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BLOODBORNE PATHOGENS. THE OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION STANDARD. INTRODUCTION. What is the bloodborne pathogens standard? Who needs bloodborne pathogens (BBP) training? What content needs to be covered?. Duties of Employers provide a plan

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bloodborne pathogens

BLOODBORNE PATHOGENS

THE OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION STANDARD

introduction
INTRODUCTION
  • What is the bloodborne pathogens standard?
  • Who needs bloodborne pathogens (BBP) training?
  • What content needs to be covered?
osha s expectations
Duties of Employers

provide a plan

identify job types and classifications

provide appropriate training

provide appropriate equipment

Compliance

Duties of Employees

to follow the employer’s plan

to use equipment provided by the employer

Compliance

OSHA’S EXPECTATIONS
osha required information
OSHA REQUIRED INFORMATION
  • Documents
  • General explanation of bloodborne pathogens
  • Hepatitis B immunization
  • Explanation of tasks that may involve exposure
bloodborne pathogens defined
BLOODBORNE PATHOGENS DEFINED
  • Disease-causing microorganisms that may be present in human blood or OPIM (other potentially infectious material)
    • Viruses
    • Bacteria
    • Parasites
modes of transmission
MODES OF TRANSMISSION
  • Puncture wounds or cuts
  • Contact (Touch, Splash, or Spray) with blood or OPIM on:
    • mucous membrane
    • non-tact skin
      • cuts, abrasions burns
      • acne, rashes
      • papercuts, hangnails
    • contaminated sharps
risk of exposure
RISK OF EXPOSURE
  • The objective of the BBP standard is to minimize or eliminate the hazard posed by work that may expose you to blood or OPIM
risk of exposure1
RISK OF EXPOSURE
  • If a risk of exposure exists, you must know:
    • if there is a way to prevent infection
    • the symptoms and course of infection
    • that counseling is available
    • that post-exposure treatment & follow-up are available
occupational exposure incidents
OCCUPATIONAL EXPOSURE INCIDENTS
  • Occupational contact with blood or OPIM is considered an exposure incident
  • If an exposure occurs:
    • wash with soap & water
    • report the incident
    • document the incident
    • seek “immediate” medical evaluation
    • follow employer’s exposure control plan
immediate medical evaluation
IMMEDIATE MEDICAL EVALUATION
  • Immediate means prompt medical evaluation and prophylaxis
  • An exact time cannot be stated
  • Time limits on the effectiveness of prophylactic measures vary depending on the infection of concern
reporting an incident
Date and time of the incident

Job classification

Location in the worksite where the incident occurred

Work practice being followed

Engineering controls in use

Procedure being performed

PPE in use

REPORTING AN INCIDENT

Minimal information to report

medical evaluation after an exposure incident
Medical Evaluation After an Exposure Incident
  • 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 the health care provider
blood testing
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
  • The results of the tests of source blood will be made known to you
specific bloodborne pathogens
SPECIFIC BLOODBORNE PATHOGENS
  • Definition
  • Signs and Symptoms
  • Course of infection
  • Prevention and control
  • Post-exposure prophylaxis and follow-up care
hiv defined
HIV DEFINED
  • HIV is the Human Immunodeficiency Virus
  • HIV causes acquired immune deficiency syndrome (AIDS)
  • Risk of HIV infection from a puncture injury exposure to HIV infected blood is very low -- 0.3%
signs symptoms of hiv
SIGNS & SYMPTOMS OF HIV
  • Signs and symptoms include:
    • Weight loss
    • Night Sweats or fever
    • Gland Swelling or pain
    • Muscle and/or joint pain
  • Cannot rely on signs and symptoms to know if you are infected
course of infection of hiv
COURSE OF INFECTION OF HIV
  • Incubation period from HIV infection to AIDS may be 8 to 10 years
  • Varies greatly among individuals
hiv prevention
HIV PREVENTION
  • There is no vaccine to prevent HIV infection
  • Follow Universal Precautions
hiv post exposure prophylaxis follow up
There is no cure for HIV infection

