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Bloodborne Pathogens
Awareness and safe practices for
employees and responders who may
come into contact with blood or other
potentially infectious materials.
INTRODUCTION
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Bloodborne Pathogens (BBP)
Learning Objectives
Key Concepts
• Understand risks associated
with BBP in the workplace
• Understand how to
minimize risks and potential
for exposure at work
• Determine proper action if
exposure occurs
• Demonstrate skill of soiled
glove removal
• 3.3 million workplace injuries
and illnesses
• OSHA developed standard
for employers (1910.1030)
• Purpose: reduce risk of
occupational exposure to
BBP
• Microorganisms cause
bloodborne diseases
• Includes needle safety
protocols
• www.osha.gov
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You will learn
• What bloodborne pathogens are and why
they are dangerous
• Basic information on HIV, hepatitis B (HBV) and
hepatitis C (HCV)
• Routes of exposure, techniques to reduce risk of
exposure, and use of personal protective
equipment (PPE)
• Resources available to employees
• How to respond safely to an emergency at work
• Post-exposure actions
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Why me?
• Why do you need this training?
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To provide care to an injured or ill person
To handle contaminated sharps
To clean a blood or body fluid spill
To learn what to do if you’re exposed to BBP
• You should know:
– Risks of workplace duties that might involve blood or
body fluid exposure
– Routes of entry for BBP
– Protective and preventive measures for handling
blood or other body fluids
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Who is covered by the BBP Standard?
• Employees who could come into contact
with blood or Other Potentially Infectious
Materials (OPIM) while performing their jobs
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A coworker coming to the aid of a bleeding victim
Public safety, correctional officers, first responders
Healthcare or dental workers
Custodial or maintenance workers
Workers in labs, tissue or blood banks, laundries or
mortuaries
– Workers handling medical equipment or regulated
waste
– Workers who provide body art
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What is a bloodborne pathogen?
• Disease-causing microorganism present in
human blood
• Transmitted through exposure to the blood or
certain body fluids of an infected person
• Most serious types: HIV, HBV, HCV
• What are Other Potentially infectious fluids
(OPIM)?
– Human body fluids
– Unfixed tissue or organs from a human
– Any cell, culture, fluid, tissue or organ containing the
HIV or hepatitis B virus
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What is an Exposure Incident?
• Defined by OSHA
• “A specific eye, mouth, or 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”
• Exposure incidents are reported after initial care
and decontamination
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HUMAN IMMUNODEFICIENCY
VIRUS (HIV)
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HIV: Key Concepts
The HIV Virus
• Breaks down immune
system
– Kills T-Cells that help fight
against infection
• >1M cases of HIV in U.S.
– 20% unaware of infection
– 56,000 new cases annually
• No known cure or vaccine
• AIDS is most advanced
stage of HIV infection
– Allows opportunistic
illnesses
– Common cold becomes
fatal pneumonia
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How is HIV transmitted?
• Must have a route of entry
• Primary methods of transmission:
– Unprotected sex with infected partner
– Sharing needles during injection drug use
• Can pass disease without knowing you’re
infected
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What body fluids transmit HIV?
• Blood (any fluid contaminated w/ blood)
• Semen, vaginal secretions
• Breast milk or amniotic fluid (from a mother’s
pregnancy)
• Saliva (usually bloody) from dental procedures
• Cerebrospinal fluid (brain and spinal column)
• Synovial fluid (surrounding joints)
• Pleural fluid (around lungs)
• Peritoneal fluid (in abdomen)
• Pericardial fluid (around heart)
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NOT transmitted through casual contact
• No transmission from saliva or tears
• No known transmission from sharing
– Food and drink
– Towels, tools, eating utensils
– Restroom facilities
• Very weak virus outside the body
– Can only live about 5 min in a drop of blood on the
ground
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What are the symptoms of HIV?
