Occupational Safety & Health Administration (OSHA) 29 CFR Part 1910

1. Occupational Safety & Health Administration (OSHA)29 CFR Part 1910 Effective December 6, 1991 Patricia A. Bunch, EMT-P Kirkwood Community College Click right arrow to go forward

2. Bloodborne Pathogens; Needlesticks & Other Sharps Injuries(Effective: April 18, 2001) Reviewed by: Jolene Ott, RN, MS Infection Control Coordinator Mercy Medical Center Cedar Rapids, IA Click right arrow to go forward

3. signed into law Nov. 6, 2000 required OSHA to revise standards of 1991 Needlestick Safety & Prevention Act click left arrow to go back

4. a government agency from the Department of Labor designed to write and enforce safety practice standards in the workplace Who/What is OSHA?

5. designed to meet the Occupational Exposure Bloodborne Pathogens; Needlesticks & Other Sharps Injuries standards established by OSHA for healthcare professionals at risk of exposure to bloodborne pathogens PURPOSE:

6. as a healthcare worker, you are responsible for practicing your field of medicine according to the administrative rules addressing bloodborne pathogens identified by OSHA. (It’s the law!) PURPOSE: OSHA Regulators

7. provides standards for Occupational Exposure to Bloodborne Pathogens; Needlesticks & Other Sharps Injuries mandates compliance to bloodborne pathogen standards as of December 6,1991 & the revised standards of April 18, 2001 as well as future revisions OSHA REGULATORY TEXT

8. OSHA REGULATORY TEXT • mandates that an employer having employees that are at risk for occupational exposure have an “Exposure Control Plan” designed to eliminate or minimize employee exposure Exposure Control Plan Kirkwood Comm. College

9. Occupational Exposure refers to any contact with bloodborne pathogens via needle stick, sharps stick, or splash of contaminated body fluids to the eyes, nose, mouth, or non-intact skin while on duty REGULATORY TEXT

10. provides standards designed to minimizerisk of disease transmission in the workplace by safe work practices and barriers provides standards designed to reducerisk of needle sticks & other sharps injuries with new & safer devices key point REGULATORY TEXT

11. the standards require annual training in bloodborne pathogens to stay abreast of current information the standards require annual review of Exposure Control Plan & mustidentify new technology considered & implemented in the past year that will eliminate or reduce sharps injuries key point REGULATORY TEXT

12. the standards require non-managerialstaff with direct patient care contact be involved in the identification, evaluation & selection of new devices to eliminate sharps injuries key point REGULATORY TEXT

13. the standards mandate that a log of all sharps injuries be maintained to identify high risk areas and evaluate devices being used the log must protect confidentiality and contain: the type & brand of device involved in incident the location of incident how injury occurred key point REGULATORY TEXT

14. failure to comply with OSHA regulations for safety and training, may result in large fines key point REGULATORY TEXT

15. Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) Human Immunodeficiency Virus (HIV) Note: Other forms of viral hepatitis have been identified since the original ruling Bloodborne Pathogens in OSHA Standards

16. any virus or microorganism present in human blood and other body fluids that can cause disease Definition: Bloodborne Pathogens

17. there are at least 6 forms of viral hepatitis, A-B-C-D-E & G hepatitis causes inflammation & swelling of the liver and loss of normal liver function What about Hepatitis?

18. What about Hepatitis? • Hepatitis B (HBV) does not respond to antibiotics • HBV has no socioeconomic boundaries

19. HBV can lead to acute/chronic cirrhosis of liver & possible liver cancer HBV Specific Characteristics healthy sick

20. HBV is major cause of viral hepatitis HBV can be prevented 1- ml of HBV blood contains 100 million infected doses of the hepatitis B virus HBV is a hardy virus that may live outside of the body for several weeks on surfaces outside the body HBV Specific Characteristics

21. HBV Vaccine ProtocolSeries of 3 Injections: • (Given in Upper Extremity) • #1 - initial injection • #2 - 30 days after initial injection • #3 - 180 days after initial injection • recommend HBV titre 1-2 months after completion of series

22. Titre for HBV should have an antibody level greater than 10 to determine immunity routine boosters are not recommended, only given if titre is less than 10, not to exceed 3 boosters HBV Vaccine is free to employees that are at risk of exposure to HBV on the job HBV Vaccine Protocol

23. percutaneous exposure to infected fluids via: open wounds, chapped skin, hangnails, needle sticks, tattoos, body piercing etc. permucosal exposure to infected fluids via: mucosal linings of eyes, mouth & nose HBV Modes of Transmission

24. HBV Modes of Transmission • human bite that breaks through skin by an HBV infected person • unprotected sex with an HBV infected person

25. Risky Tasks with HBV Patient • invasive procedures: • intravenous lines, injections, nasogastric tubes, catheterizations, tracheostomy care, suctioning, surgery, wound care, etc.

