Download bloodborne pathogens program

SAMPLE SAFETY TRAINING AND
INSTRUCTION PROGRAM
BLOODBORNE
PATHOGENS PROGRAM
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
DISCLAIMER
This sample safety program is intended solely as a
guide and template for employer reference and
use. This sample program is not intended to be
implemented as is, nor is it intended to comply with
any federal, state, or local regulation or
statute. Rather, the sample program is meant to
assist each employer in developing its own written
safety program based upon its specific needs and
requirements. An employer should review the OSHA
standards for specific requirements applicable to its
operations and make adjustments to this sample
program based upon those requirements.
An
employer will need to modify the sample safety
program by adding information relevant to its
particular jobsites or facilities in order to develop an
effective, comprehensive program. The failure of an
employer to develop its own written safety program
designed for its own operations may result in a
violation of OSHA standards.
SAMPLE SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
2
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
29 CFR 1910.1030
PURPOSE: The Occupational Safety and Health Act (OSHA) 1910.1030, requires
that an employee exposed to blood and other infectious materials be advised of the
hazards associated with potential bloodborne pathogens and be trained in how to
guard against these hazards. OSHA further requires an exposure control plan,
training program and a labeling system be developed for all infectious materials in
such instances.
SCOPE: This program applies to all (EMPLOYER NAME) controlled work
locations where an employee or a subcontract employee may be occupationally
exposed to bloodborne pathogens.
RESPONSIBILITIES:
MANAGEMENT - It is management's responsibility .to determine what specific
applications require use of this program. Management must also provide proper
equipment to meet the needs of each specific application. Employees must be
provided with adequate training and instructions on all equipment.
MANAGEMENT/SUPERVISORY - Superintendents, supervisors, foremen, or
group leaders of each area are responsible for insuring that all personnel under
their control are knowledgeable of the for the areas in which they work. They are
also responsible for insuring that their subordinates comply with all facets of this
program.
EMPLOYEES - It is the responsibility of.the employee to have an awareness of
the requirements for their work areas (as explained by management), according
to proper instruction, and for maintaining equipment in a clean and operable
condition.
SAMPLE SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
3
BLOODBORNE
PATHOGENS PROGRAM
(EMPLOYER NAME)
TABLE OF CONTENTS
1. Definitions
7. Checklist
2. Exposure Plan
8. Job Hazard Analysis
3. Training Document
9. Employee Acknowledgement
4. Code of Safe Practices
10. Hepatitis “B” Vaccine
5. Specific Safety Training and
Acceptance
Instruction
11. Hepatitis “B” Vaccine Decline
6. Written Assessment
SAMPLE SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
4
BLOODBORNE
PATHOGENS PROGRAM
(EMPLOYER NAME)
1. DEFINITIONS
Assistant Secretary — The Assistant Secretary of Labor for Occupational Safety and
Health, or designated representative.
Assistant Secretary — Human blood, human blood components, and products made
from human blood.
Bloodborne Pathogens — Microorganisms that are present in human blood and can
cause disease in humans. These pathogens include, but are not limited to, hepatitis B
virus (HBV) and human immunodeficiency virus (HIV).
Clinical Laboratory — A workplace where diagnostic or other screening procedures
are performed on blood or other potentially infectious materials.
Contaminated — The presence or the reasonably anticipated presence of blood or
other potentially infectious materials on an item or surface.
Contaminated Laundry — Laundry which has been soiled with blood or other
potentially infectious materials or may contain sharps.
Contaminated Sharp — Any contaminated object that can penetrate the skin
including, but not limited to, needles, scalpels, broken glass, broken capillary tubes,
and exposed ends of dental wires.
Decontamination — The use of physical or chemical means to remove, inactivate, or
destroy bloodborne pathogens on a surface or item to the point where they are no
longer capable of transmitting infectious particles and the surface or item is rendered
safe for handling, use, or disposal.
Director — The Director of the National Institute for Occupational Safety and Health,
U.S. Department of Health and Human Services, or designated representative.
Engineering Controls — controls (e.g., sharps disposal containers, self-sheathing
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
2
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
needles, safer medical devices, such as sharps with engineered sharps injury
protections and needleless systems) that isolate or remove the bloodborne pathogens
hazard from the workplace.
Exposure Incident — A specific eye, mouth, other mucous membrane, non-intact
skin, or parenteral contact with blood or other potentially infectious materials that
results from the performance of an employee's duties.
Handwashing Facilities — A facility providing an adequate supply of running potable
water, soap, and single-use towels or air-drying machines.
Licensed Healthcare Professional — is a person whose legally permitted scope of
practice allows him or her to independently perform the activities required by
paragraph (f) Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up.
HBV — Hepatitis B virus.
HIV — Human immunodeficiency virus.
Needleless Systems — A device that does not use needles for:
1.
The collection of bodily fluids or withdrawal of body fluids after initial venous
or arterial access is established;
2.
The administration of medication or fluids; or
3.
Any other procedure involving the potential for occupational exposure to
bloodborne pathogens due to percutaneous injuries from contaminated
sharps
2. OCCUPATIONAL EXPOSURE
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.
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
3
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
Other Potentially Infectious Materials:
1.
The following human body fluids: semen, vaginal secretions, cerebrospinal
fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic
fluid, saliva in dental procedures, any body fluid that is visibly contaminated
with blood, and all body fluids in situations where it is difficult or impossible to
differentiate between body fluids;
2.
Any unfixed tissue or organ (other than intact skin) from a human (living or
dead); and
3.
HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBVcontaining culture medium or other solutions; and blood, organs, or other
