Download bloodborne pathogens - New Mexico School Health Manual

THE OCCUPATIONAL SAFETY AND
HEALTH ADMINISTRATION
(OSHA) STANDARD
Revised January 2011
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What is the bloodborne pathogens standard?
Who needs bloodborne pathogens (BBP) training?
What content needs to be included?
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Employers Duties
identify job risks and
classify
 provide appropriate
training
 provide exposure plan
 provide appropriate
equipment
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Compliance
Employees Duties
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follow employer’s plan
know job classification
complete training
use equipment provided by
employer
Compliance
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Documents
General explanation of bloodborne
pathogens
Hepatitis B immunization
Explanation of tasks that may
involve exposure
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Disease-causing microorganisms that may be
present in human blood or other potentially
infectious material (OPIM)
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Viruses – Hepatitis B (HBV), Hepatitis C (HCV),
HIV
Bacteria - Syphilis
Parasites - Malaria
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Puncture wounds or cuts
Contact (touch, splash, or spray)
with blood or OPIM on:
mucous membrane
 non-intact skin
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 cuts, abrasions, burns
 acne, rashes
 paper cuts, hangnails
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contaminated sharps
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Objective of BBP standard is to
minimize or eliminate the hazard
posed by work that may expose
one to blood or OPIM
Effectively treat employees
involved in an exposure to BBP
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If an exposure occurs one should
know:
Is there a way to prevent infection
 What are signs & symptoms of infection
 availability of counseling
 availability of post-exposure treatment &
follow-up
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Occupational contact with blood or OPIM
is considered an exposure incident
If an exposure occurs:
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wash with soap & water
report incident
document incident
seek “immediate” medical evaluation
follow employer’s exposure control plan
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“Immediate” means prompt medical evaluation and
prophylaxis
An exact timeline cannot be stated
Time limits on effectiveness of prophylactic measures
vary depending on the infection of concern
Minimal Information to Report
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Date and time of
incident
Job classification
Location in the worksite
where incident occurred
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Work practice being
followed
Engineering controls in
use
Procedure being
performed
PPE in use
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Entitled to confidential medical evaluation
Personal decision about blood testing
Blood may be tested only with consent
Blood may be stored for 90 days, while considering testing
Interpretation of any test results occurs with health care
provider
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Blood may be tested for antibodies to:
Human Immunodeficiency Virus (HIV)
 Hepatitis C Virus (HCV)
 Hepatitis B Virus (HBV)
 Other disease-causing organisms
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Source blood may also be tested with
consent
Results of tests of source blood will be made
known to exposed person
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Definition
Signs and symptoms
Course of infection
Prevention and control
Post-exposure prophylaxis and
follow-up care
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HBV is Hepatitis B Virus
It is a virus which affects the liver
Highest rate of disease in persons 20-49 years of age
HBV carriers are people infected who never fully recovered.
30-40% of people with acute HBV have no idea how or when
the became infected
HBV very durable, can survive in dried blood for up to 7 days
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Jaundice - yellow color to the skin and whites of eyes
Fatigue
Abdominal Pain
Loss of appetite
Nausea and vomiting
Joint pain
30% of infected persons have no signs & symptoms
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Incubation period ranges from a few weeks to
several months
Some cases of HBV resolve without complications
Chronic liver disease may occur in 6 to 7% of those
infected with HBV
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A vaccine does exist to prevent HBV infection
Employers are required to offer HBV vaccination to
employees covered under BBP standard
Follow Universal Precautions any time you are dealing
with blood or body fluids
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No cure for HBV infection
Post-exposure prophylaxis
should begin within 24
hours; no later than 7 days
after exposure
Unvaccinated exposed
person should receive HBV
vaccine
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Treatment requires health
care provider
OSHA requires treatment
meet CDC’s most recent
guidelines
HBV infection treatment
may require liver transplant
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Employees with routine occupational exposure to
blood/OPIM have the right to Hepatitis B vaccination at
no personal expense
Employee refusal established by signing Hepatitis B
vaccination declination form
Must be made available within 10 working days of initial
assignment to job
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Vaccine given in 3 dose series over 6 months
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1st - on initial assignment
2nd - 30 days later
3rd - 6 months after 1st dose
CDC recommends HBVantibody testing 1 to 2 months
following 3rd dose
Employer cannot require employee to use health insurance
to cover test cost
Pre-screening is not required
HBV is declining because of vaccine use!
