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OSHA BBP Standard

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  1. OSHA BBP Standard • Reason: Concern for employees who are occupationally exposed to blood and other body fluids and could acquire certain disease through exposure • Purpose:To minimize risk for employees with occupational exposure to blood and body fluids • Location:BCDP and BEOH, also at www.osha.gov Requires:Exposure Control Plan

  2. Blood Borne Pathogens Training

  3. Blood Borne Pathogens Training • Overview of BBP Standard • Types of pathogens • Exposure Control Plan

  4. Blood Borne Pathogens • Human immunodeficiency virus (HIV) • Hepatitis B virus (HBV) • Hepatitis C virus (HCV)

  5. Blood Borne Pathogens • Can acquire from • blood • body fluids containing visible blood • other potentially infectious material (OPIM) • cerebral spinal fluid (CSF), synovial fluid, pleural fluid, peritoneal fluid, amniotic fluid

  6. Blood Borne Pathogens Feces, nasal secretions, saliva (except in dental settings), sputum, sweat, tears, urine, and vomitus are not considered infected with blood borne pathogens unless they contain visible blood.

  7. Blood Borne Pathogens • Occupational exposure occurs by: • percutaneous injury (needlestick or cut) • contact with mucous membranes • contact with non-intact skin in which there is blood, body fluids with visible blood, OPIM

  8. Blood Borne Pathogens • HIV • virus that causes AIDS • incubation period 1 to 3 months • person is infectious from • onset of infection throughout life • all persons are susceptible

  9. Blood Borne Pathogens • HIV • risk of transmission • needlestick: 0.3% • splash/spray to mucuous membranes: 0.09% • non-intact skin: less than mucous membrane exposure

  10. Blood Borne Pathogens • HBV • virus that causes hepatitis B • incubation period 45 to 180 days • person is infectious if test for antigen (HBsAG) is positive • unvaccinated persons are susceptible • vaccination is recommended for persons with occupational exposure

  11. Blood Borne Pathogens • HBV • risk of transmission • needlestick: 22-31% if source is HBeAG + • needlestick: 1-6% if source is HBeAG - • direct or indirect contact with non-intact skin or mucous membranes is an important source of occupational exposure

  12. Blood Borne Pathogens • HCV • virus that causes hepatitis C • incubation period 6 to 9 weeks • most persons are infectious for life • all are susceptible

  13. Blood Borne Pathogens • HCV • risk of transmission • needlestick: 1.8% • mucous membranes: rare • non-intact skin: very rare

  14. DPH Exposure Control Plan • universal/standard precautions • hand hygiene • PPE • engineering controls • work practice controls • HBV vaccination • post-exposure management • training

  15. DPH Exposure Control Plan • available to employees • copies available in BCDP and BEOH • reviewed, updated annually • use of safe medical devices included

  16. DPH Exposure Control Plan Exposure Determination Any DPH employee who performs or may perform phlebotomies, fingersticks, administers immunizations (including smallpox vaccinations) has occupational exposure to blood borne pathogens

  17. Universal Precautions • part of OSHA BBP standard • used on ALL individuals • used for ALL contact with: • blood, body fluids, OPIM • mucous membranes • non-intact skin • to protect against blood borne pathogens

  18. Standard Precautions • part of CDC guidelines on infection control • used on ALL individuals • blood, all body fluids, secretions, excretions(except sweat) considered infectious (regardless of visible blood) • used to protect against all infectious agents

  19. Standard Precautions • Hand hygiene • use of personal protective equipment

  20. Hand Hygiene • Wash hands • after touching blood, body fluids, secretions, excretions, contaminated items, regardless if gloves are worn • immediately after removing gloves • before leaving work area • whenever hands are dirty or contaminated

  21. Hand Hygiene • Hand washing technique • turn on faucets to comfortable water temperature • wet hands, apply soap, lather • rub with friction for at least 15 seconds, making sure to wash back of hands, fingers, fingertips, in between fingers • rinse with fingertips pointing downward • dry hands with paper towel • discard paper towel and turn off faucets with clean paper towel

  22. Hand Hygiene • Waterless alcohol gel • may use if hands are not visibly soiled • more effective against organisms • convenient • gentler to skin than soap, water, paper towels • takes less time than soap • and water wash

  23. Hand Hygiene • Use of waterless gel • press pump down completely to dispense appropriate amount • dispense into palm of one hand • rub palms, backs of hands, fingers, fingertips, between fingers until dry, about 30 seconds • make sure hands are dry before resuming activities

  24. PPE • gowns, gloves, surgical masks, face shields, goggles, shoe covers, aprons • used when there is a reasonable anticipation of exposure to blood, body fluids, mucous membranes, non-intact skin • provides protection for clothing, skin, eyes, mouth, nose

