Download Infection Control

OSHA, LABORATORY SAFETY,
BIOMEDICAL AND BIO-HAZARDOUS
WASTE TRAINING
PART A
Hazard
Communication/Chemical
and
Biohazard Safety
Bloodborne Pathogens/Exposure Control Plan
Biomedical/Biohazardous Waste
Occupational Safety and Health
Administration
A federal agency of the United
States that regulates workplace
safety and health.
 The threat of infectious disease through
occupational exposure is a primary concern
for all healthcare employees and employees
with exposure risks.
 Health care workers are responsible for
protecting both their patients’ health and
their own.
1. Identify items defined as Biomedical waste.
2.
Identify points of origin for all Biomedical waste generated
by his/her specific educational program.
3.
Summarize Personal Protective Equipment worn when
handling Biomedical waste per OSHA standards.
4.
Label Biomedical waste bags and containers in compliance
with your facilities’ Biomedical Waste Plan.
5.
Dispose of Biomedical waste bags and containers in
compliance with your facilities’ Biomedical Waste Plan
6.
Identify the correct disinfectants utilized in areas generating
Biomedical waste.
7.
Explain important aspects in the current Biomedical Waste
Plan.
1.
2.
3.
4.
5.
6.
7.
8.
Evaluate a bloodborne pathogen.
Identify three viruses of special concern to healthcare
providers.
Identify several sources of potentially infectious material in
the workplace.
Explain engineering and work practice controls used to
minimize exposure to Bloodborne pathogens.
Identify specific infection control measures used in clinics,
labs, and externship site facilities by employees.
Summarize legal and ethical guidelines used when a
significant exposure has occurred.
Explain post-exposure step-by-step instructions taken in the
event of an occupational exposure to blood
Identify local, state, and national informational resources to
contact in case of a need for counseling and/or treatment
services.
1.
Identify items defined as chemical or biohazardous waste.
2.
Identify points of origin for all chemical and biohazardous waste
generated by his/her specific educational program.
3.
Summarize Personal Protective Equipment worn when handling
chemical or biohazardous waste per OSHA standards.
4.
Label chemical and biohazardous waste containers in
compliance with a Chemical Safety and Bio-hazards Plan.
5.
Dispose of chemical and biohazardous waste containers in
compliance with a Chemical Safety and Biohazardous Waste
Plan
6.
Identify the correct storage methods for storing compatible and
non-compatible chemicals
7.
Explain basic steps for emergency and spill procedures
Exposure Control Plan
Biomedical Waste Plan
Hazard Communication Plan
 CFR
1910.1030… is the OSHA Bloodborne Pathogens
Standard…this standard is located in your facilities’ Exposure
Control Plan (ECP)
 This standard is designed to protect employees from occupational
exposure to HIV, HBV and other bloodborne pathogens.
Health care facilities shall ensure that all employees with
occupational exposure are trained at no cost to the employee: at the
time of initial assignment, within 90 days after effective date of the
standard, when re-assigned to a new position, and then annually
 The training shall consist of: contents of the regulatory text,
explanation of epidemiology and symptoms of bloodborne
pathogens, modes of transmission of bloodborne disease,
explanation of ECP, the use of PPE and engineering controls,
exposure risks, information on HBV vaccination, emergency
procedures if exposed, post-exposure follow-up protocols and
medical follow-up, and an explanation of sign, labels and color
coding.
• A Control plan is accessible to all employees
• The plan must be reviewed/ updated at least
annually
 *Website location: Go to your facilities’ website, then click on policies or
simply type in Exposure Control plan on the search area and it will
bring up all of the plans
 According to the State of Florida Dept. of Health Bureau
of Community Environmental Health Chapter 64E-16,
Florida Administrative Code, Biomedical Waste
Regulation:
 Each biomedical waste facility shall implement a
written operating plan to manage biomedical waste, in
accordance with
 This
plan shall be available for review by the
department and facility personnel.
 The plan shall include the following: a description of training
for personnel; procedures for segregating, labeling, packaging,
transporting, storing, and treating, biomedical waste;
procedures for decontaminating biomedical waste spills; and a
contingency plan for emergencies.
 Facilities which have multiple specialty services shall include
procedures specific to each specialty if procedures vary. Plans
shall be updated when regulations, facility policies, or
procedures change.