tissues from experimental animals infected with HIV or HBV.
Parenteral — Piercing mucous membranes or the skin barrier through such events as
needlesticks, human bites, cuts, and abrasions.
Personal Protective Equipment — Is specialized clothing or equipment worn by an
employee for protection against a hazard. General work clothes (e.g., uniforms, pants,
shirts or blouses) not intended to function as protection against a hazard are not
considered to be personal protective equipment.
Production Facility — A facility engaged in industrial-scale, large-volume or high
concentration production of HIV or HBV.
Regulated Waste — Liquid or semi-liquid blood or other potentially infectious
materials; contaminated items that would release blood or other potentially infectious
materials in a liquid or semi-liquid state if compressed; items that are caked with dried
blood or other potentially infectious materials and are capable of releasing these
materials during handling; contaminated sharps; and pathological and microbiological
wastes containing blood or other potentially infectious materials.
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
4
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
Research Laboratory — A laboratory producing or using research-laboratory-scale
amounts of HIV or HBV. Research laboratories may produce high concentrations of
HIV or HBV but not in the volume found in production facilities.
Sharps with engineered sharps injury protections — A nonneedle sharp or a
needle device used for withdrawing body fluids, accessing a vein or artery, or
administering medications or other fluids, with a built-in safety feature or mechanism
that effectively reduces the risk of an exposure incident.
Source Individual — Any individual, living or dead, whose blood or other potentially
infectious materials may be a source of occupational exposure to the employee.
Examples include, but are not limited to, hospital and clinic patients; clients in
institutions for the developmentally disabled; trauma victims; clients of drug and
alcohol treatment facilities; residents of hospices and nursing homes; human remains;
and individuals who donate or sell blood or blood components.
Sterilize — The use of a physical or chemical procedure to destroy all microbial life
including highly resistant bacterial endospores.
Universal Precautions — Is an approach to infection control. According to the
concept of Universal Precautions, all human blood and certain human body fluids are
treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.
Work Practice Controls — Controls that reduce the likelihood of exposure by
altering the manner in which a task is performed (e.g., prohibiting recapping of
needles by a two-handed technique).
3. EXPOSURE CONTROL PLAN
(Employer Name) is responsible for developing and maintaining a list of tasks that
could reasonably be anticipated to involve occupational exposure to blood or other
infectious materials. After identifying hazardous or potentially hazardous tasks
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
5
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
develop methods to control exposure and means to train applicable employees,
medically evaluate those employees and maintain medical records.
The Bloodborne Pathogen Exposure Control Plan should be periodically reviewed for
compliance and updated as necessary. This is to occur annually and/or when
conditions, tasks, employees involved or procedures change.
1. Employee Training Program
All affected employees should be provided with information regarding the
Bloodborne Pathogen Exposure Control Plan. Orientation sessions should take
place prior to work assignment that discuss the hazardous tasks present in
their work place, potential health risks of these tasks, how to identify hazardous
condition, methods to reduce risk and appropriate control procedures and what
to do if an exposure occurs. Employees should be trained on how to interpret
the task list and Exposure Control Plan, as well as how to review tasks to
minimize the potential hazards of infection. If a task involves the handling of
blood and other infectious materials, employees should be trained to ensure
knowledge of how those materials are to be contained, labeled and properly
disposed. The necessity for proper housekeeping and personal hygiene
techniques, including hand washing, should be emphasized.
2. Container Labeling and Disposal
All containers used to store or transport blood and other infectious materials
generated at the site are clearly labeled with warning labels that include the
orange or orange-red biohazard symbol.
Only handling blood and infectious material that are properly labeled. Labels
should indicate the contents, the hazards involved, and the name and address
of the project. Red bags or containers may be used instead of labeling, but the
management of these receptacles should be controlled by employees
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
6
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
specifically trained in the handling of these receptacles.
All containers of blood and other infectious materials should be controlled until
delivered to an authorized disposal facility for incineration or decontamination
by legally approved means.
Arrangements may be made with a local hospital to receive and dispose of
limited quantities of these regulated wastes in cases of first-aid treatment. Each
subcontractor will be responsible for proper disposal of all regulated wastes
generated by their work.
3. Hazardous Non-Routine Tasks and Nearby Work
In the event an employee is assigned to perform a non-routine task, a
specialized task or is assigned to work in an area where special hazards exist,
they should be given additional training on the hazards associated with these
tasks/areas. Examples of specialized training include work in HIV or HBV
research labs and production facilities. The information should include the
specific hazards of the task, the controls and protective measures required, the
types of personal protective equipment required.
Additional information should include the use of equipment, the nature of other
work being performed in or near the non-routine task, and any emergency
procedures required for the task.
4. Universal Precautions
Universal precautions should be followed on all tasks involving blood or other
infectious material. This means that all blood and potentially infectious material
are treated as if they contain HIV, HBV and other bloodborne pathogens.
Particular attention should be given to contaminated sharp objects that may
penetrate the skin including, but not limited to, needles, broken glass, and
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
7
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
exposed ends of wires. Work practices and engineering controls should be
followed diligently, including:

The provision and use of latex gloves

Masks and eye protection

Resuscitation bags and mouthpieces

Gowns, aprons or specialized clothing where required by established
engineering practices

Hand-washing facilities (washing hands is recommended for a minimum
of 30 seconds)

Other decontamination where required by established engineering
practices

Use and provision of sharps containers

Good hygiene practices – no smoking, eating, drinking or handling
contact lenses in these areas
Decontamination of the above personal protective items should be conducted
by trained personnel following approved procedures. Disposable items should
be discarded into red bags or properly labeled containers and delivered for
disposal as required elsewhere in this program. Reusable items and any work
areas contaminated by blood and other infectious materials should be cleaned
and disinfected with an appropriate solution consisting of a strong
concentration of chlorine bleach or suitable alternative.
If cleaning blood:

Put on latex or other protective surgical type glove and other PPE as
required
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
8
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM

Carefully cover the spill with paper towels or rags

Lysol or other EPA registered tuberculoidal disinfectant; check the label
to ensure it meets this standard

Leave for at least 10 minutes to ensure that all bloodborne pathogens
are killed

Wipe up and dispose of properly
5. Hepatitis B Vaccination
Hepatitis B vaccinations should be made available to all affected employees
within 10 working days of assignment to the applicable task. These
vaccinations will be at no cost to the employee, at a reasonable time and place,
under the supervision of a licensed physician or health care professional and
according to the latest recommendations of the U.S. Public Health Service
(USPHS).
Prescreening may not be required as a condition of receiving the vaccine.
Employees should sign a declination form if they choose not to be vaccinated,
but they may later opt to receive the vaccine at no cost. Should booster doses
later be recommended by the USPHS, they must be offered to employees.
6. Post-Exposure Evaluation and Follow-up
In the event an employee is exposed or potentially exposed to blood or
infectious material an exposure report should be completed. Additionally, a
confidential medical evaluation and follow-up should be made immediately
available to the exposed employee by the employer. These medical
evaluations must be conducted by an accredited laboratory and offered at no
cost to the employee.
Follow-up procedures should include: a confidential medical evaluation
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
9
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
documenting the circumstances of exposure; identifying and testing the source
individual, if feasible; testing the exposed employee's blood (if consented by
the employee); post-exposure prophylaxis counseling; and evaluation of
reported illnesses. All diagnoses must remain confidential.
7. Record Keeping
(Employer Name) will establish and maintain an accurate medical record of
each employee with an occupational exposure to blood and other infectious
materials for the duration of employment plus 30 years. These records must
remain confidential and may only be disclosed or reported to any party with the
expressed consent of the employee. Medical records must be made available
to the employee at their request.
Training records should include the date, agenda, instructor’s name and
attendance list. These records are to be maintained for 3 years.
Hepatitis B Vaccine Fact Sheet
The following information is derived from the Centers for Disease Control and
Prevention (CDC) and the National Vaccine Information Center (NVIC).
Hepatitis B Disease
Hepatitis B is primarily an adult disease transmitted through infected body fluids, most
frequently infected blood, and is prevalent in high risk populations such as needle
using drug users (28%); sexually promiscuous heterosexual (22%) and homosexual
(9%) adults; residents and staff of custodial institutions such as prisons; health care
workers exposed to blood; persons who require repeated blood transfusions and
babies born to infected mothers (2%). Hepatitis B is not common in childhood and is
not highly contagious.
Hepatitis B is not a killer disease for most people. Symptoms of hepatitis B include
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
10
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