  25. PPE • employer responsibilities • provide in appropriate sizes • make accessible • require use by employees • clean, launder, repair, replace as needed • provide training

  26. PPE • Employee responsibilities: • use appropriately • dispose of appropriately

  27. PPE for DPH • Gloves • non-latex • wear for phlebotomies, fingersticks, smallpox vaccinations • remove between clients, wash hands • select correct size • have readily available at work station

  28. PPE for DPH Gowns • protect skin, prevent soiling of clothing • do not re-use disposable gowns • wash hands after removing • use when cleaning spills of blood/body fluids

  29. PPE for DPH • “Over shirts” • use if desired at STD clinics and HIV testing sites • remove immediately if saturated with blood/body fluids • place in designated laundry bags for professional cleaning

  30. PPE for DPH • Lab coats • disposable lab coats used by vaccinators at smallpox clinics • remove and dispose of before leaving vaccination station, wash hands

  31. PPE for DPH • Surgical masks with eye protection/face shields • cover eyes, nose, and mouth when anticipating splash or spray to face • eye glasses are not protective

  32. PPE Removal 1) Remove gloves by grasping outside of gloved hand with other gloved hand and peel off. Hold removed glove in gloved hand. 2) Slide fingers of ungloved hand under remaining glove. Discard gloves.

  33. PPE Removal 3) Remove any PPE from face next, handling by head bands, ear pieces, or ties. Discard. 4) Remove gown by pulling away from neck and shoulders, touching inside of gown only. Turn gown inside out. Discard.

  34. PPE Removal Wash hands!

  35. Engineering Controls • Safety devices on sharps: needles, lancets • must be used if available • evaluated by staff • Shearing, breaking, bending, re-capping of contaminated sharps is prohibited • Do not remove needle from used tube holder after phlebotomy

  36. Engineering Controls • Place used sharps in disposal containers immediately after use • Sharps containers • puncture resistant • leakproof • labeled or red in color • stabilized if portable

  37. Engineering Controls • Sharps containers • Replace sharps containers when 2/3 full • The users of the containers are responsible for replacing when necessary

  38. Work Practice Controls • Do not eat, drink, apply make-up, handle contact lenses, or smoke in areas with likely exposure to blood or OPIM • testing areas • areas where specimens located • Do not store food or beverages in refrigerators, freezers, coolers, shelves, cupboards where specimens are located

  39. Work Practice Controls • Do not place hands into used sharps containers • Use a brush and dustpan or tongs or forceps to pick up broken glass or other sharp items

  40. Waste Disposal • Infectious waste • sharps • disposable items that are saturated with blood or OPIM to the point where such material can be squeezed, poured, dripped, or flaked off the items • for DPH, most infectious waste will be sharps

  41. Waste Disposal • Infectious waste • place in red biohazard bags, seal to prevent spillage during handling • store in designated areas for collection by waste haulers • Central Health Clinic: biohazard collection room • Madison:???

  42. Waste Disposal • Document waste disposal • date removed • amount • where shipped • by whom • send completed forms to ICE

  43. Laundry • handle with minimal agitation • place dry laundry in bags at point of use • laundry that is wet from blood or OPIM is placed in plastic bags • send to professional cleaners • “over” shirts • personal clothing visibly soiled with blood or OPIM

  44. Labels • Infectious waste: red bag with biohazard label • Sharps containers: biohazard label • blood specimens: biohazard labeled storage bags, storage containers • refrigerators, coolers where blood or OPIM is stored: biohazard label

  45. Specimens • label with appropriate information • wrap in material to prevent breakage • place in plastic biohazard bag • place paperwork in outside pouch of bag • do not place specimens back into clean collection kits • store or ship appropriately

  46. Cleaning/Disinfection • Clean first, then disinfect all equipment and environmental surfaces after contact with blood or OPIM • use EPA registered disinfectant with activity against HIV, HBV, HCV or 1:10 bleach • follow instructions on disinfectant label

  47. Handling Blood Spills • Procedure for Cleaning Blood Spills • wear PPE: gown, gloves, goggles • wet cloth with the disinfectant • wipe item/area with wet cloth • spray disinfectant on item/area • wipe with clean cloth, let air dry

  48. Hepatitis B Vaccination • Any one with occupational exposure to blood or OPIM should be vaccinated • recommended unless: • employee has documentation of receipt of series • antibody testing shows immunity • employee has medical contraindications

  49. Hepatitis B Vaccination • available within 10 working days of work start date • if employee declines, must sign statement of declination • employee may request the series later

  50. Hepatitis B Vaccination • Safety • very safe vaccine • US: as of 2000 more than 100 million adults have received vaccine with few side effects • serious reactions are rare • mild symptoms may occur: soreness at injection site, low-grade fever • may be given during pregnancy