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Senior Housing Management
Title: Bloodbourne Pathogens: Lesson 1 Safety Seminar
Effective Date: July 15, 2009
Prepared by: MJJ
Outdated SOP#: P840
Reviewed Date: June 28, 2017
Approved by: DKJ
Occupational Exposure to Bloodbourne Pathogens
The Occupational Exposure to Bloodborne Pathogens Standard (OSHA 29 CFR 1910.1030)
was published December 6, 1991. The purpose of the standard is to reduce worker risk by
eliminating or minimizing employee exposure incidents to bloodborne pathogens, such as
Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV).
Bloodbourne Pathogens mean “pathogenic microorganisms that are present in human blood
and can cause disease in humans. These pathogens include, Immunodeficiency Virus (HIV)”.
Because it is the exposure to the blood or other body fluids that carries the risk of infection,
those individuals whose occupational duties place them at risk of exposure to blood and other
potentially infectious materials are also at risk of becoming infected with these bloodborne
pathogens, developing disease, and in some cases, dying. Over 5.5 million health care workers
are at risk under this standard and, therefore, compliance is mandatory. The standard
encompasses workers in physician office settings, nursing homes, hospitals, laboratories,
dentist offices, emergency personnel, housekeeping, linen services, and others who may come
in contact with blood and other potentially infectious materials in the performance of their duties.
This training session will inform and explain the standard, Senior Housing Management
Exposure Control Plan to reduce the risk of exposure, and the compliance of the standard due
by March 6, 1992. This training program will be offered at no cost to the employee during normal
working hours. Training must be offered within ten days of initial assignment to a task that has a
potential for exposure to blood and other potentially infectious materials. These training records
must be maintained by Senior Housing Management for three (3) years. Training will be
conducted within each calendar year and with each assignment of a new or modified task that
may result in the potential for exposure. Training records will include:
1.
2.
3.
4.
The dates of the training sessions;
The contents or a summary of the training session;
The names and qualifications of the persons conducting the training sessions;
The names and titles of all persons attending the training session.
These files may be kept in each employee’s file. Senior Housing Management is required to
provide a safe working environment with the necessary barriers and equipment that are
appropriate and accessible, at no charge, to ensure the safety of the employee. The employees
are required to follow the procedures developed by Senior Housing Management, but also have
the right to demand protection necessary to ensure safety.
The Bloodborne Pathogen Standard administers the full legal force behind OSHA standards and
Universal Precautions. A copy of the standard and Senior Housing Management Exposure
Control Plan are available upon request from the community executive director, and are in the
community’s Standard Operating Procedures.
Universal Precautions is “an approach to infection control. According to the concept of
Universal Precautions, all human blood and certain body fluids are treated as if known to be
infectious for HIV, HBV, and other bloodborne pathogens”.
Senior Housing Management ® 6/28/2017
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Senior Housing Management
Title: Bloodbourne Pathogens: Lesson 1 Safety Seminar
Effective Date: July 15, 2009
Prepared by: MJJ
Outdated SOP#: P840
Reviewed Date: June 28, 2017
Approved by: DKJ
A Health and Safety Manager or other facility representative will be assigned the task of
implementing and assuring compliance with the Exposure Control Plan. The community
executive director, is the overall coordinator of the program, acting as a representative of Senior
Housing Management, and has overall responsibility. The training of the Bloodborne Pathogen
Standard and Senior Housing Management Exposure Control Plan (ECP) will consist of the
following elements:
1.
A copy of the OSHA Standard 29 CFR 1910.1030 and an explanation of its
contents are located in the facility’s administrative office.
2.
A general explanation of the epidemiology and symptoms of bloodborne
diseases;
3.
An explanation of the modes of transmission of bloodborne pathogens;
4.
An explanation of Senior Housing Management Exposure Control Program and
its availability and location in community located in the community’s administrative
office;
5.
An explanation of the appropriate methods for recognizing tasks and other
activities that may involve exposure to blood and other potentially infectious
materials;
6.
An explanation of the use and limitations of methods that will prevent or reduce
exposure, including appropriate engineering controls, work practices, and
personal protective equipment;
7.
Information on the tapes, proper use, location, removal, handling,
decontamination and disposal of personal protective equipment;
8.
An explanation of the basis for selection of personal protective equipment;
9.
Information on the Hepatitis B vaccine, including information on its efficacy,
safety, methods of administration, and the benefits of being vaccinated, and that
the vaccine and vaccination be offered free of charge;
10.
Information on the appropriate actions to take and persons to contact in an
emergency involving blood and other potentially infectious materials;
11.
An explanation of the procedure to follow if an exposure incident occurs, including
the method of reporting the incident and the medical follow-up that will be made
available;
12.