 Each facility or their designee shall train new personnel who
handle biomedical waste as part of their work responsibilities.
 This training shall be provided prior to commencement of duties
related to biomedical waste handling.
 Refresher training shall be completed annually by all personnel
who handle biomedical waste. Training shall detail compliance
with the facility’s operating plan and Chapter 64E-16, F.A.C., and
shall be maintained as a part of the operating plan.
 Each facility or their designee shall train new personnel who
handle biomedical waste as part of their work responsibilities.
 This training shall be provided prior to commencement of duties
related to biomedical waste handling.
 Refresher training shall be completed annually by all personnel
who handle biomedical waste. Training shall detail compliance
with the facility’s operating plan and Chapter 64E-16, F.A.C., and
shall be maintained as a part of the operating plan.
 Those fluids which have the potential to harbor pathogens, such
as human immunodeficiency virus and hepatitis B virus,
hepatitis C virus and tuberculosis include: blood, blood
products, lymph, semen, vaginal secretions, cerebrospinal,
synovial, pleural, peritoneal, pericardial and amniotic fluids. In
instances where identification of the fluid cannot be made, it
shall be considered to be a regulated body fluid
 Body excretions such as feces and secretions such as nasal
discharges saliva, sputum, sweat, tears, urine, and vomitus shall
not be considered biomedical waste unless visibly
contaminated with blood.
 The OSHA bloodborne pathogens standard
defines occupational exposures as:
Any reasonably anticipated skin, eye,
mucous membrane or parenteral contact
with blood or other potentially infectious
materials (to include saliva in dental
procedures that is visibly contaminated
with blood) that may result from the
performance of an employees duties.
Routes of transmission of bloodborne
pathogens may occur in several ways:
 Parenteral exposure (i.e., needle stick or
cut by sharp instrument).
 Contact
with mucous membranes
through direct contact or airborne
contaminants…mouth, eyes.
 Contact with wounds and abrasions in
the skin (non-intact skin).
Parenteral exposure, contact with
mucous membranes and contact
with non-intact skin
• A pathogen is any
microorganism such as viruses
and bacteria that can cause
disease.
• Bloodborne pathogens are those
agents found in the blood or
other potentially infectious
materials (BOPIM) that can
cause disease.
• Hepatitis B (HBV), Hepatitis C
(HCV), tuberculosis, and the
human immunodeficiency virus
(HIV) are the 4 bloodborne
pathogens of most concern.
• The most infectious of all the
bloodborne pathogens.
• Blood contains the highest HBV
titers of all body fluids and is the
most important vehicle for
transmission
• HBV may be found in most body
fluids, however, they are not
efficient
vehicles
of
transmission…they contain low
quantities of infectious HBV
• HBsAg-positive
saliva has not
been found to be infectious
when applied to oral mucous
membranes
• Symptoms of hepatitis include:
yellowing of skin and eyes
(jaundice), fatigue, low-grade
fever, loss of appetite, abdominal
pain
• Yellowing of the skin, eyes and
gingiva (jaundice)
• CDC recommends that saliva is
not
considered
infectious unless
blood
potentially
it contains
• HBV is able to survive in dried
blood at room temp on surfaces
for at least 1 week
• Following a needle stick the risk
of infection is approximately 30%
in comparison to HIV which is
0.3%
• Vaccination
of employees
against HBV and the use of
standard precautions is the key
to preventing hepatitis infection
• Hepatitis can destroy the liver
(cirrhosis).
