Download BBP In-Depth Resource

 Table of Contents
Introduction .................................................................................................................................................. 2
The Bloodborne Pathogens Standard ........................................................................................................... 3
Human Immunodeficiency Virus ................................................................................................................... 5
Hepatitis B and C ........................................................................................................................................... 8
Prevention ................................................................................................................................................... 11
Workplace Transmission ............................................................................................................................. 13
Personal Protective Equipment (PPE) ......................................................................................................... 14
Exposure Control Plan ................................................................................................................................. 17
Management of Sharps ............................................................................................................................... 19
Management of Sharps ............................................................................................................................... 19
Blood Spills .................................................................................................................................................. 21
Labeling ....................................................................................................................................................... 22
Hand Washing ............................................................................................................................................. 24
Hygiene ....................................................................................................................................................... 25
Maintenance and Housekeeping ................................................................................................................ 26
HBV Vaccination .......................................................................................................................................... 27
Responding to Emergencies ........................................................................................................................ 28
What if you’re exposed on the job? ........................................................................................................... 30
Bloodborne Pathogens Appendices ............................................................................................................ 33
This In Depth Resource will provide the Instructor with statistics and more detailed
information on the instructional content of the course. Although EMS Safety Services
has made every effort to ensure that the information provided in this section is current at
the time of publication, medical recommendations, standards and statistics are updated
regularly. It is the responsibility of the Bloodborne Pathogens Instructor to update the
instructional content as needed to reflect changes in standards, accepted medical
practice or recommendations.
© 2011 EMS Safety
Bloodborne Pathogens
Introduction
Overview
The introduction is the opener to warm everyone up to the fact that bloodborne
pathogens are dangerous and exposures can occur at work. There were 3.3 million
cases of workplace illness and injury in the year 2009. This training will help to minimize
the risk of exposure, as well as satisfy the organization’s requirement for annual training
in bloodborne pathogens, as described in the Occupational Exposure to Bloodborne
Pathogens Standard 29 CFR 1910.1030.1
Lecture on the key points from the introduction in the student text (see below). A
discussion may involve someone from your course who can relate a story about an
exposure to bloodborne pathogens and give a testimonial to the fact that exposure can
occur at work.
This training will help to…
 Understand what bloodborne pathogens are and why they are dangerous.
 Understand basic information regarding HIV, hepatitis B (HBV) and hepatitis C
(HCV).
 Learn the routes of exposure, techniques to reduce the risk of exposure, and the
use of personal protective equipment (PPE).
 Understand what resources are available to employees in the workplace.
 Respond safely to an emergency at work.
 Provide guidelines for postexposure situations.
 Satisfy the OSHA annual training requirement in bloodborne pathogen
awareness.
Discussion: “Who has a story?”
Who is willing to share an incident in which a potential exposure to a
bloodborne pathogen occurred at work?
Ask the student to share his or her story without sharing any specific names or personal
information about the victim. It can be about the student or a witnessed event where an
exposure occurred. Help keep the story brief and to the point, with just the facts. Key
discussion points include:
1. Exposures do occur at work.
2. Training and preparation can make a difference.
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The Bloodborne Pathogens Standard
Overview2,3,24
Businesses must provide annual awareness training to employees who have the
potential for exposure to bloodborne pathogens. This course will satisfy the annual
training required by 29 CFR 1910.1030. Anyone can view the Bloodborne Pathogens
Standard at www.osha.gov.
In 1970, the U.S. Congress enacted the Occupational Safety and Health (OSH) Act to
ensure safe and healthful working conditions for men and women. In 1991, the
Occupational Safety and Health Administration (OSHA) issued the Occupational
Exposure to Bloodborne Pathogens Standard (29 CFR 1910.1030) because of a
significant health risk associated with exposure to viruses and other microorganisms
that cause bloodborne diseases.
In response to the passage of the Needlestick Safety and Prevention Act of 2000, the
Bloodborne Pathogens Standard was revised in 2001 to require employers to select
safer needle devices as they become available, and to involve employees in identifying
and choosing the devices. The updated Standard also requires employers to make
additions to the Exposure Control Plan, and maintain a log of injuries from contaminated
sharps.
Why take this training?
This training can help reduce the risk of exposure to bloodborne pathogens in the
workplace by providing the employee with awareness to the presence of bloodborne
pathogens. This course will also identify how they transmit, as well as the steps to take
to reduce the risk of exposure, what to do if exposed, and what the employer has done
to provide a safer working environment.
Who is covered by the Standard?
The bloodborne pathogens standard applies to “all employees who could be anticipated
to come into contact with blood or OPIM while performing their jobs.”2,3 Examples of atrisk employees include the following:
 First responders, public safety employees, healthcare workers
 Custodial or maintenance workers; personnel who clean up after an injury
 Workers in labs, tissue or blood banks, laundries, or mortuaries
 Workers who handle medical equipment or regulated waste
 A co-worker coming to the aid of a bleeding victim
What are bloodborne pathogens?
Bloodborne pathogens are pathogenic microorganisms that are present in human blood
and can transmit from person to person when one is exposed to the blood or certain
body fluids of an infected individual. The three bloodborne pathogens of greatest
concern in the workplace are the human immunodeficiency virus (HIV), the hepatitis B
virus (HBV) and the hepatitis C virus (HCV).
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There are many other microorganisms that can be transmitted through contact with
human blood and cause diseases such as syphilis, malaria, hepatitis D, and arboviral
infections.
What are Other Potentially Infectious Materials (OPIM) besides blood?
Besides blood, there are other body fluids and tissues that may be infectious. OPIM is
to be treated with the same precautions as blood. According to OSHA, OPIM includes:2
 Human body fluids
 Unfixed tissues or organs from a human
 Any cell, culture, fluid, tissue or organ containing the HIV or hepatitis B virus.
What is an exposure incident?
According to OSHA, an exposure incident is “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.”2
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Human Immunodeficiency Virus
HIV
The human immunodeficiency virus (HIV) is a bloodborne pathogen that, after years of
infection, causes AIDS. The human body can normally defend itself against most
viruses by sending CD4+ T lymphocytes, or “T-cells,” to the site of infection. The T-cells
organize the immune system’s fight against an infection. HIV attacks and gradually
destroys T-cells, thus weakening the body’s immune system.4
AIDS
Acquired immunodeficiency syndrome (AIDS) is the most advanced stage of HIV
infection, in which opportunistic infections develop within a weakened immune system.4
Infections that the body could normally fight become progressively more serious. For
example, when an uninfected individual is exposed to the common cold, it means a few
days of sneezing, tissues and orange juice. However, an HIV infected individual,
especially in the later stages, may develop serious or fatal pneumonia when exposed to
the common cold.
AIDS is diagnosed when an infected person’s T-Cell count falls below a certain level, or
when an AIDS-defining disease is present.4
Statistics
AIDS was first reported in the U.S. in 1981 and is now a worldwide epidemic. The
Centers For Disease Control and Prevention (CDC) estimates that there are more than
1 million cases of HIV in the United States, with 56,000 new cases each year. According
to the CDC, 1 in 5 of those infected in the U.S. are not aware they are infected.
Worldwide there are more than 33 million people infected with HIV/AIDS, with 2.6
million newly infected each year.4,5,6
Modes of Transmission4,5,7
HIV is transmitted through direct exposure to the blood or certain body fluids of an
infected individual. HIV can be found in blood, semen, vaginal secretions, synovial fluid
(fluid surrounding the joints), breast milk, pleural fluid (fluid around the lungs), amniotic
fluid, peritoneal fluid (fluid in the abdomen), pericardial (fluid around the heart),
cerebrospinal fluid (fluid of the spine and brain), and other body fluids containing blood.
Exposure to HIV-infected blood or body fluids does not mean certain transmission of the
disease. Factors that determine if an exposure results in a transmission include the area
exposed, the fluid type, the length and volume of exposure, and the route of exposure.
According to the Centers For Disease Control and Prevention, the most common
causes of new infections are men having sex with men (53%), heterosexual sex (31%)
and injection drug use (12%).18 The risk of HIV infection during unprotected sex is
increased substantially when either partner is infected with another sexually transmitted
disease (STD).
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Although HIV is spread most commonly by having sex with an infected partner or
sharing of needles among injection drug users, HIV can be spread through other means
of contact with infected blood. Before blood was routinely screened and treated for HIV,
the virus was transmitted through transfusions of contaminated blood or blood
components. Now the risk of HIV transmission during a transfusion is extremely small.
Occupational exposure to HIV rarely results in transmission of the virus. Healthcare
workers are exposed to HIV primarily through needlesticks and injuries from other sharp
instruments. The risk of HIV transmission for healthcare workers on the job is less than
1%. As of December, 2001, there were 57 documented cases of HIV seroconversion
(evidence of antibody response) among healthcare personnel in the United States. This
means that approximately 0.3% of exposures to HIV-contaminated sharps resulted in
actual transmission. Since 2001, there has been only one confirmed case reported.
Women can pass HIV to their babies during pregnancy or birth. If pregnant women