Testing for HIV antibodies

at time of exposure

at 3 months

at 6 months

HIV antibodies usually become detectable within 3 months of infection

Treatment of HIV requires visits with your health care provider

OSHA requires recommended treatment meet the most recent CDC guidelines

Treatment can include antiviral medications and a protease inhibitor

HIV Post-exposure Prophylaxis & Follow-up
hcv defined
HCV Defined
  • HCV is Hepatitis C Virus
  • It affects the liver
  • It is the most common chronic bloodborne infection in the United States
  • Needlestick injury is the only occupational risk factor that has been associated with HCV
  • Risk of HCV infection after exposure to HCV infected blood is 1.8%
  • 70 to 75% of those with acute HCV infection have no symptoms
signs symptoms of hcv
SIGNS & SYMPTOMS OF HCV
  • Jaundice - a yellow color to the skin
  • Fatique
  • Headache
  • Abdominal Pain
  • Loss of appetite
  • Nausea & Vomiting
course of hcv infection
COURSE OF HCV INFECTION
  • Incubation period averages 7 weeks
  • Chronic liver disease may occur in 70% of those infected with HCV
hcv prevention
HCV PREVENTION
  • There is no vaccine to prevent HCV infection
  • Follow Universal Precautions
hcv post exposure prophylaxis follow up
There is no cure for HCV infection

No recommendation for post-exposure prophylaxis

Tests for HCV antibodies & liver function tests should be done at time of exposure

Tests should be repeated 4 to 6 months after exposure

Treatment of HCV requires visits with your health care provider

OSHA requires recommended treatment meet the most recent CDC guidelines

HCV infection may require liver transplantation for treatment

HCV Post-exposure Prophylaxis & Follow-up
hbv defined
HBV DEFINED
  • HBV is the Hepatitis B Virus
  • It affects the liver
  • The prevalence of HBV infection among healthcare workers is 10 times greater than HCV infection
signs symptoms of hbv
SIGNS & SYMPTOMS OF HBV
  • Jaundice - a yellow color to the skin
  • Fatique
  • Headache
  • Abdominal Pain
  • Loss of appetite
  • Nausea & Vomiting
course of hbv infection
COURSE OF HBV INFECTION
  • Incubation period averages 12 weeks
  • Most cases of HBV resolve without further complication
  • Chronic liver disease may occur in 6 to 7% of those infected with HBV
hbv prevention
HBV PREVENTION
  • There is a vaccine to prevent HBV infection
  • It is required to be offered to anyone covered by the BBP standard
  • Follow Universal Precautions
hbv post exposure prophylaxis follow up
There is no cure for HBV infection

Post-exposure prophylaxis should begin within 24 hours and no later than 7 days after exposure

If not previously vaccinated, the person should receive the HBV vaccine

Treatment of HBV infection requires visits with your health care provider

OSHA requires recommended treatment meet the CDC’s most recent guidelines

Chronic HBV infection may require liver transplantation for treatment

HBV Post-exposure Prophylaxis & Follow-up
hbv immunization
HBV IMMUNIZATION
  • All people with routine occupational exposure to blood or OPIM have the right to receive the HBV vaccine at no personal expense
  • Refusal requires signing the Hepatitis B Vaccination declination form
  • Vaccine is Recombivax HB or Energix - B
  • Vaccine is prepared from recombinant yeast cultures
  • Must be made available within 10 working days of initial assignment to job
hbv vaccination schedule
HBV VACCINATION SCHEDULE
  • Vaccine is given in 3 doses over 6 months
    • 1st on initial assignment
    • 2nd one month later
    • 3rd five months after 2nd dose
  • CDC recommends Hepatitis B antibody testing 1 to 2 months following the 3rd dose
  • Employer cannot require you use your health insurance to cover the cost
  • Pre-screening is not required
  • HBV is declining because of vaccine use!
prevention
PREVENTION
  • Engineering Controls
  • Work Practice Controls
  • Personal Protective Equipment
  • Universal Precautions
engineering controls
ENGINEERING CONTROLS
  • Design safety into the tools and work space organization
  • Engineering controls can:
    • Remove the risk of exposure to the hazard
    • Eliminate the hazard
    • Isolate the hazard
examples of engineering controls
EXAMPLES OF ENGINEERING CONTROLS
  • Hand and eyewashing facilities
  • Sharps containers
  • Labeling
  • Self-sheathing needles
  • Needleless IV systems
labeling regulated waste
LABELING REGULATED WASTE
  • Label liquid or semi-liquid blood or OPIM
  • Label item(s) covered with blood or OPIM
  • Label sharps contaminated with blood or OPIM
  • Labels are necessary for containers, storage, equipment that is contaminated
  • exception is certain blood or blood products that have been screened
sharps containers must be
SHARPS CONTAINERS MUST BE:
  • closable
  • puncture resistant
  • leakproof
  • labeled or color-coded
  • functional
  • sufficient in number
  • easily accessible
  • maintained in an upright position
  • replaced per policy
  • NOT be overfilled
sharps injury protection
SHARPS INJURY PROTECTION
  • Reusable sharps require proper handling (mechanical means) and decontamination
  • Retractable needles
  • Needleless systems
work practice controls
WORK PRACTICE CONTROLS
  • Behaviors necessary to use engineering controls safely & effectively
  • Work Practice Controls include:
    • using sharps containers
    • using an eyewash station
    • WASHING HANDS after using PPE
    • cleaning work surfaces
    • proper laundering
prohibited work practices
Do not break, shear, bend or recap needles