Information on the medical counseling that Senior Housing Management will
provide for exposed individuals;
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Senior Housing Management
Title: Bloodbourne Pathogens: Lesson 1 Safety Seminar
Effective Date: July 15, 2009
Prepared by: MJJ
Outdated SOP#: P840
Reviewed Date: June 28, 2017
Approved by: DKJ
13.
An explanation of the signs, labels, and/or color coding used to denote
biohazards; and,
14.
An opportunity for interactive questions and answers with the person conducting
the training session.
Epidemiology, Symptoms and Modes of Transmission of Bloodborne Pathogens
In discussing bloodborne pathogens, the training will focus on Hepatitis B Virus and the Human
Immunodeficiency Virus. By incorporating the information presented on these disease states
regarding the modes of transmission and prevention, the same principles will protect the worker
against exposure to other bloodborne diseases, such as Hepatitis C, Delta Hepatitis, Syphilis,
Malaria, and others.
Hepatitis means “inflammation of the liver” and can be caused by a number of agents or
conditions, including drugs, toxins, autoimmune disease, and infectious agents, including
viruses. The most common causes of Hepatitis are viruses. There are four types of viral
Hepatitis important in the U.S.
1.
Hepatitis A, formally called “infectious hepatitis” is spread by fecal contamination
and is not generally considered a significant risk to health care workers.
2.
Hepatitis B, formally called “serum hepatitis” is transmitted by blood contact and
is a major risk to health care workers.
3.
Delta Hepatitis may co-infect with Hepatitis B or may infect persons already
infected with HBV and can increase the severity of acute and chronic liver
disease. Nosocomial infection has been reported.
4.
Non-A, non-B Hepatitis is caused by viral agents other than Hepatitis A and
Hepatitis B. Two that have been identified are Hepatitis E transmitted by oralfecal route, and Hepatitis C spread by blood contact.
Of the types of Hepatitis listed, Hepatitis B virus is the major infectious bloodborne occupational
hazard to health care workers. The Centers for Disease Control (CDC) estimates there are
approximately 8,700 infections in health care workers with occupational exposure to blood and
other potentially infectious materials in the U.S. each year. Approximately 200 deaths each year
are reported due to these occupational exposures. Infected health care workers can spread the
infection to family members, or rarely, to their patients. The use of Hepatitis B vaccine,
engineering and work practice controls, and personal protective equipment, will work in
conjunction to prevent almost all of these occupational exposures.
Hepatitis B is caused by the Hepatitis B virus (HBV) that attacks and replicates in liver cells.
There is a laboratory test to determine its presence in blood, and indicate an individual who is
currently infected, and therefore, is potentially infectious to others. All viral hepatitis look
basically the same. Unfortunately, the destruction of liver cells is clinically apparent with the
Hepatitis B virus.
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Senior Housing Management
Title: Bloodbourne Pathogens: Lesson 1 Safety Seminar
Effective Date: July 15, 2009
Prepared by: MJJ
Outdated SOP#: P840
Reviewed Date: June 28, 2017
Approved by: DKJ
Approximately one-third (1/3) of those infected will have a severe clinical course with jaundice
(yellowing of the eyes and skin), dark urine, extreme fatigue, anorexia, nausea, abdominal pain,
and sometimes joint pain, rash, and fever. About twenty percent (20%) of jaundice cases will
require hospitalization, and will cost several weeks to months of work loss. However, not all
infected individuals will demonstrate these clinical signs. Approximately one-third (1/3) will show
no symptoms when infected with the virus, and one-third (1/3) will have a relatively mild clinical
course with flu-like symptoms, which is not diagnosed as Hepatitis. These individuals, however,
are still considered infectious.
Development of chronic HBV infection has more severe long-term consequences. About six to
ten percent (6-10%) of newly infected adults cannot clear the virus from their liver cells, and
become chronic HBV carriers. These carriers are at high risk of developing Chronic Persistent
Hepatitis, Chronic Active Hepatitis Cirrhosis of the Liver, and primary Liver Cancer. Chronic
Active Hepatitis is a progressive, debilitating disease that often leads to Cirrhosis of the Liver
after five to ten (5-10) years. Chronic HBV infection has been estimated to cause ten percent
(10%) of the 25-30,000 deaths that occur due to Cirrhosis each year. Groups as diverse as the
AMA stated, “the loss of health care workers to Hepatitis B virus infection overshadows the risk
of AIDS and is almost entirely preventable”.
Modes of Transmission
Hepatitis B Virus is spread via several routes:
1.
Parenteral-by direct inoculation through the skin;
2.
Mucous membranes-blood contamination of the eye or mouth;
3.
Sexual; or,
4.
Perinatal-infected mother to a newborn infant.