receive appropriate treatment during pregnancy and delivery, they can greatly reduce
the risk of infecting their babies with HIV. Infected mothers who are breastfeeding can
also spread HIV to their babies through their breast milk.
Signs and Symptoms4,9
When someone is infected with HIV, the virus may lie dormant for several years. A
person newly infected with HIV often experiences flu-like symptoms initially, and then
may have no symptoms for more than ten years.
During this asymptomatic period, the virus is actively multiplying, infecting and killing
CD4+ T cells. As the immune system deteriorates, early signs and symptoms of HIV
infection may appear and include the following:
 Anorexia, weight loss
 Fatigue, weakness
 Persistent cough
 Swollen lymph nodes
 Diarrhea, abdominal discomfort
 Mouth lesions, dark skin blemishes
 Afternoon fevers, night sweats, chills
 Memory loss, neurological disorders
 Increased illnesses due to a weakened immune system
 Persistent or frequent yeast infections
 Pelvic inflammatory disease in women
 Shingles, a painful nerve disease
There is currently no vaccine or cure for HIV. Reducing the amount of virus in the body
with anti-HIV medications can slow the development of AIDS. Other drugs are available
to help treat the opportunistic infections and cancers to which people with AIDS are
prone.
As HIV infection progresses to AIDS, opportunistic infections can cause symptoms,
which may include the following:
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Coughing and shortness of breath
Seizures and lack of coordination
Difficult or painful swallowing
Mental symptoms such as confusion and forgetfulness
Severe and persistent diarrhea
Fever
Vision loss
Nausea, abdominal cramps, and vomiting
Weight loss
Extreme fatigue
Severe headaches
Coma
Persons with AIDS may also develop various cancers, such as Kaposi’s sarcoma
(tumors in mucous membranes or connective tissues), cervical cancer, or lymphomas
(cancers of the immune system).
Treatment
The only way to know if you are infected is through a blood test for antibodies to HIV.
Rapid HIV tests can provide results in as little as 20 minutes. The time between getting
infected with HIV and the time it takes for your body to develop antibodies is called the
window period. It can take anywhere from two to eight weeks for most people infected
with HIV to seroconvert, or develop antibodies to the virus. Very rarely, it can take up to
six months.4
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Hepatitis B and C
Hepatitis B Virus (HBV)10,11,13
Hepatitis B is a serious disease caused by a virus that attacks the liver. According the
Centers for Disease Control and Prevention, HBV can cause “lifelong infection, cirrhosis
(scarring) of the liver, liver cancer, liver failure and death.” Although HBV is usually not
as deadly as HIV, it is more contagious.
The hepatitis B virus can cause both acute and chronic hepatitis. Most people who are
infected recover completely within 6 months and become immune to the virus.
Approximately 5-10% of those infected develop a chronic (longer than 6 months), lifelong infection. Of these HBV carriers, 25% will die as adults from cirrhosis or liver
cancer. Approximately 1% of acute hepatitis B cases are fatal.
Age is inversely proportional to the risk of becoming a chronic carrier of HBV.
The
younger a person is when he or she becomes infected, the more likely he or she is to
become a chronic carrier. Approximately 5 -10% of adults, 50% of children, and more
than 90% of infected infants become chronic carriers. Unfortunately, 90% of all HBV
cases occur in adolescents and young adults.
Statistics (HBV)
Hepatitis B is a serious public health problem. Approximately 1 in 20 American adults
have had HBV infections. There are as many as 1.4 million cases of chronic HBV in the
United States, with about 38,000 new cases diagnosed each year (2008). This is
decreased from an average of 260,000 new cases per year in the 1980s, primarily due
to routine HBV vaccination of children, adolescents, and those at risk. Approximately
2,000 - 4,000 die per year in the U.S. from illness caused by HBV.
Hepatitis C Virus (HCV)10,12,15
Hepatitis C is also a serious disease of the liver that can cause chronic infection (7585%), chronic liver disease (70%), and, in some cases, death (<3%). Chronic hepatitis
C is a leading indication for liver transplant.
Statistics (HCV)
Hepatitis C is the most common bloodborne infection in the United States. There are 3.2
million people in the U.S. who suffer from chronic infection and about 18,000 new cases
each year (2008). Most infections are due to illegal injection drug use. In U.S. jails and
prisons, 1 in 3 people, or about 2.2 million, have HCV.
Mode of Transmission (HBV/HCV)10,11,12
HBV is transmitted when the blood or body fluids of an infected individual enter the body
of a person who is not immune to HBV. Any body fluid with visible traces of blood may
carry the hepatitis B virus. Like HIV and HBV, HCV is spread through contact with
infected blood or body fluids containing blood. Hepatitis infections can also occur during
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birth, when an infected mother transmits the virus to her baby, or in healthcare or other
settings where there is contact with blood.
You are at higher risk for transmission of hepatitis B and C if you:
 Have sex with someone infected (rarely for HCV)
 Have sex with more than one partner in six months
 Are an injection drug user
 Are a man and have sex with a man
 Live in the same household with someone who has chronic infection
 Have a job that involves contact with human blood (healthcare, public safety)
 Have hemophilia
 Have been on long-term kidney dialysis
 Share personal items (razor, toothbrush) with an infected person
 Were born to an infected mother
 Received a blood transfusion prior to July, 1992
 Received blood, blood products, or solid organs from an infected donor
 Receive a tattoo or acupuncture with contaminated instruments
 Are from an area of the world with high rates of hepatitis B and C infection
Those most at risk are people who have multiple sex partners, IV drug abusers (sharing
needles), and household members of infected individuals.
The risk for occupational transmission of HBV is much higher than the risk for HIV. The
risk is primarily related to the degree of contact with blood in the workplace. For an
employee who has not had the HBV vaccine, transmission rates range from 6% to 30%
after a single needlestick exposure to HBV-infected blood.33
The average incidence of occupational transmission of HCV through accidental
exposure from sharps or needlesticks is only 1.8%.33
Acute Signs and Symptoms (HBV/HCV)11,12,13
Nearly all children and infants and 50% of adults with acute hepatitis B have no
symptoms at all. In hepatitis C, 80% of infected individuals have no signs or symptoms.
The acute stage can last from several weeks to several months. If symptoms are
present, they can include any of the following:
 Flu-like symptoms (fatigue, diarrhea, sweats, headache)
 Jaundice (yellowing of the skin and whites of the eyes) and dark urine due to
increased bilirubin
 Abdominal pain, nausea/vomiting
 Low-grade fever
 Decreased appetite, weight loss
 Joint or muscle pain
 Inability to work or function for long periods of time
 Pale or clay-colored stools
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Chronic Signs and Symptoms (HBV/HCV)
Chronic hepatitis occurs when the liver damage from the acute illness does not
completely recover. Many people with chronic hepatitis B or C may have no signs or
symptoms for many years after the acute infection. Chronic hepatitis can lead to
cirrhosis (scarring) of the liver in which the liver is damaged and cannot effectively
cleanse the body of wastes. It can also lead to liver failure and liver cancer. Signs and
symptoms can include the following:
 Weight loss
 Fatigue
 Jaundice
 Nausea and vomiting
 Loss of appetite
Treatment (HBV/HCV) 11,12,13
There is no cure for acute hepatitis B or C. Treatment of the acute condition involves
careful monitoring of liver function. Treatment of chronic hepatitis B and C is focused
on decreasing inflammation, symptoms, and infectivity. In cases of liver failure, liver
transplantation is the only cure. Rest, exercise, a nutritious diet, and plenty of fluids are
recommended. Avoid drugs and alcohol, and any potentially liver toxic drugs, since
they can exacerbate liver damage.
A blood test is the only way to confirm a diagnosis of HBV or HCV infection. Most
people do not have symptoms, but can pass the disease to others. If chronic hepatitis
is detected early enough, liver damage may be prevented or slowed with appropriate
treatment. Anyone who is in a higher risk group for contracting hepatitis B or C should
contact their doctor for testing, and for information on the hepatitis B vaccine. Get
vaccinated, because hepatitis B is preventable.
Vaccination3,11
The HBV vaccination is the best protection against HBV infection. The vaccination is
usually a series of 3 injections that creates immunity to HBV. The HBV vaccination is
supplied by the employer to employees who are designated as at-risk to exposure.
There is more information on the HBV vaccination series under the topic “Reducing the
Risk of Exposure.” There is currently no vaccine for HCV.
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Prevention
Misconceptions about HIV
Although HIV has been detected in the saliva and tears of infected individuals, there is
no evidence that the virus is spread through saliva, tears, sweat, urine, or feces.
Studies have clearly shown that HIV is not spread through casual contact such as
sharing of food, drink, eating utensils, towels, bedding, toilet seats, telephones, or
swimming pools. HIV is also not spread by mosquitoes or other biting insects.
HIV can be transmitted through breast milk; new mothers should abstain from
breastfeeding.
Misconceptions about hepatitis B and C
There is no evidence that HBV or HCV can be spread through hugging, sneezing,
coughing or other casual contact (working, studying, or playing with carriers). Sharing
food, drink, or restroom facilities has not been shown to transmit hepatitis B or C.
Although household members of HBV and HCV carriers have a higher incidence of
infection, it is most likely due to a previous direct exposure to the blood of the infected
household member.
Breast-feeding alone has not been shown to pass HBV or HCV. It is important that
nursing mothers take good care of their nipple areas to prevent cracking and bleeding,
and abstain from breast-feeding if the skin is not intact. If a mother has hepatitis B, her
baby must receive a shot called H-BIG (hepatitis B immune globulin) and begin the HBV
vaccination series within 12 hours of birth in order to safely breast-feed.10,16,37
How can I protect myself?
Practice universal precautions when handling blood and body fluids. Do not inject
illegal drugs, and especially, do not share needles with anyone. If you inject illegal
drugs, seek treatment for substance abuse. Have your sexual partner screened for
STDs, HIV and hepatitis. When having sex outside of stable, monogamous
relationships, practice safe sex. Avoid sharing personal items that can get contaminated
with blood, such as razors, nail clippers, or toothbrushes. Consider the health risks
when getting tattoos or body piercings. Only use reputable businesses for body art. Get
the HBV vaccination if you are 19 years or younger, or are in a higher risk category for
contracting the disease.
Exposure to blood during athletic activities poses a very small risk of transmission of
bloodborne pathogens, according to the American Academy of Pediatrics. However,
since HBV is more easily transmitted than HIV, athletes, coaches, trainers, and
equipment personnel should receive the HBV vaccination. An athlete who is actively
bleeding should be removed from competition until the bleeding has stopped, and the
wound has been cleaned and covered.2
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For More Information:
Some students may have many specific questions about HIV, HBV, and HCV, which are
beyond the scope of this training course. In order to provide the OSHA required
information to the entire class within the allotted time period, you may refer these
students to their personal physician, or to one of the resources listed below.

