Bloodborne Pathogens • Prevention of Spread of Infectious Diseases • OSHA Long Term Care Worker Protection Program
Define bloodborne pathogens. • Recognize OSHA standards related to bloodborne pathogens. • Identify employer responsibilities related to compliance with OSHA standards. • Recognize key strategies to control the spread of infectious diseases.
Bloodborne Pathogens • Pathogens include but are not limited to: Hepatitis B HIV – human immunodeficiency virus Pathogenic microorganisms that are present in human blood or other potentially infectious materials and can cause disease in humans.
29 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens • Published December 1991 • Effective March 1992 • Scope • ALL occupational exposure to blood and other potentially infectious material (OPIM)
Hepatitis B HIV/AIDS
What would you do? and what would other employees do?
…reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties. • Duties may include: • Direct Patient Care • Phlebotomy/Laboratory • Environmental Services • Waste Management • Other?
Exposure Determination • all job classifications in which all employees in those job classifications have occupational exposure. • job classifications in which some employees have occupational exposure. • all tasks and procedures…in which occupational exposure occurs and that are performed by the above listed employees.
Exposure Control Plan • The schedule and method of implementation for: • Methods of compliance. • Hepatitis B vaccination and post-exposure evaluation and follow-up for any exposure. • Communication of hazards to employees. • Recordkeeping.
Exposure Control Plan • The procedure for the evaluation of circumstances surrounding exposure incidents: • Immediate availability for exposed employees to confidential medical evaluation and follow-up. • Documentation of the route(s) of exposure, and the circumstances under which the exposure incident occurred.
Standard (universal) Precautions • …shallbe observed to prevent contact with blood or other potentially infectious materials. • …allbody fluids shall be considered potentially infectious materials.
Purpose- to eliminate or minimize employee exposure: • Readily accessible hand washing facilities. • Contaminated sharps management. • Keeping food and drink out of the work area. • Procedures involving blood handling. • Transport of specimens. • Contaminated equipment. • CFR 1910.1030 (d)(2)
Teaching appropriate technique, make no assumptions! • Availability of materials. • Reinforcing and reminding. • Monitoring.
Provide alcohol-based hand cleansers in multiple locations. • Monitor use by volume replacement and observation. • When they should be used: if hands are not visibly dirty, if soap and water are not available. • Frequent use is recommended, good amount, rubbing into all surfaces of hands until dry. • Washing with soap and water: careful technique, 20-30 seconds, if hands are dirty, and after direct contact with potentially infectious material, after toileting, and when caring for a patient with a C. Difficile infection.
Shall be used where exposure remains after institution of engineering and work practice controls. • Employer shall provide appropriate PPE at no cost to employee. • May include: gloves, gowns, laboratory coats, face shields or masks, eye protection, mouthpieces, resuscitation bags, pocket masks, or other ventilation devices.
Use • Accessibility • Cleaning, laundering, and disposal • Repair and replacement • Garment penetration • PPE removal prior to leaving work area
Worksite maintained in clean and sanitary condition. • Cleaning and decontamination of items. • Safe disposal.
Contaminated sharps discarding and containment: • Approved sharp containers • Easily accessible • Upright • Not allowed to overfill • Container removal • Close immediately prior to removal • Place in secondary container if leakage is possible • Reusable containers • Should NOT be opened, emptied, or cleaned manually
Other regulated waste containment: • Closeable, constructed to contain all contents, labeled or color-coded, closed prior to removal. • If outside contamination of the container occurs, it shall be placed in a second container. • Disposal of all regulated waste shall be in accordance with applicable regulations.
Public Law 106-430 • Signed into law November 2000 – enacted in 2001 – part of OSHA standards • “Needlestick Safety and Prevention Act” • Why? In 2000, it was estimated that over 300,000 percutaneous injuries would occur involving contaminated sharps.
Requires that organizations use safer medical devices with injury protection or needleless systems. • Need to reflect the changes in technology that can eliminate or reduce exposure to blood borne pathogens. • Must document annually the consideration and implementation of safer devices.
Must maintain a Sharps Injury Log. • List for each incident the type and brand of device involved, department/work area, and how the incident happened. • Must “solicit input” from non-managerial staff in the identification, evaluation, and selection of effective engineering and work practice controls and shall document this input process in the Exposure Control Plan.
Shall be handled as little as possible: • Bagged or containerized at the location where it was used. • Containers labeled or color-coded. • Leak proof bags or containers. • Employer shall ensure that employees who have contact with contaminated laundry wear protective gloves and other appropriate PPE. • Shipping to an off-site facility.