• Initially flu-like symptoms that dissipate
• May have no other signs and symptoms for
years
• Common symptoms of HIV infection include:
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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
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HEPATITIS B (HBV) AND
HEPATITIS C (HCV) VIRUSES
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Key Concepts
• Hepatitis is inflammation of the liver
– Usually caused by a viral infection
– Hepatitis B (HBV) and Hepatitis C (HCV) are the most
serious workplace exposures
• Hepatitis can cause:
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Cirrhosis (scarring) of the liver
Liver cancer
Liver failure
Death
Chronic liver infections
• Hepatitis is very contagious
– Strong virus, even outside the body
– HBV can live in drop of dried blood for up to 2 weeks
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Comparing HBV and HCV
HBV
HCV
• 38,000 new cases in 2008
• 90% patient recovery
• 5 -10% develop chronic liver
infection
• 30-50% of infected children
become chronic carriers
• 1.4 million Americans have
chronic HBV
• More easily transmitted
than HIV or HCV
• Vaccine preventable
• 18,000 new cases in 2008
• Can cause acute or chronic
(life-long) infection
• 75-85% develop chronic
infection, which can cause
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– Chronic liver disease
– Death
• 3.2 million Americans with
chronic HCV
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Transmission of HBV and HCV
• Contracted through direct contact with
infected blood or OPIM
• Transmission is most commonly from:
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Needlesticks or other contaminated sharps exposures
Sharing needles during injection drug use
Infected mother to her baby during birth
Unprotected sex with an infected person (rarely HCV)
• Can transmit HBV or HCV w/o having signs or
symptoms (carrier)
• Not spread through casual contact (working,
studying, or playing)
• No known transmission from:
– Sharing food/drink
– Sharing restroom facilities
– Insects
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Signs and Symptoms of HBV/HCV
• Jaundice
– Yellowing of the skin
– Yellowing sclera around the eyes
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Fatigue
Loss of appetite, nausea and vomiting
Abdominal pain, diarrhea, dark urine
Joint pain (HBV)
Many infected people may not have any signs or
symptoms
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WORKPLACE TRANSMISSION
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Transmission from Infected to Non-Infected
• Workplace transmission of a BBP can occur when
– Responding to an emergency
– Handling a contaminated sharp
– Cleaning a blood or body fluid spill
• BBP must have a route of entry
• Mucous membranes
– Unprotected eyes, mouth, nose
– Unprotected sex
• Skin breakdown
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Cut or open wound
Fresh scab
Rash
Hangnail
• Puncture
– Needlesticks
– Handling contaminated sharp objects
– Sharing needles during injection drug use
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Protection from Infection
• Get vaccinated against HBV
• Avoid unprotected sex with infected persons or
multiple partners
• Do not share items possibly contaminated with
blood or OPIM:
– Needles from injection drug use
– Razors
– Toothbrushes
• Use universal precautions when there is risk of
exposure to blood or body fluids (We’ll discuss later)
• Use personal protective equipment (PPE) to protect
routes of entry
• Follow your organization’s Exposure Control Plan
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Suspect Exposure? Get Tested.
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Report possible exposure
See your doctor for a blood test
There may be no signs or symptoms
A blood test is required for diagnosis
Early diagnosis is important to:
– Ensure appropriate and early care
– Avoid spreading the disease to others
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PERSONAL PROTECTIVE
EQUIPMENT (PPE)
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Personal Protective Equipment (PPE)
• Protects potential routes of
entry from exposure
• Employer provides PPE
– For employees at risk of
exposure to a BBP
– Responders, housekeepers,
lab workers…
• Standard PPE Includes:
– Gloves (disposable, watertight)
– Protective clothing: gowns,
aprons, lab coats, shoe covers
– Face shields or face masks
– Eye protection
– CPR barrier masks or bag
masks for rescue breathing
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PPE Preparation
• Requires training for proper use
– Must fit correctly
– Be appropriate for each situation
• Practice selecting, donning and removing PPE
before a real emergency
• PPE Location
– Store at each workstation
– First aid kits
– Any site where there is a potential for exposure to
BBP
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PPE Disposal
• Remove PPE as soon as possible after an
exposure, before leaving the scene
• Contaminated PPE must be disposed of properly
as regulated waste
– Not with regular trash
– Use plastic red bag or other leak-proof, container
– Label as biohazard
• Uncontaminated PPE may be discarded in the
regular trash
• Wash your hands thoroughly after removing
PPE
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PPE Practice
• Discuss: Where is your
PPE?
• Disposable glove removal
– Pinch base of glove, peel
off slowly
– Hold in other hand
– Slip finger(s) inside other
glove
– Carefully peel off so that it
is inside out
– Dispose in proper, leakproof container
• Practice disposable glove
removal
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A written plan for management of bloodborne pathogens in the
workplace…
EXPOSURE CONTROL PLAN
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Key Concepts
• Developed by employer
• Must be accessible to employees
• Identifies
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Workplace specific BBP issues
Employees at risk for exposure
How to determine if an exposure has occurred
Response to an exposure
• Reviewed annually
– New or modified activities or jobs that may result in
exposure to BBP
– New technology, devices or procedures that could
decrease risk of exposure
– Employee input
– Includes engineering controls and work-practice controls
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Workplace ‘Controls’ of Exposure Control Plan
• Engineering Controls: Items or hardware that
isolate or remove BBP hazards from the workplace
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Sharps disposal containers
Needleless injection systems
Self-sheathing needles
Blunt-tip suture needles for less-dense tissue
Specially marked bags for contaminated (regulated) waste
• Work-practice Controls: Systems or everyday
practices in the workplace that reduce risk and
exposure to BBP.