Do not reach into containers of contaminated sharps

Do not pick up contaminated items, such as broken glass, with your bare hands

Do not use a vacuum cleaner to clean up contaminated items

Do not open, empty or clean sharps containers

Do not pipette or mouth suction blood or OPIM

Do not eat, drink, smoke, apply cosmetics, or handle contact lenses in areas of possible occupational exposure

Do not store food or beverages in refrigerators, freezers, shelves, or cabinets where blood or OPIM are present

PROHIBITED WORK PRACTICES
handwashing
HANDWASHING
  • Facilities readily available
  • Wash after removing PPE
  • Use antiseptic hand cleanser when necessary (such as when a sink isn’t handy)
handwashing1
HANDWASHING
  • First roll out your paper towel or have the towel readily available (so you don’t touch other surfaces to get it)
handwashing2
HANDWASHING
  • Turn on the tap water and adjust temperature
  • Use plenty of soap
handwashing3
HANDWASHING
  • Wash your hands using friction on all surfaces for at least 30 seconds
handwashing4
HANDWASHING
  • Dry your hands thoroughly
  • DON’T turn off the water yet
handwashing5
HANDWASHING
  • Turn off the tap with a dry part of the towel
  • Don’t touch surfaces with your hands
cleaning
CLEANING
  • Clean work surfaces according to the employer’s exposure control plan
  • Use PPE and EPA-approved solution
  • 10% bleach and water, if used must be made daily
  • Place contaminated laundry in color-coded laundry bag, use PPE, and handle as little as possible
  • DO NOT take home to launder!
personal protective equipment ppe
PERSONAL PROTECTIVE EQUIPMENT (PPE)
  • Specialized clothing or equipment used for protection when risk of exposure exists
  • Must prevent blood or OPIM from contaminating clothing or skin
  • Must be readily available at no cost to employee
  • Must be in appropriate sizes
  • Must be in good working condition
  • Must be properly maintained
  • Must be trained in proper use
types of personal protective equipment
TYPES OF PERSONAL PROTECTIVE EQUIPMENT
  • Gloves
  • Mask
  • Eye shields
  • Gowns/Aprons
  • Resuscitation devices
latex gloves
LATEX GLOVES
  • Medical products containing latex must be labeled
  • Allergies to latex have been on the rise
  • Substitutes to latex-containing materials must be available
universal precautions
UNIVERSAL PRECAUTIONS
  • Infection Control approach that treats all human blood and certain body fluids as if they are known to contain bloodborne pathogens
materials that require precautions
MATERIALS THAT REQUIRE PRECAUTIONS
  • Blood
  • Semen
  • Vaginal Secretions
  • Cerebrospinal, synovial, or pleural fluid
  • Body fluids with visible blood
  • Any unidentifiable body fluid
  • Saliva from dental procedures
materials that do not require precautions
MATERIALS THAT DO NOT REQUIRE PRECAUTIONS
  • Universal Precautions do not apply to these fluids UNLESS blood is visible:
      • feces
      • nasal secretions
      • sputum
      • sweat
      • tears
      • urine
      • vomitus
body substance isolation bsi
BODY SUBSTANCE ISOLATION (BSI)
  • An acceptable alternative to Universal Precautions
  • Treats ALL body fluids and substances as infectious
exposure control plan
EXPOSURE CONTROL PLAN
  • Site specific plan provided by employers for the protection of employees working where the potential for occupational exposure exists
  • Lists job classifications and tasks in which exposure may occur
  • Identifies engineering controls, work practice controls, PPE, and Universal Precautions
  • Identifies who will be trained and who will do the training
  • Includes record keeping provisions and is reviewed annually