nausea, vomiting, fatigue, low grade fever, pain and swelling in the joints, headache
and cough that may occur one to two weeks before the onset of jaundice (yellowing of
the skin) and enlargement and tenderness of the liver, which can last for three to four
weeks. Fatigue can last up to one year. According to Harrison’s Principles of Internal
Medicine (1994) ‘most patients do not require hospital care”, “95% of patients have a
favorable course and recover completely” and the case fatality ratio is “very low
(approximately 0.1%). Those who recover completely acquire life long immunity from
the disease.
Hepatitis B Vaccine Safety
Public health organizations and the CDC endorse the vaccine as a safe and effective
way to prevent disease and death. The Institute of Medicine and NVIC cite a lack of
conclusive evidence and adequate unbiased scientific study on the adverse effects or
long term safety of the hepatitis B vaccine. During the past decade, there have been
many reports in the medical literature that hepatitis B vaccination is causing chronic
immune and neurological disease in children and adults.
Common short term reactions to the hepatitis B vaccine include fatigue, weakness,
fever, headache and joint pain. One or several of these symptoms were reported in up
to 17% of all hepatitis B injections.
Hepatitis B Vaccine Efficacy
All vaccines stimulate only an artificial, temporary immunity, and the length of
immunity conferred by the hepatitis B vaccine and the future need for more “booster”
doses later in life is still not clear. Current research shows that about “30-50% of
people who develop adequate antibody after three doses of vaccine will lose
detectable antibody within 7 years”.
Vaccine Schedule
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
11
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
The recommended dose schedule for hepatitis B vaccine is a three shot dose
including the initial shot, and follow up shots at 1-2 months and 4-6 months. The
second and third dose should be separated by at least 2 months.
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
12
BLOODBORNE
PATHOGENS PROGRAM
(EMPLOYER NAME)
4. CODE OF SAFE PRACTICES
BLOODBORNE PATHOGENS
1. Employees should recognize that Human Immunodeficiency Virus (HIV), Hepatitis B
Virus (HBV), and other pathogens may be present in blood, body fluids and in unfixed
tissues or organs.
2. HBV is highly contagious and represents the greatest risk for exposure of the
bloodborne pathogens. HBV is durable and can live for 7 days outside the body.
3. Body fluids of concern are blood, semen, vaginal secretions, cerebrospinal fluid,
synovial fluid, pleural fluid, saliva from dental procedures, any body fluid with visible
blood, and any unidentifiable body fluid. Feces and vomit should also be considered
potentially infectious, since they may contain blood, which is not easily visible.
4. Pathogens can enter the body through cuts, nicks, skin abrasions, and the mucous
membranes of the mouth, eyes, or nose. Unintentional needle pricks and broken
glassware are other potential modes of transmission.
5. Personnel protective equipment should be used in areas where unintended exposure
may occur during an employee’s job duties.
6. All blood or other body fluids of concern, as described above, should be assumed to
be infectious. Universal Precautions should be followed when working with these
potentially infectious materials.
7. Universal Precautions to be followed include:
o Wear impervious gloves. Latex, neoprene, or other impervious materials are
acceptable. Leather gloves do NOT offer protection from infectious agents.
Wash gloves with soap and water or disinfectant before removing.
o Use disinfectants (10% bleach) on spills before handling. Let 10% bleach sit on
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
13
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
spill for 10 minutes before wiping (or follow manufacturer’s directions for
commercial disinfectant).
o Wash hands immediately after removing gloves. Use soap and water or
disinfectant towelletes.
o Wear an impervious apron or suit if the possibility exists of splashing infectious
materials onto exposed skin.
o Wear eye protection if the possibility exists of splashing infectious materials
into your eyes.
o Wear a face mask if the possibility exists of splashing infectious materials onto
your face.
o Dispose of all contaminated personal protective equipment and cleanup
materials in properly labeled Biohazard Waste for Disposal.