U.S. Public Health Service: Guidelines for the Management of Occupational
Exposures to HBV, HCV, and HIV and Recommendations for Postexposure
Prophylaxis
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm

MEDLINEplus, U.S. National Library of Medicine, NIH
http://medlineplus.gov

National Center for HIV, STD, and TB Prevention, CDC
http://www.cdc.gov/nchstp/od/nchstp.html

National Institute for Allergy and Infectious Disease, National Institutes of
Health
http://www.niaid.nih.gov/

National Institute for Occupational Safety and Health
http://www.cdc.gov/niosh/homepage.html

National Prevention Information Network
http://www.cdcnpin.org

UCSF Center for HIV Information
http://hivinsite.ucsf.edu/InSite

World Health Organization
http://www.who.int/en/
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Workplace Transmission
Overview:
Students should understand that potential or confirmed exposure to a bloodborne
pathogen does not necessarily mean there is a transmission of disease. The chances of
transmission are small, but there is still a possibility.
Modes of Transmission:
In the workplace there are many ways employees can be exposed on the job. Common
methods of transmission include but are not limited to:
 Responding to an emergency involving bleeding: possible exposure to the blood
of an infected individual.
 Cleaning a contaminated sharp object: possible puncture wound.
 Managing a blood spill: possible exposure to BBP via droplets or splashing
during overly vigorous cleaning.
Routes of Entry7
In order for a disease transmission to occur, there needs to be exposure to the blood or
OPIM of an infected individual, commonly known as a source individual. As the source
individual’s blood or OPIM enters the blood of a non-infected individual, a transmission
can occur. The mixing of the blood of a source individual and a non-infected individual
can only occur if there is a route of entry from the source individual to the non-infected
individual.
Students should know the possible routes of entry for BBP, and how to protect those
routes of entry from exposure to blood or OPIM. Routes of entry can be protected
though the use of personal protective equipment (see next topic – Personal Protective
Equipment)
Common routes of entry include:
 Mucous membranes: eyes, mouth, and nose. Unprotected sex can also be a
route of entry.
 Skin breakdown: rashes, cuts, open wounds, and fresh scabs.
 Puncture: needlesticks, cleaning contaminated sharp objects, sharing needles
(IV drug abuse).
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Personal Protective Equipment (PPE)
Personal Protective Equipment16
Employers are responsible for providing employees with a plan and the equipment to
deal with a possible exposure to bloodborne pathogens in the workplace. One of the
responsibilities of the employer is to provide, at no cost to the employee, personal
protective equipment (PPE). PPE is protective coverings that are used to reduce
risk to exposure to bloodborne pathogens.2
Common examples of PPE include:
 Watertight, disposable gloves (latex, or non-latex alternative to avoid latex
allergies)
 Protective eye shields and facemasks
 Splash-resistant gowns, lab coats, aprons, and shoe covers
 Ventilation devices and CPR barrier masks
PPE requires training for proper use. The first time your students try on PPE should not
be during a real-life emergency. PPE should fit correctly and be used appropriately for
each situation. Employers should provide a selection of glove sizes to ensure proper fit.
Use common sense in discussing good locations for PPE with your students. PPE
should be readily available for use by anyone who needs them. Store PPE at each
workstation or patient care area, in first aid kits, and any other sites of potential
exposure to BBP.
Gloves will become brittle over time, especially when removed from their original
packing. Glove stock, when not frequently used, should be rotated every six months.
Ensure that the proper size glove is available to all employees.
Encourage students to practice selecting, donning and removing PPE.
Gloves:
Gloves are the primary and most common form of PPE. They should be used every
time there is a risk of exposure to blood or OPIM. Gloves for the purpose of PPE are
usually made of latex, but non-latex alternatives are available for those with latex
allergies.
In order to properly protect us from exposure to BBP, gloves must fit properly, be
watertight, and intact (no punctures, tears or holes). An easy way to ensure that gloves
are intact is the “balloon test” – if they hold air, they are watertight. Inflate the glove by
blowing into its base, and then twist the base of the glove so that no air can escape. If
the glove is airtight, it is watertight.
Although gloves are the primary form of protection against BBP exposure, there is no
guarantee that they won’t rip during use, or have minute punctures invisible to the
naked eye. To ensure maximum protection users should bandage any cuts before
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putting on gloves. Avoid handling uncontaminated items such as pens or tools with
soiled gloves.
Additional protection can be provided by double gloving (wearing two pairs of gloves,
one over the other). By double gloving one has an additional layer of protection. If one
glove rips, the hand is still protected by a second layer of glove. Also, if the rescuer
needs to touch an uncontaminated item, he or she may remove the outer glove, quickly
grab the needed item, and return to the scene with PPE still intact.
Removal and Disposal:
PPE that has been exposed to blood or OPIM should be removed as soon as possible,
and before leaving the scene. Taking contaminated PPE out of an emergency scene
only increases the possibility of further contamination. Avoid touching any unprotected
areas when removing PPE.
Soiled gloves should be removed with great care to avoid splashing or aerosolizing
(creating airborne droplets). When removing soiled gloves, care should also be given to
avoid contaminating other surfaces.
Procedure for glove removal:
1. Pinch the base of one glove and slowly peel the glove off so that it is inside out.
2. Place the removed glove in the palm of the gloved hand.
3. Insert a non-gloved finger into the base of the remaining glove. Slowly peel the
remaining glove off so that it turns inside out, with the first glove tucked safely
inside.
Sequence for Donning PPE:19
1. Gown
2. Mask or respirator
3. Goggles or face shield
4. Gloves
Sequence for Removing PPE:19
1. Gloves
2. Face shield or goggles
3. Gown
4. Mask or respirator
Discard contaminated PPE in a red bag or proper leak-proof container affixed with the
biohazard symbol (see labeling requirements). Wash hands thoroughly after removal
and disposal of contaminated PPE. Uncontaminated PPE may be discarded in the
regular trash.
Discussion: “Where is your PPE?”
What type of PPE do you have available in this organization? Where is it
located? If you need more, who is your resource?
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Have a student share his or her thoughts. Open the discussion so that everyone is
aware of the location and types of PPE available to them at their workplace. Key
discussion points include:
1. Types of PPE available
2. Location of PPE
3. Organization’s process to re-supply PPE if low, inadequate or
damaged.
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Exposure Control Plan
Overview2,20,21,22
OSHA regulations state that it is the responsibility of the employer to provide a control
plan for employees who may come into contact with blood or OPIM. This plan is know
as the company’s Exposure Control Plan.
The Exposure Control Plan covers every aspect of handling exposure to bloodborne
pathogens, including:
 Identifying the employees who are “at-risk” for exposure
 Sharps management
 Spill cleanup
 Handling contaminated (regulated) waste
 Labeling
 Storing, transporting, and cleaning contaminated laundry
 Area maintenance, hygiene, and housekeeping
 Hepatitis B vaccinations
 Postexposure evaluation, treatment, and follow-up care
It is the employer’s responsibility to maintain the Exposure Control Plan in writing and
make it accessible to all employees.
The Exposure Control Plan is reviewed annually and updated as needed. Review of an
organization’s Exposure Control Plan should include:
 Assessing for new or modified tasks and procedures, which affect occupational
exposure.
 Changes in technologies that eliminate or reduce exposure to bloodborne
pathogens.
 New or revised employee positions with risk of occupational exposure.
 Incidents from previous year.
 Assessment of any deficiencies in the plan.
The Exposure Control Plan identifies methods of compliance that help the employer
adhere to the standard. Methods of compliance can be broken down into two
categories:
 Engineering Controls (hardware)
 Work-practice Controls (systems)
Engineering Controls are hardware that is put into place by the employer to help
achieve methods of compliance. OSHA regulations state that engineering controls refer
to control systems that isolate or remove the bloodborne pathogens hazards from the
workplace.
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Engineering controls can include:
 Special containers for disposal of contaminated sharps
 Needleless injection systems or self-sheathing needles
 Specially marked bags for non-sharps contaminated with blood
 Blunt-tip suture needles for less-dense tissue, such as muscle and fascia23
 PPE
Work-practice Controls refer to the every day practices or systems in the workplace
that help employees reduce the risk of exposure, and help limit the exposure level
should one occur. Common examples of work-practice controls include policies and
practices regarding:
 Sharps management
 Regulated waste
 Management of a blood spill
 Labeling requirements
 Housekeeping and hygiene
 Hepatitis B vaccination
See appendix A for a Model Exposure Control Plan.24
Discussion: “Where is your Exposure Control Plan?”
Every employer is required to have an Exposure Control Plan as mandated by OSHA.
As part of this training, review the location of the Exposure Control Plan with the
students.
Have a student share his or her thoughts. Open the discussion so that everyone is
aware of the Exposure Control Plan. It is best to have a copy of the organization’s
Exposure Control Plan for this discussion. Key discussion points include:
1. Location(s) of the plan.
2. Who is the designated administrator of the Exposure Control Plan?
3. How are sharps injuries tracked?
4. To whom do you report a potential exposure?
5. When was the Exposure Control Plan last updated?
6. How are employees notified of changes to the Exposure Control Plan?
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Management of Sharps
Overview2
Caution should be used when handling sharp objects contaminated with blood. A
careless individual using poor clean-up technique or an improper container can create a
bloodborne exposure. OSHA estimates that 5.6 million workers in the healthcare
industry and associated occupations are at risk for exposure to bloodborne pathogens
through sharps-related injuries.
A needlestick (puncture wound from a contaminated syringe or needle) is the most
common cause of occupational exposure to bloodborne pathogens. It is estimated that
there are 600,000 to 800,000 needlesticks annually in the United States. Despite the
frequency of exposure to BBP through needlesticks, actual transmission of a BBP
through this route is extremely rare.25
A contaminated sharp is defined as any object contaminated with blood or OPIM that
can penetrate the skin, including needles, scalpels, broken glass, broken capillary
tubes, and exposed ends of dental wires. When dealing with contaminated sharps,
work-practice controls should include a sharps injury log and safe techniques for
handing sharps.2
Most needlestick injuries and up to 2/3 of sharps injuries occur during disposal. The
CDC estimates that up to 88% of sharps injuries could be prevented by using safer
medical devices.26
Sharps Injury Log
The sharps injury log is a confidential record maintained by the employer to track sharps
injuries. The purpose of the sharps injury log is to track common elements of workrelated sharps injuries, assess for patterns in sharps injuries, and prevent future injuries
by eliminating the common causes. Common elements of the sharps injury log
include:30
 Type and brand of device used in the incident
 Location of the incident
 Description of the incident
Note: OSHA also requires needlestick injuries and cuts from contaminated sharps to be
recorded on the OSHA 300 log.
Handling Sharps: When handling sharps, there are a few common sense techniques
and safeguards that can help prevent exposure to bloodborne pathogens:
DO NOT:
 Recap needles.
 Self-blunt (break/bend) needles.
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DO:





Follow your state’s needle safety legislation.
Use a mechanical means (tongs, broom, dustpan) while wearing PPE to pick up
broken glass and other sharps.
Dispose of sharps in a leak-resistant, puncture-resistant, closeable container
labeled with the biohazard symbol and placed within easy reach of the user.
Replace sharps containers when they are 2/3 full.27
Include a sharps provision to the Exposure Control Plan that includes the
following:
o Annual evaluation of appropriate engineering controls related to sharps
and sharps containers (e.g. needleless system, needle with engineered
sharps injury protection, or other advanced technology in laboratories and
healthcare environments).
o Solicitation of non-managerial healthcare workers in evaluating and
choosing devices.
© 2011 EMS Safety
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Blood Spills
Overview
Spills in the workplace should be cleaned immediately. Care should be taken to isolate
the spill area to prevent spreading of the contaminate. Disinfect the area and report the
spill and any potential exposure to a supervisor at the earliest possible opportunity.
Review general spill clean-up guidelines with your students.
The goal of cleaning a blood or OPIM spill is to decontaminate the area, killing any
particles that could create a bloodborne hazard. Decontamination means 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.
Clean-Up
There are commercially available, EPA-registered tuberculocidal disinfectants for
decontaminating equipment or working surfaces which have come in contact with blood
or OPIM. If no manufactured disinfectant is available, it is recommended to use a
solution of chlorinated bleach and water. Depending on the amount and type of spill,
use one part household (chlorinated) bleach to 10 - 100 parts water. Mixed bleach and
water solutions should be changed daily, since they lose potency over time. The
employer’s written schedule for cleaning and decontaminating should identify the type of
disinfectant to use for different circumstances.11,20,28,30
General clean-up for blood or OPIM:
1. Follow the Exposure Control Plan.
2. Clear the immediate area to reduce the risk of further contamination/exposure.
Isolate the exposure area.
3. Locate the bloodborne pathogen spill kit and PPE. If a germicide is available,
follow the manufacturer’s guidelines for use. If a commercial germicide is
unavailable, use a chlorinated bleach and water solution as described above.
4. Don personal protective equipment (mask, goggles, gloves, gown, and shoe
covers).
5. Thoroughly clean the area of visible blood and OPIM.
6. Follow protocol for decontamination to completely disinfect the area of blood or
OPIM. Leave the area wet with disinfectant for at least 10 minutes.
7. Dispose of all materials used in the clean-up process in the properly labeled
container according to workplace policy.
8. Wash your hands.
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Labeling
Regulated waste requires special clean up, handling and disposal. Regulated waste
includes liquid or semi-liquid blood or OPIM; items heavily contaminated with blood or
OPIM, and pathological/microbiological wastes containing blood or OPIM.2 Items
heavily soiled with blood or OPIM can either be properly cleaned or disposed of as
regulated waste. Items that drip blood (i.e. used gauze, bandages, towels used for
clean-up) must be disposed of as regulated waste.
Regulated waste should be easily identifiable, and stored in a special container that is
leak-proof and labeled with a biohazard sticker and/or is bright red in color. Regulated
waste is not to be discarded with other regular trash, as there is still potential for
exposure.2
Discarded feminine hygiene products used to absorb menstrual flow are not generally
considered regulated waste by OSHA. The absorbent material of which they are made
normally prevents the release of liquid or semi-liquid blood. These products should be
discarded into waste containers properly lined with plastic or wax paper bags to protect
people from physical contact with the contents. 2
Contaminated laundry should be cleaned by a professional service that provides pickup and cleaning. It should be handled as little as possible and bagged in the location it
was used. Place contaminated laundry in a properly labeled, closeable, leak-proof
container. 2
Labeling2, 29
According to most state and federal OSHA guidelines, warning labels shall be affixed to
containers of regulated waste, used or contaminated sharps, laundry or any item
exposed to blood or OPIM, refrigerators and freezers containing blood or OPIM, and
other containers used to store, transport or ship blood or OPIM.
Containers carrying blood or OPIM must be labeled using a fluorescent orange or
orange red label with the biohazard symbol and lettering in a contrasting color. In the
absence of the biohazard warning, red bags or red containers may be substituted for
labels. The warning labels should be part of the container or affixed as close as feasible
to the containers by string, wire, or other adhesive methods to prevent their loss, or
accidental or purposeful removal.1,30
Blood and blood products that are labeled as to their contents and are released for
transfusion or other clinical use are exempted from the labeling requirements.
Warning signs (the biohazard symbol) must be posted by the employer, as specified
by the standard, at the entrance to work areas, as well as HIV and HBV research
laboratories and production facilities. Refer to the bloodborne pathogens standard for
additional information on research laboratories and production facilities.
© 2011 EMS Safety
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Activity: “Show the Proper Label”
1. Discuss the proper labeling of biohazardous materials.
2. Show the biohazard label to the class; discuss characteristics including proper
color and biohazard symbol.
3. Pass the label around so that everyone can see it.
4. Discuss the following:
a. What to do in the absence of a proper label.
1. Red bag
2. Red container
b. What types of objects need a biohazard label?
1. Refer to the organization’s Exposure Control Plan.
2. Refer to the bloodborne pathogens standard.
© 2011 EMS Safety
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Hand Washing
Overview17,18
Proper hand washing techniques can make the difference between exposure and
transmission. It can prevent bloodborne pathogens from being transmitted from the
hands to the mucous membranes of the eyes, nose, or mouth of the employee. Without
proper hand washing, germs can be spread to surfaces, then to other individuals.
Hands should be washed before donning gloves and as soon as possible after
engaging in tasks that potentially expose the employee to bloodborne pathogens (e.g.
rendering first aid or cleaning up a blood spill).
Proper hand washing technique:
1. Wet hands with running water and apply soap.
a. Place bar soap back on rack to allow it to drain.
b. The use of liquid soap reduces the bacteria associated with bar soap.
2. Rub hands together vigorously and scrub all surfaces. Do not forget under nail
beds and between fingers.
3. Continue scrubbing for at least 20 seconds. Soap combined with friction
(scrubbing action) dislodges and removes germs.
4. Rinse well with warm water and dry.
The creation of friction when washing hands is essential to dislodging germs. Rubbing
hands together vigorously for 30 seconds, without soap and water, is said to remove
80% of bacteria. By adding soap and water we can eliminate nearly all bacteria.
If hand washing facilities are not immediately available, use an alcohol-based hand
sanitizer that contains at least 60% alcohol as a temporary method to kill bacteria. Wash
hands properly at the earliest opportunity.
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Hygiene
Overview
The purpose of good hygiene is to further reduce the risk of exposure to BBP. Good
hygiene is directly related to using common sense.2
Good personal hygiene in the workplace includes the following:

Food: do not store food, eat or drink in areas where it may be exposed to blood
or OPIM.

Personal Hygiene: avoid applying makeup or lip balms, smoking, or handling
contact lenses in places where BBP are present.

Creams: avoid the use of petroleum-based creams, as they deteriorate latex
gloves, causing exposure.

Use caution around potentially infectious materials: utilize PPE at all times, and
minimize splashing or aerosolization (spattering, spraying or otherwise creating
droplets of blood in the air or onto surfaces) of infectious materials.
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Maintenance and Housekeeping
Overview
Good housekeeping techniques are critical in reducing the incidence of exposure to
bloodborne pathogens at work. Although studies have shown that HIV dies when it dries
out on environmental surfaces, HBV can survive up to one week.7
Employees are most commonly exposed at the beginning and end of their shifts (when
they are tired, distracted or in a hurry). This is when good housekeeping is most
important.
Follow these general guidelines on good housekeeping practices:2

Clean and disinfect equipment and work area at the beginning and end of each
shift.

Remove and replace any equipment coverings that have been exposed to BBP.

Clean spills immediately.

Pick up sharps properly and dispose of them as soon as possible.

Use the proper containers for contaminated or used sharps, regulated waste, or
contaminated laundry.

Handle infectious materials and containers as little as possible.