26. Risky Tasks with HBV Patient • contaminated needle sticks or sharps sticks to include dental burs, dental wires, surgical instruments, glass vials, microscope slides, capillary tubes etc.

27. “NEEDLELESS SYSTEMS” • should be used whenever possible • defined as a device that does not use needles for collection of body fluids, administration of meds or fluids

28. Risky Tasks with HBV Patient • procedure that induces coughing, vomiting or bleeding such as: oral suction, throat swabs, bronchoscopy, trach care, NG insertion, intubation, etc., trauma and childbirth

29. fatigue (early sign) anorexia (early sign) abdominal pain, nausea & vomiting disruption of normal liver function fever/headache (early sign) jaundice (late sign) swollen liver Signs & Symptoms of HBV

30. Hepatitis C (HCV) identified in 1989 (formerly known as Non-A, Non-B) 85% risk of becoming chronic disease as very difficult for immune system to fight leading indicator for liver transplants HCV Specific Characteristics

31. cycle of infection, exposure to significant liver disease, up to 20 years or longer HCV Specific Characteristics serious liver disease exposure infection

32. HCV Characteristics • blood transfusions account for 10% of all HCV cases

33. HCV Modes of Transmission • Same as HBV

34. transfusions prior to July 1992 (whole blood, blood components, hemodialysis, or clotting factors prior to 1987 solid organ transplants prior to July 1992 HCV Modes of Transmission

35. typically mild initially, significant when liver damage is done fatigue abdominal pain anorexia/nausea/vomiting may become jaundice in late stages (less frequent than in HBV) Signs & Symptoms of HCV

36. Hepatitis D (HDV) always associated with coexistence of HBV HDV tends to be severe HDV has greater incidence of chronic disease leading to liver cirrhosis HDV Specific Characteristics

37. Modes of Transmitting HDV • believed to be similar to HBV through percutaneous or permucosal exposure

38. Resemble HBV & HCV fatigue anorexia/nausea/vomiting abdominal pain fever swollen liver with disrupted function Signs & Symptoms of HDV

39. virus attacks T-4 cells, macrophages, lymphocytes & certain brain cells virus alters T-4 cell growth, reproduction & eventually destroys the cells Human Immunodeficiency Virus (HIV)

40. HIV Characteristics • HIV does NOT respond to antibiotics • no vaccine yet • vaccine in clinical trials Phase III now

41. highest concentration of HIV is found in blood, semen and vaginal secretions HIV eventually results in Acquired Immune Deficiency Syndrome (AIDS) for every HIV diagnosed patient, there are 40 unknown others Early stages patient may be asymptomatic HIV Characteristics key point

42. Specific AIDS Infections & Malignancies • leads to infections caused by fungi, viruses, and parasites which a healthy immune system could fight successfully • Also susceptible to certain malignancies Example: oral candidiasis (oral thrush)

43. HIV/AIDSModes of Transmission key point • blood to blood contact via an infected needle stick or sharps cut (greatest risk for healthcare workers) • 384,325 hospital workers affected annually

44. HIV/AIDSModes of Transmission • very similar to HBV, although human bites do not pass the HIV virus as it does HBV • splash to non-intact skin, eyes, nose, or mouth with infected body fluids

45. infected mother to child unprotected sexual contact with HIV infected person HIV/AIDSModes of Transmission

46. AIDS is the #1 public health concern in the country is the second leading cause of death in America between the ages of 24 & 44 Did You Know? wow!

47. Body Fluids that Pose Risks!

48. defined as the means of isolating or removing bloodborne pathogens from the workplace Examples: self-sheathing needles properly labeled waste containers properly labeled disposable sharps containers clean-up kits for bloodborne pathogen spills ENGINEERING CONTROLS

49. Self-sheathing needles & IV catheters ENGINEERING CONTROLS Auto Guard Shielded IV Catheter Safety Glide Syringe & Shielding IM Needle

50. ENGINEERING CONTROLS • Properly lined & functional waste containers • routine inspection of infectious waste containers for evaluation of effectiveness & proper working order required