8. Universal Precautions to be followed inIf contact with blood or bodily fluids occurs on
the skin, begin washing with soap and water. If contacted in eyes, begin flushing eyes
for 15 minutes in eye wash or sink.
9. Report all possible exposure incidents to your supervisor immediately. Employees
who have had exposure to potentially infectious materials may have a confidential
consultation with a physician.
10. An effective vaccine exists to prevent hepatitis B infections. Employees who may be
exposed to potentially infectious materials can receive a hepatitis B vaccination.
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
14
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
5. SPECIFIC SAFETY TRAINING AND INSTRUCTION
TOPIC: Bloodborne Pathogens
SOURCE: OSHA 29-CFR 1926.1030
The employer shall train each employee with occupational exposure in accordance
with the requirements of this section. Such training must be provided at no cost to the
employee and during working hours. The employer shall institute a training program
and ensure employee participation in the program.
At the time of initial assignment to tasks where occupational exposure may take place
and at least annually thereafter. Annual training for all employees shall be provided
within one year of their previous training.
(Employer Name) will provide additional training when changes such as modification
of tasks or procedures or institution of new tasks or procedures affect the employee's
occupational exposure. The additional training may be limited to addressing the new
exposures created.
Material appropriate in content and vocabulary to educational level, literacy, and
language of employees shall be used and shall contain at a minimum the following
elements:
1. An accessible copy of the regulatory text of this standard and an explanation of its
contents;
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 the employer's exposure control plan and the means by which
the employee can obtain a copy of the written plan;
5. An explanation of the appropriate methods for recognizing tasks and other
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
15
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
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 types, proper use, location, removal, handling, decontamination
and disposal of personal protective equipment;
8. Explanation of the basis for selection of personal protective equipment;
9. Information on the hepatitis B vaccine, including information on its efficacy, safety,
method of administration, the benefits of being vaccinated, and that the vaccine
and vaccination will be offered free of charge;
10. Information on the appropriate actions to take and persons to contact in an
emergency involving blood or 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 post-exposure evaluation and follow-up that the employer is
required to provide for the employee following an exposure incident;
13. An explanation of the signs and labels and/or color coding required;
14. An opportunity for interactive questions and answers with the person conducting
the training session.
15. The person conducting the training shall be knowledgeable in the subject matter
covered by the elements contained in the training program as it relates to the
workplace that the training will address.
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
16
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
6. WRITTEN ASSESSMENT
1. An occupational exposure is defined as a 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.
 True  False
2. An employee should practice universal precautions when picking up used blood
drawing equipment.
 True  False
3. The employee is required to provide their own personal protective equipment.
 True  False
4. Can an employee store their lunch in the lab refrigerator labeled “biohazard”?
 Yes  No
5. An employer can charge employees their costs to provide hepatitis B vaccinations.
 True  False
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
17
BLOODBORNE
PATHOGENS PROGRAM
(EMPLOYER NAME)
BLOODBORNE PATHOGENS — OSHA 29-CFR 1926.1030
Date:
Project:
Supervisor:
Attendees:
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
18
BLOODBORNE
PATHOGENS PROGRAM
(EMPLOYER NAME)
7. BLOODBORNE PATHOGENS
COMPLIANCE CHECKLIST
√ – ACCEPTABLE
X – NOT ACCEPTABLE
Project:
N/A – NOT APPLICABLE
Date:
Comments
√/X/NA
Exposure Control Program
Management Training
Spill Containment/Procedures
Employee Training
Personnel Protective
Equipment
Signage
Other:
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