Ensure containers are labeled properly.
Refer to your company’s Exposure Control Plan for detailed information.
© 2011 EMS Safety
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HBV Vaccination
Overview2,11
One of the most effective ways to reduce transmission of Hepatitis B is through the HBV
vaccination series. It is recommended that persons who are at higher risk for exposure
to HBV, all infants, and children under 19 years of age receive the vaccination. The
average number of new infections of HBV was reduced from 260,000 in the 1980’s to
about 38,000 in 2008. This dramatic decline in new infections (especially among
children and adolescents) was primarily due to routine HBV vaccination.
The HBV vaccination works by introducing small amounts of a manufactured protein
related to the virus into the body, allowing antibodies (immunity) to the disease to
develop. The HBV vaccination provides immunity to the hepatitis B virus 95% of the
time.
The hepatitis B vaccine has been shown to be safe when administered to both adults
and children. Over 20 million people have been vaccinated in the United States. There
is no confirmed evidence that the hepatitis B vaccine causes chronic illnesses. Very
rarely a person may have a severe allergic reaction (anaphylaxis) to the vaccine. The
hepatitis B vaccine is made in yeast cells, so people with known allergies to yeast
should not receive the vaccine. When considering the incidence of severe liver disease
and death from HBV infection, the benefits of the HBV vaccine far outweigh the risks.
Employees who are designated as “at-risk” for coming into contact with a BBP as part of
their job are eligible for the Hepatitis B vaccination, a series of shots provided at no cost
to all at-risk employees. The vaccination series is given under the supervision of a
licensed physician or another licensed healthcare professional. After an exposure
incident, post-vaccination testing for continued immunity should be offered.
HBV vaccinations should be offered to the employee within 10 days of being classified
as “at-risk”. An employee has the right to refuse the vaccination, but at any time may
choose to begin the HBV vaccination series. If the employee refuses the vaccination, he
or she must sign a HBV vaccination declination form.
A post-vaccination titer may be needed. It is recommended by OSHA and the CDC that
employees who have “ongoing contact with patients or blood and are at on-going risk of
injuries with sharp instruments or needlesticks be tested for antibodies to Hepatitis B
surface antigen, one to two months after completion of the three-dose vaccination
series.” All testing shall be conducted by an accredited laboratory at no cost to the
employee.2,13
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Responding to Emergencies
Overview
Responding to emergencies in the workplace is a common occurrence. There were 3.3
million cases of workplace illness and injury in the year 2009. A significant percentage
of these cases involved a potential occupational exposure to a bloodborne pathogen.
When responding to emergencies, having a plan and practicing it can reduce the risk
and occurrence of being exposed.
The organization’s Exposure Control Plan identifies isolation techniques for exposure to
bloodborne pathogens. Having a plan and the supplies needed to execute that plan are
essential. Refer to the organization’s techniques for responding to emergencies.
Universal precautions and body substance isolation are techniques to limit and
prevent exposure on a daily basis and on emergency scenes.
Universal Precautions2,16
Universal precautions are a standard of isolation recommended by the Centers for
Disease Control and Prevention. The practice of universal precautions means to treat all
blood and body fluids as potentially infectious, even without a diagnosis or known
history of infectious disease. Universal precautions apply to:
1. Blood
2. Body fluids (Does not apply to feces, nasal secretions, sputum, sweat, tears,
urine, or vomit unless contaminated by visible blood.)
3. Non-intact skin
4. Mucous membranes
To utilize universal precautions:
 Wash hands before and after each patient contact.
 Utilize PPE for every patient contact, every time. Suggested PPE includes the
following:
o Gloves
o Mask/respiratory protection
o Goggles/eye protection/face shield
o Gowns, shoe covers and other water-resistant protection for clothes and
skin.
Body Substance Isolation (BSI)
BSI is another standard of isolation techniques recommended by the Centers for
Disease Control and Prevention. BSI requires the responder to treat every body fluid as
if it is infectious, regardless of whether or not they contain visible blood. If every moist
substance that a body produces is considered infectious (except sweat), proper
protections (isolation gear) will be used each time.
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Although sweat, tears, saliva, urine, feces, vomit and nasal secretions do not normally
present a risk for transmission of BBP, they may contain other infectious
microorganisms (i.e. flu virus).
Standard Precautions
Standard Precautions are the isolation precautions used in hospitals. For the best
protection organizations can follow Standard Precautions, which combine the
techniques of universal precautions and BSI, and include airborne, droplet and contact
precautions.
When responding to emergencies, remember to:
 Wash hands before and after each patient contact
 Don appropriate PPE prior to rendering first aid
 Utilize CPR barrier devices when providing rescue breathing
 Consider all moist body fluids as potentially infectious.
Follow the organization’s Exposure Control Plan for detailed guidelines on what type of
precautions should be taken when one can be reasonably expected to come into
contact with blood or OPIM.
© 2011 EMS Safety
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What if you’re exposed on the job?
Overview
Employees need to understand what steps to take after an exposure occurs on the job.
Certain actions aimed at cleaning and disinfecting the exposed area(s) will reduce the
possibility of infection or further exposure. Secondary actions include reporting the
exposure to a supervisor, and beginning the postexposure evaluation and follow-up.
Discuss these actions with your students.
If an exposure incident has occurred, take immediate action. Immediate postexposure
actions are aimed at cleaning and disinfecting the exposed area(s). By cleaning the
exposure sites, one can reduce the possibility of infection or further exposure from
contaminating other objects or areas of the skin. Refer to the organization’s Exposure
Control Plan for guidelines on immediate postexposure actions.
Immediate actions can include:32
 Wash hands and other affected/exposed areas.
o Flush splashes to nose, mouth or skin thoroughly with water.
o Irrigate eyes with water or saline.
 Dispose of contaminated PPE, clothing or objects in the appropriately labeled
container.
 Ensure the clean-up of any spill of blood or OPIM.
 Report the exposure to a supervisor immediately.
 Seek medical treatment immediately.
Report to your supervisor the following information:
 Date and time of the exposure
 Body part exposed to the BBP
 Job classification
 Work site location
 Engineering controls being used
 Work practices being followed
 Activity being performed at the time of the exposure incident
 Previous training for the activity
When a sharp is involved, report:
 If the sharp had engineered sharps injury protection.
 If the protective mechanism was activated, and if the incident occurred before or
after activation.
 If there was no engineered sharps injury protection, could engineered protection
have prevented the injury?
 Could any other engineering control, work practice control, or administrative
policy have prevented the injury?
The employer is required to provide postexposure evaluation and follow-up. After
taking the immediate actions of decontamination, the exposure incident will need to be
© 2011 EMS Safety
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reported to a supervisor, who will begin postexposure evaluation and follow-up. The
employer should have arrangements in place to provide follow-up within three to four
hours of the exposure. The employee should receive the following at no cost:2
 Documentation of the routes and circumstances of the exposure.
 Identification and documentation of the source individual (unless prohibited by
law).
 Confidential medical evaluation by a qualified physician.
 Laboratory testing of the source and person exposed with follow-up results and
retesting as needed.
 Treatment of exposure and administration of postexposure medications when
appropriate.
 Employee counseling
 Continued follow-up as needed.
Discussion: “What if you’re exposed on the job?”
The Exposure Control Plan includes the postexposure actions to be taken. Lead an
open discussion on the appropriate postexposure actions within the organization you
are teaching. Refer to their Exposure Control Plan when possible.
Discuss the following points:
 To whom does one report an exposure?
 What are the immediate postexposure actions?
 Review the postexposure procedures from the Exposure Control Plan.
© 2011 EMS Safety
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Bloodborne Pathogens References
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2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
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18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
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31.
32.
33.
34.
35.
Department of Labor. “Workplace Injury and Illness Summary, Workplace Injuries and Illnesses in 2009.” United States
Department of Labor, Bureau of Labor Statistics. (7/27/11) http://www.bls.gov/news.release/osh.nr0.htm
OSHA. “Regulations (Standards-29 CFR) Bloodborne Pathogens – 1910.1030.” 1991. OSHA, U.S.
Department of Labor. (7/27/11)
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051
CDC. “Hepatitis B Virus: A Comprehensive Strategy for Eliminating Transmission in the United States Through Universal
Childhood Vaccination.” 22 Nov. 1991. Immunizations Practices Advisory Committee, CDC. (7/27/11)
http://www.cdc.gov/mmwr/preview/mmwrhtml/00033405.htm
CDC. Basic Information about HIV and AIDS.” CDC (5/6/11) http://www.cdc.gov/hiv/topics/basic/index.htm
CDC. “HIV in the United States.” CDC. (5/6/11) http://cdc.gov/hiv/resources/factsheets/us.htm
WHO. “UNAIDS REPORT ON THE GLOBAL AIDS EPIDEMIC, 2010.” Joint United Nations Programme on HIV/AIDS
(UNAIDS). (8/11/11) http://www.unaids.org/globalreport/Global_report.htm
CDC. “HIV Transmission.” CDC. (5/7/11) http://www.cdc.gov/hiv/resources/qa/transmission.htm
CDC. “Occupational HIV Transmission and Prevention among Health Care Workers.” CDC, National Center for
HIV/AEDS, Viral Hepatitis, STD, and TB Prevention. (7/27/11) http://www.cdc.gov/hiv/resources/factsheets/hcwprev.htm
MEDLINEplus. “HIV infection.” National Library of Medicine, National Institutes of Health. (7/27/11)
http://www.nlm.nih.gov/medlineplus/ency/article/000602.htm
CDC. “Surveillance Data for Acute Viral Hepatitis – United States, 2008.” CDC. (7/27/11)
http://www.cdc.gov/hepatitis/Statistics/2008Surveillance/
CDC. “Hepatitis B FAQs for the Public.” CDC. (4/13/11) http://www.cdc.gov/hepatitis/B/bFAQ.htm
Committee on Sports Medicine and Fitness. “Human Immunodeficiency Virus and Other Blood-borne Viral Pathogens in
the Athletic Setting.” American Academy of Pediatrics. Pediatrics 104.6 (1999): 1400-03.
CDC. “Hepatitis B FAQs for Health Professionals.” CDC. (4/13/11) http://www.cdc.gov/hepatitis/HBV/HBVfaq.htm
CDC. “Hepatitis C and Incarceration.” CDC. (5/11/11)
http://www.cdc.gov/hepatitis/HCV/PDFs/HepCIncarcerationFactSheet.pdf
CDC. “Correctional Facilities and Viral Hepatitis.” CDC. (7/27/11) http://www.cdc.gov/hepatitis/Settings/corrections.htm
Siegel JD et al. “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare
Settings.” (5/11/11) http://www.cdc.gov/hicpac/pdf/isolation/isolation2007.pdf
CDC. “Wash Your Hands.” CDC. (5/21/11) http://www.cdc.gov/Features/HandWashing
CDC. “Handwashing: Clean Hands Save Lives.” CDC. (5/21/11) http://www.cdc.gov/handwashing
CDC. “Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings.” (5/21/11)
http://www.cdc.gov/ncidod/dhqp/pdf/ppe/PPEslides6-29-04.pdf
OSHA. “Most Frequently Asked Questions Concerning the Bloodborne Pathogens Standard.” 1 Feb. 1993. OSHA, U.S.
Department of Labor. (5/11/11)
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=21010
OSHA. “Needlestick Safety and Prevention Act: Frequently Asked Questions.” OSHA, U.S. Department of Labor.
(5/11/11) http://www.osha.gov/needlesticks/needlefaq.html
OSHA. “Model Exposure Control Plan.” OSHA, U.S. Department of Labor. (5/11/11)
http://www.osha.gov/Publications/osha3186.pdf
CDC. “Use of Blunt-Tip Suture Needles to Decrease Percutaneous Injuries to Surgical Personnel: Safety & Health
Information Bulletin.” NIOSH, CDC. (5/11/11) http://www.cdc.gov/niosh/docs/2008-101/
OSHA. “Needlestick Safety and Prevention Act.” 2001. Public Law 106-430, 106th Congress. (5/1/11)
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=106_cong_public_laws&docid=f:publ430.106
OSHA. “Safety and Health Topics: Needlestick Prevention.” OSHA, U.S. Department of Labor. (19 Mar. 2003)
http://www.osha-slc.gov/SLTC/needlestick/index.html
OSHA. “Bloodborne Pathogens and Needlestick Prevention.” OSHA, U.S. Department of Labor. (5/11/11)
http://www.osha.gov/SLTC/bloodbornepathogens/index.html
CDC. “Body Art: Prevent Needlestick Injuries.” CDC. (5/11/11) http://www.cdc.gov/niosh/topics/body_art/needlestick.html
CDC. “Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008.” CDC. (7/27/11)
http://www.cdc.gov/hicpac/Disinfection_Sterilization/6_0disinfection.html
A Best Practices Approach for Reducing Bloodborne Pathogens Exposure. California Department of Industrial Relations,
California OSHA (Cal/OSHA), 2001. http://www.dir.ca.gov/dosh/dosh_publications/bbpbest1.pdf
USA. OSHA. “Frequently Asked Questions: Bloodborne Pathogens.” 11 Nov. 2001. OSHA, U.S. Department of Labor.
(7/27/11) http://www.osha.gov/html/faq-bbp.html
CDC. “(Lack of) Universal Precautions.” OSHA, U.S. Department of Labor. (11 July 2003)
http://www.osha.gov/SLTC/hospital_etool/hazards/univprec/univ.html
CDC. “Bloodborne Infectious Diseases: HIV/AEDS, Hepatitis B, Hepatitis C, Emergency Needlestick Information.” CDC.
(7/27/11) http://www.cdc.gov/niosh/topics/bbp/emergnedl.html
CDC. “Exposure to Blood: What Healthcare Personnel Need to Know.” CDC, July, 2003. (7/27/11)
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Morbidity & Mortality Weekly Report, 12-19-03, Vol. 52, N. RR-17
California Code of Regulation, Section 1005. Minimum Standards for Infection Control
© 2011 EMS Safety
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Bloodborne Pathogens Appendices
Table of Contents
Appendix A: Model Exposure Control Plan
Appendix B: Hepatitis B Vaccine Declination (Mandatory)
Appendix C: Biohazard Symbol
Appendix D: Irrigation Practices for CA Dental Providers
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APPENDIX A: MODEL EXPOSURE CONTROL PLAN
The Model Exposure Control Plan is intended to serve as an employer guide to the
OSHA Bloodborne Pathogens standard. A central component of the requirements of the
standard is the development of an exposure control plan (ECP).22
The intent of this model is to provide small employers with an easy-to-use format for
developing a written exposure control plan. Each employer will need to adjust or adapt
the model for their specific use.
The information contained in this publication is not considered a substitute for the OSH
Act or any provisions of OSHA standards. It provides general guidance on a particular
standard-related topic. For specific compliance requirements refer to www.osha.gov.
POLICY
The (Facility Name) __________ is committed to providing a safe and healthful work
environment for our entire staff. In pursuit of this endeavor, the following exposure
control plan (ECP) is provided to eliminate or minimize occupational exposure to
bloodborne pathogens in accordance with OSHA standard 29 CFR 1910.1030,
"Occupational Exposure to Bloodborne Pathogens."
The ECP is a key document to assist our firm in implementing and ensuring compliance
with the standard, thereby protecting our employees. This ECP includes:
 Determination of employee exposure
 Implementation of various methods of exposure control, including:
o Universal precautions
o Engineering and work practice controls
o Personal protective equipment
o Housekeeping
 Hepatitis B vaccination
 Post-exposure evaluation and follow-up
 Communication of hazards to employees and training
 Recordkeeping
 Procedures for evaluating circumstances surrounding an exposure incident
The methods of implementation of these elements of the standard are discussed in the
subsequent pages of this ECP.
PROGRAM ADMINISTRATION
 (Name of responsible person or department)__________________ is
(are) responsible for the implementation of the ECP. (Name of responsible
person or department)_______________ will maintain, review, and update
the ECP at least annually, and whenever necessary to include new or
modified
tasks
and
procedures.
Contact
location/phone
number:____________________________
©