Hepatocellular
carcinoma may be seen in final
stages of the disease
• Stages of liver pathology from hepatitis
•
HCV is not transmitted efficiently
occupational exposures to blood
•
Efficient transmission of the virus requires repeated
exposure
•
IV drug users and transfusion patients are at greatest
risk
•
The HCV infected blood has lower levels of
transmissible virus than HBV
•
Seroconversion after accidental needle stick is only
1.8%
•
Transmission rarely occurs from mucous membrane
exposures
•
No documented transmission from intact or non-intact
skin exposures
•
No immunization at this time
•
Over 50% of the patients develop chronic liver
disease
•
Conditions associated with HCV infection include
cryoglobulinemia which causes inflammation of the
blood vessels in the tissue resulting in joint pain,
nerve pain, accompanied by a raised purple skin
rash
•
Cirrhosis of the liver and hepatocellular carcinoma
are seen in the final stages of the disease
patients with cryoglobulinemia rash
through
•
Risk of HIV transmission following a needle stick
is 0.3%
•
Risk of HIV transmission after a mucous
membrane exposure is 0.09%
•
No immunization available but there are specific
post exposure guidelines to follow if occupational
exposure occurs
•
The virus destroys the bodies CD4 cells. These
cells play a large role in fighting off disease
•
Initially if infected you will develop flu-like
symptoms within 1-2 months, then symptoms
disappear
•
There may be a latent period of up to 8-10 years
where the individual is asymptomatic
•
The disease then progresses to symptomatic HIV
infection then to AIDS
•
Secondary infections are common in late AIDS
stage and include: yeast and fungal infections,
Epstein Barr infections, Kaposi's Sarcoma,
tuberculosis, toxoplasmosis
•
Oral Hairy Leukoplakia (top)
Coccidioidomycosis (fungal disease)(lower
left), and Candidiasis (yeast infection)(lower
right)
• Between 10-15 million people in the
United States are infected with
mycobacterium tuberculosis and an
increasing number of HIV positive
patients will become infected with
TB
• Cause
by
a
bacterium,
Mycobacterium tuberculosis. They
usually attack the lungs but can
attack anywhere in the body
• Bacilli
are extremely resistant
organisms capable of surviving in
the air for up to nine hours and in
dried sputum for several weeks.
• 82% of cases are acquired through
inhalation
• Two tests for TB infection: TB skin
test and TB blood tests
• Clinical
manifestations include
fever, night sweats, anorexia, weight
loss, pain in chest, and cough
The process by which
infectious diseases are
transmitted from one
person to another
involves three essential
“links” in the chain of
infection.
A pathogen
A reservoir of agent
A mode of transmission
A portal of entry
A susceptible host
 Effective infection
control strategies are intended to
break one or more of these “links” in the chain,
preventing infection
 Route of exposure (parenteral exposure, mucosal
exposure, exposure through non-intact skin)
 The dose of the pathogen transferred during an
exposure incident important. In some cases only a small
amount of pathogen is needed, while in other cases large
amounts of the pathogen must be present
 Differences in host susceptibility. How good is your
immune system?
 The volume of infectious body fluid is critical. In some
cases it may only take one drop of blood to be an
efficient transmission of the pathogen, while in other
cases it requires repeated exposure to large amounts of
blood containing the pathogen
Universal /Standard
precautions is a
concept promoted by
the Centers for
Disease Control
(CDC). It requires that
all blood and body
fluids be considered
potentially infectious,
regardless of the
patients perceived
infectious status.
Their handling
requires the use of
personal protective
clothing and
equipment
Employees are categorized into 3
exposure categories based on
potential of occupational exposure
while performing their job duties
CATEGORY 1
• The employee performs tasks that
involve potential for mucous
membrane or skin contact with
blood, body fluid, tissues or a
potential for spills or splashes.
• Dentist, physician, PA/ANP, dental
hygienist & assistant, registered
nurses,
histology/
laboratory
technicians,
housekeeping,
security officer, paramedic and
other healthcare workers or
individuals that work in direct
patient care areas
• Correctional institution employees,
police officers
CATEGORY 2
CATEGORY 3
The employee performs
tasks that involve no
routine exposure to
blood, body fluids or
tissues
during
the
normal work routine, but
may be required to
perform
unplanned
category 1 tasks.
The employee performs
tasks that do not involve
exposure to blood, body
fluids or tissues during
the normal work routine.