– Company policy that says to use watertight gloves when
responding to emergencies.
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Elements of an Exposure Control Plan
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Sharps management
Spill clean-up
Regulated waste
Contaminated laundry
Labeling
Hand washing
Hygiene
Maintenance and housekeeping
HBV vaccination
Postexposure follow-up and treatment
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Discussion
• Where is your Exposure Control Plan
• Who is covered by the plan
• Name one engineering control
– Item or hardware
• Name one work-practice control
– System, policy or practice
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A contaminated sharp is any object contaminated with blood
or OPIM that can penetrate the skin
MANAGEMENT OF SHARPS
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Key Concepts
• Contaminated sharp is object contaminated
with blood or OPIM that can penetrate skin
– Needles, scalpels
– Broken glass or capillary tubes
– Exposed ends of dental wires
• Needlesticks
– Most common cause of occupational exposure to
BBP
– 800,000 needlesticks annually in the U.S
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Sharps Injury Log
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Part of the Exposure Control Plan
The employer is required to track sharps injuries
Tracks how sharps injuries occur at workplace
Helps future prevention efforts
Confidential between the employer and
employee
• Must include:
– Type and brand of device used in the incident
– Location of the incident
– Description of the incident
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Safe Handling of Sharps
• Use a mechanical means to pick up
contaminated sharps (tongs, broom, dust pan)
• Wear PPE
• Dispose of sharps in proper container
• Review sharps policies annually or as needed
– New technology
– New products
– Employee input on sharps use
• Follow your state’s needle safety legislation
• Labs and healthcare settings:
– Use a needleless system or other advanced technology
– DO NOT Recap needles
– DO NOT Self-blunt (bend/break) needles
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Sharps Containers
• Features
– Closeable
– Puncture-resistant and leak-resistant
– Properly labeled as a biohazard
• Keep visible and within easy reach
– Avoid bending, stretching or straining to discard
sharps
– Plainly visible to the workers, including how full it is
• Do not overfill
– Change when 2/3 full
– Avoid injury from discarding sharps into full container
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BLOOD SPILLS
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Key Concepts
• Follow Exposure Control Plan
• Goal of clean-up is to disinfect area of potentially
infectious materials
• Use EPA-registered germicidal for disinfection
• If no germicide is available, use chlorinated
bleach
– Mix one part chlorinated bleach to 10 - 100 parts
water (1:10 to 1:100)
– Solution concentrations vary depending on the size
and type of spill
– Change bleach/water solutions daily
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Cleaning a Blood Spill
1.
Follow Exposure Control Plan
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Clear immediate area,
reduce further contamination
or foot tracking
Locate BBP spill kit
Put on appropriate PPE
Clean area of visible blood
and OPIM with paper towels
or an absorbent powder
Disinfect at least 10 minutes
Dispose of soiled clean-up
materials and PPE in proper
container
Wash hands
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LABELING
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Key Concepts
• Items contaminated
with BBP need to be
properly labeled as a
bio-hazard for
disposal,
containment, or
transport
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Regulated Waste
• Soiled material from clean-up
• Any discarded item contaminated with blood or
OPIM
• Examples
– Bloody gauze
– Heavily soiled gloves
– Shoe covers contaminated with blood or OPIM
• Special handling and disposal
– Proper biohazard container
– Disposal by a medical waste company
• Containers
– Closeable
– Leak-proof
– Labeled or color-coded to indicate a biohazard
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Contaminated Laundry
• Handle as little as possible
• Place in container
– Properly labeled
– Closeable
– Leak-proof container
• Cleaned by a professional service that provides
pick-up
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Warning Labels
• Must be attached to:
– Container: Regulated waste, contaminated laundry, used sharps
– Refrigerators and freezers containing blood or OPIM
– Any container used to ship, store or transport blood or OPIM
• Biohazard label requirements
– Color: fluorescent orange or orange-red
– Symbol: biohazard symbol in contrasting colors
– Attached so that cannot be accidentally removed or fall off
• If a biohazard label is unavailable
– Use a red bag or other red container as a temporary substitute
• Post warning Signs
– At the entrance to HIV and HBV research and production
facilities
– As otherwise specified by the Standard (29 CFR 1910.1030)
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HAND WASHING, HYGIENE
& HOUSEKEEPING
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Key Concepts
• Hand washing & hygiene prevent exposure
– Prevents touching mucous membranes with
contaminated hands
– Prevents transfer of BBP from environmental surfaces
to other people
• Wash hands as soon as possible after potential
exposure to BBP
– Providing first aid
– Cleaning a blood spill
– Handling regulated waste or contaminated laundry