Those employees who are determined to have occupational exposure to
blood or other potentially infectious materials (OPIM) must comply with the
procedures and work practices outlined in this ECP.
(Name of responsible person or department) _____________________
will maintain and provide all necessary personal protective equipment (PPE),
engineering controls (e.g., sharps containers), labels, and red bags as
required by the standard. (Name of responsible person or department)
______________________ will ensure that adequate supplies of the
aforementioned equipment are available in the appropriate sizes. Contact
location/phone number: ___________________
(Name of responsible person or department) _______________________
will be responsible for ensuring that all medical actions required are
performed and that appropriate employee health and OSHA records are
maintained. Contact location/phone number:________________________
(Name of responsible person or department) _____________________
will be responsible for training, documentation of training, and making the
written ECP available to employees, OSHA, and NIOSH representatives.
Contact location/phone number:_____________________________
EMPLOYEE EXPOSURE DETERMINATION
The following is a list of all job classifications at our establishment in which all
employees have occupational exposure:
JOB TITLE
(E.g.: Phlebotomists)
DPEARTMENT/LOCATION
(E.g.: Clinical Lab)
The following is a list of job classifications in which some employees at our
establishment have occupational exposure. Included is a list of tasks and procedures, or
groups of closely related tasks and procedures, in which occupational exposure may
occur for these individuals:
JOB TITLE
DEPT/LOCATION
TASK/PROCUDURE
(E.g., Housekeeper) (Ex: EVS)
(Handling Regulated Waste)
Part-time, temporary, contract and per diem employees are covered by the
standard. How the provisions of the standard will be met for these employees
should be described in the ECP.
METHODS OF IMPLEMENTATION AND CONTROL
Universal Precautions
All employees will utilize universal precautions.
Exposure Control Plan
Employees covered by the bloodborne pathogens standard receive an explanation of
this ECP during their initial training session. It will also be reviewed in their annual
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refresher training. All employees have an opportunity to review this plan at any time
during their work shifts by contacting (Name of responsible person or department)
__________. If requested, we will provide an employee with a copy of the ECP free of
charge and within 15 days of the request.
(Name of responsible person or department) _______________ is responsible for
reviewing and updating the ECP annually or more frequently if necessary to reflect any
new or modified tasks and procedures which affect occupational exposure and to reflect
new or revised employee positions with occupational exposure.
Engineering Controls and Work Practices
Engineering controls and work practice controls will be used to prevent or minimize
exposure to bloodborne pathogens. The specific engineering controls and work practice
controls used are listed below:



(e.g.: glass capillary tubes in the clinical laboratory, outpatient clinics,
and pediatric units)
__________________________________________________________
__________________________________________________________
Sharps disposal containers are inspected and maintained or replaced by (Name of
responsible person or department) _____________________ every (list frequency
______________ or whenever necessary to prevent overfilling.
This facility identifies the need for changes in engineering control and work practices
through (Examples: Review of OSHA records, employee interviews, committee
activities, etc.) ______________________________________________________
We evaluate new procedures or new products by (Describe the process) _______
__________________________________________________________________
__________________________________________________________________
The following staff are involved in this process: (Describe how employees will be
involved) __________________________________________________________
(Name of responsible person or department)________________will ensure effective
implementation of these recommendations.
Personal Protective Equipment (PPE)
PPE is provided to our employees at no cost to them. Training is provided by (Name of
responsible person or department) ______________________ in the use of the
appropriate PPE for the tasks or procedures employees will perform.
The types of PPE available to employees are as follows:
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(e.g., gloves, eye protection, etc.) _____________________________________
___________________________________________________________________
PPE is located (List location) _______________________________ and may be
obtained through (Name of responsible person or department) _____(Specify how
employees are to obtain PPE, and who is responsible for ensuring that it is available.)
All employees using PPE must observe the following precautions:
 Wash hands immediately or as soon as feasible after removal of gloves or
other PPE
 Remove PPE after it becomes contaminated, and before leaving the work
area
 Used PPE may be disposed of in _____________(List appropriate containers
for storage, laundering, decontamination, or disposal.)
 Wear appropriate gloves when it can be reasonably anticipated that there
may be hand contact with blood or OPIM, and when handling or touching
contaminated items or surfaces; replace gloves if torn, punctured,
contaminated, or if their ability to function as a barrier is compromised
 Utility gloves may be decontaminated for reuse if their integrity is not
compromised; discard utility gloves if they show signs of cracking, peeling,
tearing, puncturing, or deterioration.
 Never wash or decontaminate disposable gloves for reuse.
 Wear appropriate face and eye protection when splashes, sprays, spatters, or
droplets of blood or OPIM pose a hazard to the eye, nose, or mouth.
 Remove immediately or as soon as feasible any garment contaminated by
blood or OPIM, in such a way as to avoid contact with the outer surface.
The procedure for handling used PPE is as follows: (may refer to specific agency
procedure by title or number and last date of review)
____________________________________________________________
_________________________________________________________
(e.g., how and where to decontaminate face shields, eye protection, resuscitation
equipment)
Housekeeping
Regulated waste is placed in containers which are closable, constructed to contain all
contents and prevent leakage, appropriately labeled or color-coded (see Labels), and
closed prior to removal to prevent spillage or protrusion of contents during handling.
The procedure for handling sharps disposal containers is: (may refer to specific
agency procedure by title or number and last date of review)
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____________________________________________________________________
______________________________________________________________________
______________________________________________________________________
The procedure for handling other regulated waste is: (may refer to specific agency
procedure by title or number and last date of review)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Contaminated sharps are discarded immediately or as soon as possible in containers
that are closable, puncture-resistant, leak-proof on sides and bottoms, and labeled or
color-coded appropriately. Sharps disposal containers are available at __________
(must be easily accessible and as close as feasible to the immediate area where
sharps are used)
Bins and pails (e.g., wash or emesis basins) are cleaned and decontaminated as soon
as feasible after visible contamination.
Broken glassware which may be contaminated is picked up using mechanical means,
such as a brush and dust pan.
Laundry The following contaminated articles will be laundered by this company:
________________________ ________________________
________________________ ________________________
Laundering will be performed by (Name of responsible person or department)
_______________________ at (time and/or location).
The following laundering requirements must be met:
 Handle contaminated laundry as little as possible, with minimal agitation
 Place wet contaminated laundry in leak-proof, labeled or color-coded
containers before transport.
 Use (specify either red bags or bags marked with the biohazard symbol)
for this purpose.
 Wear the following PPE when handling and/or sorting contaminated laundry:
(List appropriate PPE)
______________ , ______________, ______________,______________
Labels
The following labeling method(s) is used in this facility:
EQUIPMENT TO BE LABELED
LABEL TYPE (size, color, etc.)
e.g., Specimens, contaminated laundry, etc. Red bag, biohazard label, etc.
___________________________________
____________________________
___________________________________
____________________________
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(Name of responsible person or department) ______________________ will ensure
warning labels are affixed or red bags are used as required if regulated waste or
contaminated equipment is brought into the facility. Employees are to notify
________________________ if they discover regulated waste containers, refrigerators
containing blood or OPIM, contaminated equipment, etc. without proper labels.
HEPATITIS B VACCINATION
(Name of responsible person or department) ________________________ will
provide training to employees on hepatitis B vaccinations, addressing the safety,
benefits,
efficacy,
methods
of
administration,
and
availability.
The hepatitis B vaccination series is available at no cost after training and within 10
days of initial assignment to employees identified in the exposure determination section
of this plan. Vaccination is encouraged unless any of the following occur:
1) Documentation exists that the employee has previously received the
series.
2) Antibody testing reveals that the employee is immune.
3) Medical evaluation shows that vaccination is contraindicated.
However, if an employee chooses to decline vaccination, the employee must sign a
declination form. Employees who decline may request and obtain the vaccination at a
later date at no cost. Documentation of refusal of the vaccination is kept at
_______(List location or person responsible for this recordkeeping).
Vaccination will be provided by (List Health care Professional who is responsible
for this part of the plan) at (location).
Following hepatitis B vaccinations, the healthcare professional's Written Opinion will be
limited to whether the employee requires the hepatitis vaccine, and whether the vaccine
was administered.
POST-EXPOSURE EVALUATION AND FOLLOW-UP
Should an exposure incident occur, contact (Name of responsible person) at the
following number:____________________________.
An immediately available confidential medical evaluation and follow-up will be
conducted by (Licenced health care professional) . Following the initial first aid (clean
the wound, flush eyes or other mucous membrane, etc.), the following activities will be
performed:
 Document the routes of exposure and how the exposure occurred.
 Identify and document the source individual (unless the employer can
establish that identification is infeasible or prohibited by state or local law).
 Obtain consent and make arrangements to have the source individual tested
as soon as possible to determine HIV, HCV, and HBV infectivity; document
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