• The following job classifications have been determined to have occupational exposure:
• Dentist, physician, physicians assistant
• Dental hygienist
• Dental assistant, medical assistant
• Radiology technician, surgical technician, medical laboratory technician, phlebotomist
• Nurse: RN,LPN, ANP, and CNA
• Histology laboratory technician
• Dental laboratory technician
• Housekeeping working in a healthcare facility
• Other worker in direct contact with healthcare
• Correctional institution employees
• Police officers
 Engineering controls are physical things that
isolate or remove a hazard from the workplace
The following engineering controls:
 Sharps containers/regulated waste
 Rubber dam usage
 High volume evacuation
 Needle re-capping devices
 Personal protective equipment (PPE)
 OSHA requires that both managerial and non-
managerial workers (employees) will be
involved with the input and evaluation
process regarding safer needle devices and
other engineering control used in their area
 Any suggestions for a safer work place should
be made directly to your supervisor or the
college Safety Specialist or designee
 The OSHA standard defines regulated waste as:
 Liquid or semi-liquid blood or potentially infectious
materials (only includes saliva in that is visibly
contaminated with blood)
 Contaminated items that would release blood or other
potentially infectious materials in a liquid or semi-liquid
state if compressed
 Items caked with dried blood or other potentially
infected material (BOPIM) and are capable of releasing
these materials during handling
 Contaminated sharps to include needles, glass items,
dental wires, and any object that has the potential to
break and create a puncture hazard
 Pathologic and microbiologic waste containing BOPIM
and including teeth
 Biomedical waste - Any solid or liquid waste which may present a threat of
infection to humans, including non-liquid tissue, body parts, blood, blood
products, and body fluids from humans and other primates; laboratory and
veterinary wastes which contain human disease-causing agents; and
discarded sharps. The following are also included:
 (a) Used, absorbent materials saturated with blood, blood products, body
fluids, or excretions or secretions contaminated with visible blood; and
absorbent materials saturated with blood or blood products that have
dried.
 (b) Non-absorbent, disposable devices that have been contaminated with
blood, body fluids or, secretions or excretions visibly contaminated with
blood, but have not been treated by an approved method
 Biomedical waste mixed with hazardous waste, as defined in Chapter 62-
730, F.A.C., Hazardous Waste, shall be managed as hazardous waste.
 Any other solid waste or liquid, which is neither hazardous nor radioactive
in character, combined with untreated biomedical waste, shall be
managed as untreated biomedical waste
 Sharps
 Pathological/Anatomical
waste
 Patient
from
only
care disposables
INFECTED patients
 Patient care disposables or
any
item
visibly
contaminated with blood or
saliva
that
is
visibly
contaminated with blood
 Biomedical
waste, except
sharps, shall be packaged
and sealed at the point of
origin in impermeable, red
plastic bags or, at the
discretion of the generator,
into sharps containers.
 Containers must be closable
and must be kept closed when
not in use
 Both
regulated and nonregulated waste containers
must
be
made
readily
available in clinics and
laboratory areas
 A designated person on each
campus will maintain all
vendor tracking logs for a
minimum of 3 years
Labels placed on all red bags or plastic containers
to be disposed of in biomedical containment must
include the following information.
The following must be on the label: source (department or
program) of the waste, does it contain animal parts or biology
slides, the address, the date the items were placed in the red
bag or container, and initials of the individual filling out the
label. Labels may be obtained from college-wide printing or
through the biomedical waste transporter
 Red bags may remain open for use
in the lab or class setting for 30
days .Place label with date of first
use on the bag when it is put into
the waste container.
 The
state
has
specific
specifications for the type of bags
that may be used. (Impact resistance of
165 grams and tearing resistance of 480 grams in
both the parallel and perpendicular planes with
respect to the length of the bag. Impact resistance
shall be determined using ASTM D-1709-91, and
tearing resistance shall be determined using
ASTM D-1922-89)
 Temporary use tabletop biohazard
bags used on laboratory and
treatment area table tops must be
disposed of into a biomedical
waste container each day. These
temporary bags cannot contain any
sharps. The bags must be sealed
prior to being placed into the
larger container.
Tie bag tightly and make sure
the bag is labeled correctly.
Use
the
“gooseneck"
technique for closing bags.
Refer to the Exposure Control
Plan or Biomedical Waste Plan
for details on this technique.
The “rabbit ear” technique
should not be used.
Seal and label the red bag
before placing it in the
storage/transport
container
located in the pick-up area.
Include location where waste
originated on label.
The transport container must
also be labeled appropriately
• Transport the red bag to the
storage/pick-up area and place
in a puncture-proof container
• It is “recommended” when
transporting a red bag to the
containment area located in a
different building, the red bag
should be transported in a
puncture-proof container.
Cadavers treated with Carosafe or Wardsafe are
considered chemically treated. These items
must be disposed of via incineration. These
items (if small parts) should be placed in a red
bag, sealed, and labeled and then placed into
the storage container for pick-up. Care should
be taken to make sure no odors leak through the
bag.