19
BLOODBORNE
PATHOGENS PROGRAM
(EMPLOYER NAME)
8. JOB HAZARD ANALYSIS
(EMPLOYER NAME) PRE-JOB HAZARD ANALYSIS
PROJECT:
Date:
JHA No.:
New:
Revised
Superintendent:
Analysis By:
Foreman:
Approved By:
Page _____ of _____
Controlling Contractor:
Location:
RECOMMENDED ACTION, PROCEDURE,
ACTIVITY
POTENTIAL HAZARDS
Cleaning
Contact with raw sewage
Personal Protective Equipment
CPR and First Aid
Contact with Pathogens
Personal Protective Equipment
General
Construction
AND/OR EQUIPMENT
Rabies, Hantavirus, West
Nile Virus, Colorado Tick
Research Center for Disease Control
Fever
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
20
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
9. EMPLOYEE ACKNOWLEDGEMENT
By signing below, I acknowledge that I understand and agree to comply with
(EMPLOYER NAME) “Bloodborne Pathogens Program”
Policies
and
Company
Safety
and Procedures. I have reviewed a copy of the Program and have
received a verbal orientation identifying the safety requirements associated with the
scope of work contained in this Program.
This statement is to remain in the files of (EMPLOYER NAME).
SIGNATURE
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
DATE
21
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
10. HEPATITIS B VACCINATION ACCEPTANCE
I understand that due to my reasonable occupational exposure to blood or other
potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV)
infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine,
at no charge to myself. I understand the above information related to the vaccine and
hepatitis B and have been given the opportunity to ask any questions about this to
(Employer Name) or the health care provider. I further understand that by accepting
this vaccine, I expose myself to any and all risks associated with vaccine use. Further,
if my employment at (Employer Name) is terminated prior to the completion of the full
series of vaccinations, I am responsible for ensuring that I follow-up and complete my
vaccine schedule. If in the future I choose not to be vaccinated or discontinue the
vaccination schedule, I will contact (Employer Name) and ask for and complete the
necessary Hepatitis B Vaccination Declination form.
PRINT NAME
DATE
SIGNATURE
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
22
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
11. HEPATITIS B VACCINATION DECLINATION
I understand that due to my reasonable occupational exposure to blood or other
potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV)
infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine,
at no charge to myself. However, I decline hepatitis B vaccination at this time. I
understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis
B, a serious disease. If in the future I continue to have occupational exposure to blood
or other potentially infectious materials and I want to be vaccinated with hepatitis B
vaccine, I can receive the vaccination series at no charge to me.
PRINT NAME
DATE
SIGNATURE
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
23
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
Hoja de datos—vacuna contra la Hepatitis B
Documento de archivo – NO DESECHAR
La siguiente información se obtuvo del Centro para el Control y la Prevención de
Enfermedades (Centers for Disease Control and Prevention, o CDC por su sigla en
inglés) y del Centro Nacional de Información sobre las Vacunas (National Vaccine
Information Center, o NVIC por su sigla en inglés).
La enfermedad conocida como Hepatitis B
La Hepatitis B es primordialmente una enfermedad de adultos transmitida a través de
líquidos corporales contaminados, con mayor frecuencia a través de sangre
infectada, y prevalece en poblaciones de alto riesgo, tales como los consumidores de
drogas por inyección (28%); adultos heterosexuales (22%) y adultos homosexuales
(9%) sexualmente promiscuos; residentes y personal de instituciones de custodia
tales como prisiones; trabajadores en cuidados de la salud expuestos a sangre;
personas que necesitan repetidas transfusiones de sangre y bebés nacidos de
madres infectadas (2%). La Hepatitis B no es común en la infancia y no es altamente
contagiosa.
Para la mayoría de las personas la Hepatitis B no es una enfermedad mortal. Los
síntomas de la Hepatitis B son náuseas, vómitos, fatiga, fiebre leve, dolor e
inflamación de las coyunturas, dolor de cabeza y tos, y pueden ocurrir una o dos
semanas antes de la manifestación de la ictericia (piel amarilla) y aumento en el
tamaño y sensibilidad del hígado, lo que puede durar entre tres a cuatro semanas. La