The employer shall make available the Hep B vaccine & appropriate medication…to all employees who have occupational exposure. • Post-exposure evaluation & follow-up care to all employees who have had an exposure incident: • No cost to the employee • At a reasonable time • Licensed physician or healthcare professional • According to recommendations of the US Public Health Service • All lab tests are conducted by an accredited lab at no cost to employee
Yes • Must have them complete the Declination Statement and keep that document. 1910.1030 Appendix A (mandatory) Individuals can change their mind at any time and receive the vaccinations.
Documentation of the route(s) of exposure. • Identification and documentation of the source individual. • Collection and testing of blood for HBV and HIV. • Post-exposure prophylaxis and care. • Counseling. • Evaluation of reported illnesses.
Labels and Signs • Information and Education • At the time of initial assignment • At least annually • When changes occur • Content and vocabulary appropriate • to educational level, • literacy, and language of employees
Provided to all employees who may be at risk for exposure. • At no cost. • Minimum requirements • CFR 1910.1030 (g)(2)(vii) lists all training program requirements.
Medical Records • Shall be maintained for duration of employment plus 30 years. • Training Records • Shall be maintained for 3 years from the date of training.
Lack of training • Busy, hectic, rushing • Decreased awareness of hazards • “won’t happen to me….”
What strategies can we use that are really effective? • What types of infectious diseases? • Who is accountable?
Engineering controlsinvolve making changes to the work environment to reduce work-related hazards. • Work practice controlsare procedures for safe and proper work that are used to reduce the duration, frequency or intensity of exposure to a hazard. • Administrative controlsinclude controlling employees' exposure by scheduling their work tasks in ways that minimize their exposure levels. • Personal Protective Equipment (PPE) includes all clothing and other work accessories designed to create a barrier against workplace hazards.
Keys to success with all of these strategies: * Consistency * Individual accountability
Current challenge with this: improper and infrequent hand-washing or use of alcohol-based cleansers. • Strategies to encourage: * Demonstrate proper technique * Make the materials/supplies/facilities easy to access, close to all work areas. * Monitor compliance * Role modeling
Encouraging this with all employees and customers, family members/visitors. • Consistent messages! • Providing adequate facilities and materials. • Monitor use and consistency of practices. *** We all need to practice this every day.
“Specialized clothing or equipment, worn by an employee for protection against infectious or other hazardous materials/objects. Remember: PPE is the last resort to addressing worker hazard. (Hierarchy of Controls)
PPE for eyes, face, hand, extremities, protective clothing, respiratory devices, protective shields and barriers: * Shall be provided, used, and maintained in a sanitary and reliable condition, * Wherever it is necessary by reason of hazards or processes or environment.
Must provide PPE at no cost to employee. • Must assess all work environments for potential hazards. • Must provide training to any employee who uses any PPE. • Must pay for replacement of any required PPE, unless the employee has lost or intentionally damaged the item.
Chemical • Radiological • Thermal • Mechanical • Noise • Blood and OPIM (other potential infectious material) Encountered by an employee in a manner capable of causing injury or impairment in any function/body part through absorption, inhalation, or physical contact.
Employer shall assess the workplace to determine if hazards are present that require the use of PPE. • Communicate presence of hazards to employees. • Select the appropriate PPE – must fit each employee.
Engage supervisors and employees in the process. • Assess in all work locations: support service areas, patient care areas, specialty areas, facility management areas, external areas, etc. • Need to have a written certification that identifies what was evaluated, who did it, the date. • Reassess when appropriate - if services change, locations change.
Locations/situations in where this is needed? • Must ensure that each affected employee uses eye protection that provides front and side protection from flying objects/materials. • If they wear prescription lenses, the eye protection can incorporate the prescription in the design, or be worn over the prescription lenses – must not disturb the prescription lenses or the protective lenses.
Does everyone who should wear this, do so, every time? • Are they fit properly? • Are they checked to be sure they are in good condition? • What could we do differently?
First Priority: Engineering Controls. • Includes: enclosure or confinement, general or local ventilation, or substitution of less toxic materials. • When engineering controls are not adequate or feasible: Face masks or Respirators should be used! CFR 1910.134
Provided by the employer. • Must be applicable and suitable for the purpose and potential hazards involved. • Must establish and maintain a respiratory protection program.
Identify when and where respiratory PPE needs to be used by employees and what type. • Provide Medical evaluations prior to fit-testing and use. • Follow standards on fit-testing procedure. • Documentation requirements! • N95 or higher NIOSH certified respirators.
Employer must select and provide appropriate hand protection for employees that are exposed to hazards: * skin absorption of harmful substances * severe cuts, lacerations, or abrasions * punctures * chemical or thermal burns * harmful temperature extremes
When and where: patient care, environmental services, engineering, other areas. • Glove material: vinyl, latex, nitrile, other. • Sterile and nonsterile. • Single use or reusable. • Critical to train employees on appropriate use, putting on, and taking off of gloves.