that the source individual's test results were conveyed to the employee's
health care provider.
If the source individual is already known to be HIV, HCV and/or HBV positive,
new testing need not be performed.
Assure that the exposed employee is provided with the source individual's
test results and with information about applicable disclosure laws and
regulations concerning the identity and infectious status of the source
individual (e.g., laws protecting confidentiality).
After obtaining consent, collect exposed employee's blood as soon as
feasible after exposure incident, and test blood for HBV and HIV serological
status.
If the employee does not give consent for HIV serological testing during
collection of blood for baseline testing, preserve the baseline blood sample for
at least 90 days; if the exposed employee elects to have the baseline sample
tested during this waiting period, perform testing as soon as feasible.
ADMINISTRATION OF POST-EXPOSURE EVALUATION AND FOLLOW-UP
(Name of responsible person or department) ________________________ ensures
that health care professional(s) responsible for employee's hepatitis B vaccination and
post-exposure evaluation and follow-up are given a copy of OSHA's bloodborne
pathogens standard.
(Name of responsible person or department) _____________________ ensures that
the health care professional evaluating an employee after an exposure incident receives
the following:
 A description of the employee's job duties relevant to the exposure incident
 Route(s) of exposure
 Circumstances of exposure
 If possible, results of the source individual's blood test
 Relevant employee medical records, including vaccination status
(Name of responsible person or department) _______________________provides
the employee with a copy of the evaluating health care professional's written opinion
within 15 days after completion of the evaluation.
PROCEDURES FOR EVALUATING THE CIRCUMSTANCES SURROUNDING AN
EXPOSURE INCIDENT
(Name of responsible person or department) ________________________ will
review the circumstances of all exposure incidents to determine:
 Engineering controls in use at the time
 Work practices followed
 A description of the device being used
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



Protective equipment or clothing that was used at the time of the exposure
incident (gloves, eye shields, etc.)
Location of the incident (O.R., E.D., patient room, etc.)
Procedure being performed when the incident occurred
Employee's training
(Name of responsible person) will record all percutaneous injuries from contaminated
sharps in a Sharps Injury Log.
If it is determined that revisions need to be made, (Responsible person or
department) ___________________ will ensure that appropriate changes are made to
this ECP. (Changes may include an evaluation of safer devices, adding employees
to the exposure determination list, etc.)
EMPLOYEE TRAINING
All employees who have occupational exposure to bloodborne pathogens receive
training conducted by (Name of responsible person or department) . (Attach a brief
description of their qualifications.)
All employees who have occupational exposure to bloodborne pathogens receive
training on the epidemiology, symptoms, and transmission of bloodborne pathogen
diseases. In addition, the training program covers, at a minimum, the following
elements:
 A copy and explanation of the standard
 An explanation of our ECP and how to obtain a copy
 An explanation of methods to recognize tasks and other activities that may
involve exposure to blood and OPIM, including what constitutes an exposure
incident
 An explanation of the use and limitations of engineering controls, work
practices, and PPE
 An explanation of the types, uses, location, removal, handling,
decontamination, and disposal of PPE
 An explanation of the basis for PPE selection
 Information on the hepatitis B vaccine, including information on its efficacy,
safety, method of administration, the benefits of being vaccinated, and that
the vaccine will be offered free of charge.
 Information on the appropriate actions to take and persons to contact in an
emergency involving blood or OPIM.
 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.
 Information on the post-exposure evaluation and follow-up that the employer
is required to provide for the employee following an exposure incident.
 An explanation of the signs and labels and/or color coding required by the
standard and used at this facility.
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
An opportunity for interactive questions and answers with the person
conducting the training session.
Training materials for this facility are available at ___________________________.
RECORDKEEPING
Training Records
Training records are completed for each employee upon completion of training. These
documents will be kept for at least three years at (Name of responsible person or
location of records) ______________________.
The training records include:
 Dates of the training sessions
 Contents or a summary of the training sessions
 Names and qualifications of persons conducting the training
 Names and job titles of all persons attending the training sessions
Employee training records are provided upon request to the employee or the
employee's authorized representative within 15 working days. Such requests should be
addressed
to
(Name
of
Responsible
person
or
department)
________________________.
Medical Records
Medical records are maintained for each employee with occupational exposure in
accordance with 29 CFR 1910.20, "Access to Employee Exposure and Medical
Records."
(Name of Responsible person or department) is responsible for maintenance of the
required medical records. These confidential records are kept at (List location)
________________for at least the duration of employment plus 30 years.
Employee medical records are provided upon request of the employee or to anyone
having written consent of the employee within 15 working days. Such requests should
be sent to (Name of responsible person or department and address)
______________________
OSHA Recordkeeping
An exposure incident is evaluated to determine if the case meets OSHA's
Recordkeeping Requirements (29 CFR 1904). This determination and the recording
activities are done by (Name of responsible person or department) ___________.
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Sharps Injury Log
In addition to the 1904 Recordkeeping Requirements, all percutaneous injuries from
contaminated sharps are also recorded in a Sharps Injury Log. All incidences must
include at least:
 Date of the injury
 Type and brand of the device involved (syringe, suture needle)
 Department of work area where the incident occurred
 Explanation of how the incident occurred.
This log is reviewed as part of the annual program evaluation and maintained for at
least five years following the end of the calendar year covered. If a copy is requested by
anyone, it must have any personal identifiers removed from the report.
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APPENDIX B: HEPATITIS B VACCINE DECLINATION (MANDATORY)
I understand that due to my 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.
Signed:________________________________
Employee Signature
Name:__________________________________
Print Employee Name
Date:________________________
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APPENDIX C: BIOHAZARD SYMBOL
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APPENDIX D: IRRIGATION PRACTICES FOR CA DENTAL PROVIDERS
For: California Dental Providers
Re: Irrigation Practices
When dealing with irrigation, consider the following practices:

All containers with blood or saliva (e.g. suctioned fluids) can be inactivated with
state-approved treatment technologies or carefully poured down a utility sink,
drain or toilet.34

Be sure to use proper PPE when handling any fluids potentially contaminated
with blood.
California regulations require that only sterile coolants and irrigants shall be used for
surgical procedures that involve soft tissue or bone. The sterile coolant/irrigant must be
delivered with a sterile delivery system.35
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