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HCV is Hepatitis C Virus
There is no vaccine to prevent HCV
It infects liver cells resulting in acute & chronic liver disease
An estimated 3.9 million Americans have been infected with
HCV
Up to 10,000 people per year die from HCV
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Jaundice - yellow color to skin and whites of eyes
Fatigue
Dark Urine
Abdominal Pain
Loss of appetite
Nausea
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Incubation period averages 6 to7 weeks
Chronic liver disease may occur in 70% of those infected
with HCV
Transmission occurs when blood or body fluids from an
infected person enters the body of a non -infected person
HCV is spread through sharing needles when using drugs,
needle sticks or sharps exposures on the job or from an
infected mother to baby during birth
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Please note: there is NO vaccine available to prevent HCV
infection
HCV infection in workers is best prevented by following
Universal Precautions
Do not shoot drugs
HCV may be spread by sex, but this is rare
Do not share personal care items
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Toothbrushes
Razors
Nail clippers
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No cure for HCV
No post-exposure prophylaxis recommended
Tests for HCV anti-bodies &
liver function recommended at
time of exposure
Tests should be repeated 4-6
months post exposure
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Treatment of HCV requires a
health care provider
OSHA requires treatment that
meets most recent CDC
guidelines
HCV infection treatment may
include liver transplant
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HIV is Human Immunodeficiency Virus
HIV can cause acquired immune deficiency syndrome
(AIDS)
Risk of HIV infection from a puncture injury or cut
exposure to HIV infected blood is very low - 0.3%
(1/300 )
Stated another way, 99.7% of needlestick/cut exposures
do not lead to infection
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Signs and symptoms include:
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Weight loss
Night sweats or fever
Gland swelling or pain
Muscle and/or joint pain
Flu-like symptoms
Cannot rely on signs and symptoms to confirm if
one is infected
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HIV infection progresses in stages
Course of infection varies from person to person
Acute seroconversion may occur 6-12 weeks after
exposure
Progressive disease in untreated persons is
characterized by a steady decline in specific white
blood cell counts
Increased susceptibility to infections
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NOTE : There is NO vaccine to prevent HIV infections
HIV infection in workers is best prevented through
following Universal Precautions
Post-exposure prophylaxis with anti-viral medication
can reduce risk of infection
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No cure for HIV infection
Testing schedule for HIV
antibodies
at time of exposure
 at 3 months
 at 6 months
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HIV antibodies usually
become detectable within 3
months of infection
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Treatment requires health
care provider
OSHA requires treatment
that meets most recent CDC
guidelines
Treatment may include
antiviral medications and a
protease inhibitor
Average Risk from a single Average risk from mucous
needle stick
membrane exposure
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HBV: 30% (unless vaccinated)
HCV: 1-3%
HIV: 0.3%
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HBV: 10% (unless vaccinated)
HCV: 1%
HIV: 0.1%
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Engineering Controls
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Work Practice Controls
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Personal Protective Equipment
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Universal Precautions
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Design safety into work tools and work space
organization
Engineering controls can:
Decrease risk of exposure to hazards
 Eliminate hazards
 Isolate hazards
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Hand and eye washing facilities
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Sharps container use
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Biohazard labeling
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Self-sheathing needles
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Needleless IV systems
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Label liquid or semi-liquid blood or OPIM
Label item(s) contaminated with blood or OPIM
Label sharps contaminated with blood or OPIM
Label containers holding contaminated equipment for
storage, handling and transport
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closable and puncture resistant
leak proof
labeled or color coded
functional
sufficient in number
easily accessible and
maintained in upright position
replaced per agency policy
NOT be overfilled
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Reusable sharps require proper handling
(mechanical means) and
decontamination
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Retractable needles
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Needleless systems
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Behaviors using engineering controls safely and
effectively
Work Practice Controls include:
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using sharps containers
using an eyewash station
WASHING HANDS after using PPE
cleaning work surfaces
proper laundering
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break, shear, bend or recap
needles
reach into used sharps
containers
pick up contaminated items,
such as broken glass with bare
hands
use a vacuum cleaner to clean
up contaminated items
open or empty sharps
containers
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pipette or mouth suction blood
or OPIM
store beverages or food in
refrigerators, freezers, or
cabinets where blood or OPIM
are present
eat, drink, smoke, apply
cosmetics, or handle contact
lenses in areas of potential
occupational exposure
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Readily available facilities
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Washing after removing PPE
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Using antiseptic hand cleanser when a sink isn’t
readily available
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First roll out paper towel or
have towel readily available
so as not to touch other
surfaces to reach it
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Turn on tap water and
adjust temperature
Use plenty of soap
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Wash hands using friction
on all surfaces for at least
30 seconds
Sing happy birthday to
yourself twice = 30 seconds
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Dry hands thoroughly
DO NOT turn off the
water yet
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Turn off tap with a dry
part of the towel
DO NOT touch
surfaces with clean
hands
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Clean work surfaces according to employer’s exposure control
plan
Use PPE and EPA-approved solution
10% bleach and water must be replaced weekly
Place contaminated laundry in color-coded laundry bag, use
PPE, and handle as little as possible
DO NOT take contaminated materials home to launder
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Specialized clothing/equipment used for protection when
risk of exposure exists
Must prevent blood or OPIM from contaminating clothing or
skin
Must be available at no cost to employee
Must be in appropriate sizes
Must be in good working condition
Must be properly maintained
Employee must be trained in proper use
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Gloves
Masks
Eye shields
Gowns/aprons
Resuscitation devices
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Medical products containing latex must be labeled
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Allergies to latex are increasing
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Substitutes for latex-containing materials must be
made available
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Universal Precautions is a method of
infection control in which All blood and
body fluids is treated as if infectious for
HIV, HBV, HCV or other bloodborne
pathogens
Universal Precautions always applies to:
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Blood
Semen
Vaginal secretions
Cerebrospinal, synovial or pleural fluid
Body fluids containing visible blood
Any unidentifiable body fluid
Saliva from dental procedures
Bloodborne pathogen transmission is unlikely from contact
with lower-risk body fluids, such as
 Feces
 Nasal secretions
 Sputum
 Tears
 Urine
 Vomit
However, Universal Precaution still applies
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Site specific plan provided by employers to protect employees
with occupational exposure risk
Lists job classifications with exposure risk
Identifies engineering controls, work practice controls, PPE and
Universal Precautions
Identifies who will be trained and trainer
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Includes record keeping provisions and is reviewed annually
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CDC website for Infection Control in
Healthcare Settings:
http://www.cdc.gov/ncidod/dhqp/
Occupational Safety and Health
Administration rules 29 CFR 1910.1030
A “Bloodborne Pathogens” training resource
page:
http://www4.uwm.edu/usa/safety/biologica
l_safety/bbp/index.cfm