The most efficient mode of transmission is direct inoculation of infectious blood, such as occurs
during blood transfusion, needle sharing by IV drug users, or needlestick or other sharp
instrument injury in health care workers. One milliliter of Hepatitis Positive (HbsAg) blood may
contain one hundred million infectious doses of virus. Of susceptible health care workers
sustaining needlestick puncture injuries from HBV positive patients, seven to thirty percent (730%) will become infected if they do not receive post-exposure prophylactics.
Direct inoculation may occur in less apparent ways. Pre-existing lesions on hands (i.e., torn
cuticles on hands) may provide a route of entry for the virus. In addition, transfer of contaminated
blood via inanimate objects (equipment) or environmental surfaces (counter tops) have been
shown to cause infections. In general, fewer than twenty percent (20%) of infected health care
workers report needlestick injuries from an infected patient. Therefore, although gloving will not
stop direct puncture injuries, it can provide the necessary barrier between blood and an open
lesion.
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Senior Housing Management
Title: Bloodbourne Pathogens: Lesson 1 Safety Seminar
Effective Date: July 15, 2009
Prepared by: MJJ
Outdated SOP#: P840
Reviewed Date: June 28, 2017
Approved by: DKJ
Studies document that health care workers with Chronic Hepatitis often transmit Hepatitis to their
spouses or sexual partners and other family members. Therefore, any exposure may be
significant and must be reported to the facility manager, who acts as the Health and Safety
Manager.
HBV Epidemiology
Most infected health care workers are unaware they have been exposed to or infected with HBV.
Approximately one percent (1%) or more of hospitalized patients are HBV carriers. They are
asymptomatic and unaware they are carriers, and their medical histories do not indicate a
problem. Health care workers often take extraordinary precautions when dealing with a known
carrier, but are often unaware they may treat five (5) carriers for every one (1) recognized.
Therefore, the need to implement Universal Precautions and use the Hepatitis B vaccine in
health care workers in mandated by the Bloodborne Pathogen Standard and implemented by the
facility manager, the Health and Safety Manger.
Transmission via the Environment
It has been documented that the HBV virus can survive for at least one week dried at room
temperature on environmental surfaces. Medical procedures, as well as disinfectant procedures
and sterilization techniques, must be adequate to prevent the spread of this virus. Any
sterilization or disinfection procedure, sterilizing agent, or high level disinfectant will kill the virus
if used as directed. Diluted solutions (1:10-1:100 of sodium hypochlorite - household bleach) are
particularly effective is used properly. Certain low level “germicides,” such as quaternary
ammonium compounds, are not considered effective against this virus. Unfortunately, many
facilities soak medical and dental instruments in this solution and health care workers may
handle the sharp instruments soaked in these solutions with a false sense of security.
HBV Vaccine
Hepatitis B vaccination is the most important part of any HBV control program, because gloving
and other protective devices cannot completely prevent puncture injuries from needles and other
sharp instruments. The currently licensed Hepatitis vaccines are given intramuscularly in the
deltoid in three doses over a six (6) month period. These vaccines induce protective antibody
levels in 85-97% of healthy adults. Protection against both the illness and development of the
carrier state last at least nine (9) years. For persons with normal immune status, it is not
recommended that a booster dose of Hepatitis B vaccine be given after the initial series, but may
do so in the future if it appears that immunity conferred by the vaccine wanes after a period of
time. Booster doses should be given when antibody levels fall below 10 m/ml.
Percutaneous and mucous membrane exposures to blood will continue to occur in the health
care setting and may result in exposure to Hepatitis B. Pre-exposure vaccination is the most
effective method for preventing such an infection. As the old adage states, “an ounce of
prevention is worth a pound of cure.” Senior Housing Management is required to provide this
vaccine at no charge to all employees upon initial assignment to a job task that involved
exposure to blood and other potentially infectious materials. If, however, an individual initially
declines the Hepatitis B vaccine but later changes his/her mind, the vaccine is still available at
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Senior Housing Management
Title: Bloodbourne Pathogens: Lesson 1 Safety Seminar
Effective Date: July 15, 2009
Prepared by: MJJ
Outdated SOP#: P840
Reviewed Date: June 28, 2017
Approved by: DKJ
no charge.
Post-Exposure Prophylaxis
Effective post-exposure prophylaxis exists for HBV exposures, if appropriate protocols are
followed. The February 9, 1990 recommendations of the Immunization Advisory Committee
specify that if the source individual is known to be HBV positive, then the exposed individual
should be given Hepatitis B immunoglobulin (HBIg) and the Hepatitis B vaccine series should be
initiated. Hepatitis B vaccine is recommended for any previously unvaccinated health care
worker who has a needlestick or other percutaneous accident with a sharp instrument or
permucosal (ocular or mucous membrane) exposure to blood.
Report all exposures immediately to the community executive director, or whoever is the Health
and Safety Manager so any necessary steps may be taken.
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