fatiga puede durar hasta un año. Según los Principios de Medicina Interna de
Harrison (1944), “la mayoría de los pacientes no requiere cuidados hospitalarios”,
“95% de los pacientes tiene una resolución favorable y se recupera totalmente” y la
tasa de mortalidad es “muy baja (aproximadamente 0.1%)”. Aquellas personas que
se recuperan adquieren una inmunidad vitalicia a la enfermedad.
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
24
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
La seguridad de la vacuna contra la Hepatitis B
Las organizaciones de salud pública y el CDC endosan la vacuna como un método
seguro y eficaz de prevenir la enfermedad y la muerte. El Instituto de Medicina y el
NVIC indican que no existen pruebas contundentes y suficientes estudios científicos
adecuados e imparciales sobre los efectos adversos o sobre la seguridad a largo
plazo de la vacuna contra la Hepatitis B. Durante la última década, hubo muchos
informes en publicaciones médicas que indican que la vacuna contra la Hepatitis B
causa enfermedades neurológicas e inmunológicas crónicas en niños y adultos.
Las reacciones más comunes dentro del corto plazo a la vacuna contra la Hepatitis B
incluyen fatiga, debilidad, fiebre, dolor de cabeza o de las coyunturas. Se informó
sobre la presencia de uno o varios de estos síntomas en hasta 17% de todas las
personas que recibieron inyecciones contra la Hepatitis B.
Eficacia de la vacuna contra la Hepatitis B
Todas las vacunas estimulan exclusivamente una inmunidad artificial y temporal, y
aún no tenemos idea clara de la duración de la inmunidad otorgada por la vacuna
contra la Hepatitis B y la necesidad futura para aplicar dosis de “refuerzo” en años
posteriores. La investigación actual muestra que alrededor de “30-50% de las
personas que desarrollan anticuerpos adecuados después de tres dosis de vacuna
perderán una cantidad detectable de anticuerpos en 7 años”.
Programa de vacunación
El programa de vacunación recomendado para la vacuna contra la Hepatitis B es una
dosis de tres inyecciones, incluyendo la inyección inicial, y dos inyecciones
posteriores dentro de 1-2 meses y 4-6 meses. La segunda y la tercera dosis deberán
estar separadas por un intervalo de por lo menos 2 meses.
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
25
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
Aceptación de vacunación contra la Hepatitis B
Entiendo que por motivo de mi ocupación es razonable anticipar que podré estar
expuesto/a a la sangre y otras materias posiblemente infecciosas, y que puedo correr
el riesgo de contraer una infección de virus Hepatitis B (HBV). He tenido la
oportunidad de recibir una vacuna contra la Hepatitis B, en forma gratuita.
Comprendo la información que antecede sobre la vacuna y sobre la Hepatitis B, y he
tenido la oportunidad de presentar todas mis preguntas sobre este tema a (Employer
Name)o al proveedor de servicios de la salud. Además entiendo que al aceptar esta
vacuna me expongo a todos los riesgos asociados con el uso de vacunas. Además,
si termina mi empleo en (Employer Name). antes de completar toda la serie de
vacunas, seré yo responsable de las medidas necesarias para continuar y completar
mi programa de vacunación. Si en el futuro decido no ser vacunado/a o no continuar
con el programa de vacunación, me comunicaré con el departamento de salud y
seguridad (Employer Name ) y solicitaré y completaré el formulario pertinente para
rechazar la vacuna contra la Hepatitis B.
NOMBRE EN LETRA DE IMPRENTA
FECHA
FIRMA
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
26
(EMPLOYER NAME)
BLOODBORNE
PATHOGENS PROGRAM
Rechazo a la vacunación contra la Hepatitis B
Entiendo que por motivo de mi ocupación es razonable anticipar que podré estar
expuesto/a a la sangre y otras materias posiblemente infecciosas, y que puedo correr
el riesgo de contraer una infección de virus Hepatitis B (HBV). He tenido la
oportunidad de recibir una vacuna contra la Hepatitis B, en forma gratuita. Sin
embargo, me niego a recibir la vacuna contra la Hepatitis B en este momento.
Entiendo que al rechazar esta vacuna, sigo corriendo el riesgo de contraer Hepatitis
B, una enfermedad grave. Si en el futuro sigo estando expuesto/a en mis
ocupaciones a la sangre y a otras materias posiblemente infecciosas y deseo ser
vacunado/a contra la Hepatitis B, puedo recibir la serie de vacunas en forma gratuita..
NOMBRE EN LETRA DE IMPRENTA
FECHA
FIRMA
MODEL SAFETY TRAINING AND INSTRUCTION PROGRAM | BLOODBORNE PATHOGENS PROGRAM
27