • Questions: www.michigan.gov/askmiosha

  • Consultation Education and Training Division: (517) 322-1809

  • General Industry Safety and Health Division (Compliance): (517) 322-1831

  • Link to additional online resources.

  • Return to the MIOSHA homepage.


Thank you for participating
Thank you for participating reviewing the Bloodborne Infectious Diseases Standard:

Continue to Bloodborne Infectious Diseases Training program Module-2


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