Large Quantities
Parts should be
sealed in a plastic
container or red bag,
labeled, and taken to
the Veterinary
Technology area,
building 21 to be
frozen then
incinerated.
Large Quantities
Parts should be sealed in a
plastic container or bag,
labeled, placed in a
puncture resistant
container, and transported
to be frozen and then
transported for
incineration.
Very Small
Quantities
including clams
and squid should
be placed in a red
bag, sealed,
labeled, and
placed in the
storage container
for pick-up. Be
sure NO ODORS
leak from the bag!
.
 Large Quantities
 Parts should be
sealed in a plastic
container or red
bag, labeled, and
taken to be frozen
and incinerated.
Large Quantities
Parts should be sealed in a
plastic container or bag,
labeled, placed in a puncture
resistant container, and
transported to be frozen and
incinerated.
Biology plates with bacterial
growth should be placed in a
small biohazard bag and
sealed.
Place sealed red bag in a
larger red bag.
Plastic plates and tubes are not
required to go into a sharps
container. However, if you are
concerned that the biology
plate has the potential to break
and become a puncture
hazard, place in a sharps
container or puncture resistant
container. Seal
in small
biohazard bag prior to placing
in container.
Any contaminated object that can penetrate the skin
should be disposed of in the approved sharps container,
including but not limited to: Needles, Scalpels, Glass,
Dental Wires
• Containers will be closable, puncture resistant, leak-proof
and marked with the biohazard label
• Located as close as possible to immediate area of use
• Must be kept in an upright position
• Replaced routinely to prevent overfilling (3/4 full or to the
designated fill line)
• Must be closed before they are moved and once closed
they are not to be re-opened
• Avoid placing on floor unless absolutely unavoidable
• Never attempt to retrieve an item from a sharps container
Needles must not be bent,
recapped, or removed, except:
• When administering multiple
doses or anesthetic
• When not feasible to
immediately discard the
needle
• Prior to removal of the needle
from the syringe
**Always use the one handed
technique or a mechanical
device if re-capping is
unavoidable
NEVER
DISPOSAL OF SHARPS CONTAINERS
DISPOSE OF SHARPS CONTAINERS WHEN THEY ARE ¾ FULL OR
CONTENTS ARE UP TO THE FILL LINE. NEVER PUT YOUR HAND
INSIDE OF THE CONTAINER TO RETRIEVE ITEMS OR TO PUSH
ITEMS DOWN
TAPE AND LABEL THE SHARPS CONTAINER BEFORE PLACING IT
IN THE TRANSPORT CONTAINER LOCATED IN THE STORAGE
AREA. DO NOT LEAVE TAPED AND LABELED SHARPS
CONTAINERS ON THE LABORATORY OR CLINIC COUNTERS AT
ANY TIME
 Each area has a designated location
for biomedical waste storage, labels,
supplies and containers. You are
responsible for knowing these locations.
 Refer to your Biomedical Waste Plan for
the location of the storage area.
 Remember You Are Responsible For
handling the biomedical waste! If you
need assistance please ask for it!
STEP 1
 PREPARE
 SEAL/TAPE
 LABEL
STEP 2
Transport sealed
and labeled
waste to
biomedical waste
storage area
STEP 3
• Pick up key for locked
biomedical waste
storage room
• Security can give you
access to the storage
area in the event no
one is available to
give you the key
STEP 4
Place sealed & labeled RED BAG or
TAPED AND LABELED SHARPS
CONTAINERS into the transport
container
STEP 5
Re-lock the biomedical
waste storage area and
return the key
STEP 6
Report
Full, Sealed, & Labeled
transport container
to the designated
person on the campus
for pick-up.
Items must be picked
up every 30 days unless
pick-up is needed
sooner
6 STEPS
Step 1 – Prepare, Seal, Label/Tape
Step 2 – Transport biomedical waste to
onsite storage
Step 3 – Get key to storage room
Step 4 – Place waste in transport container
Step 5 – Lock room & return key
Step 6 – Report full container(must be sealed & labeled)
END
OSHA, Laboratory Safety,
Bio-Medical and BioHazardous Waste Training
Part A