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Hand Washing Technique
• Wet hands with warm water
and apply soap
– Liquid soap reduces bacteria
associated with bar soap
• Rub hands together
vigorously on all surfaces
– Under nail beds
– Between fingers
• Create friction to dislodge
and remove germs
• Continue scrubbing for at
least 20 seconds
• Rinse well with warm water
and dry hands
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If hand washing facility is not available
• Use hand sanitizer that contains at least
60% alcohol
– Temporary solution until hand washing facility is
available
– Not a substitute for hand washing
• Wash hands properly at the earliest opportunity
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Hygiene
• In areas where BBP may be present,
DO NOT:
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Store food
Apply makeup
Apply lip balms
Smoke
Eat or drink
Handle contact lenses
• Be careful around potentially infectious materials
– Use PPE at all times
– Minimize splashing or splattering of droplets of blood
or OPIM when cleaning
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Workspace Housekeeping
• Maintain a safe work area
• Clean & disinfect at beginning and end of each shift
• Remove and replace equipment coverings that have
been exposed to BBP
• Clean spills immediately
• Pick up sharps properly and discard ASAP
• Use the proper containers for:
– Contaminated or used sharps
– Regulated waste
– Contaminated laundry
• Handle infectious materials as little as possible
• Ensure containers have biohazard symbol
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HBV VACCINATION
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Key Concepts
• Most effective method to reduce risk of HBV
transmission
• Provides 95% immunity to HBV
• Safe for adults and children
• Series of three shots
• Given under supervision of a licensed physician or
another healthcare professional
• At-risk employees are eligible for HBV vaccination
– Given at no cost to employee
– Within 10 days of being classified as “at-risk”
– After an exposure incident, employer should offer postvaccination testing for immunity
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Who should receive the HBV vaccination?
• Employees who are “at-risk” for exposure
to BBP
• Persons whose lifestyle or environment puts
them at increased risk for exposure
• All infants and children under 19 years of age
• Employee has right to refuse vaccination
– Must sign a declination form
– May choose to have vaccination at any time, even if
refused initially
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RESPONDING TO
EMERGENCIES
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Key Concepts
• Responding to emergencies creates risk
of exposure to BBP
• Put your own safety first
• Use Universal Precautions to prevent
transmission of BBP
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Universal Precautions
• Designed to prevent transmission of BBP
when providing medical aid
• Universal Precautions say to treat blood and
body fluids as infectious
• For additional protection, use Standard
Precautions and treat every body fluid as
potentially infectious
– Regardless if bloody or not
– Includes non-intact skin, mucous membranes
– Exception: sweat
• Body fluids may not carry BBP, but may contain
other infectious microorganisms
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Guidelines for Emergency Response
• Assume all moist body substances are
infectious
• Wash hands thoroughly before and after each
patient contact
• Put on PPE before providing medical aid
• Use CPR barrier devices for rescue breathing
• Follow your workplace Exposure Control Plan for
cleaning and disposal of blood and OPIM
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WHAT IF YOU’RE EXPOSED ON
THE JOB?
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Key Concepts
• Immediate Actions
– Wash hands and exposed areas immediately
– Flush splashes to nose, mouth, or skin with water
– Irrigate eyes thoroughly with water or saline
• Follow Exposure Control Plan
• Dispose of contaminated PPE, clothing or
objects
• Ensure the clean-up of any blood spill
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Reporting an Exposure
General Reporting
Sharps Reporting
• Report immediately to your
supervisor
• Date and time of exposure
• Body part exposed
• Job classification
• Work site location
• Engineering controls being
used
• Work practices being followed
• Activity performed at time of
exposure incident
• Previous training for activity
• Did sharp have engineered
sharps injury protection
mechanism?
• Did incident occur before or
after mechanism was
activated?
• If no protection mechanism,
could engineered protection
have prevented injury?
• Could other engineering
control, work-practice
control, or policy have
prevented injury?
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Postexposure Evaluation & Follow Up
• Provided by the employer, no cost to employee
• Within 3-4 hours after the exposure:
– Document routes and circumstances of exposure
– Identify & document source individual (unless prohibited by
law)
– Confidential medical evaluation by a qualified physician
– Laboratory testing of the source individual and person
exposed with follow-up testing as needed
• Treat exposure
– Postexposure medications as needed
– Employee counseling
• Continued follow-up as needed
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CONCLUSION, SCENARIOS &
TESTING
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Conclusion
• DISCUSS: What if you’re exposed on the
job?
• IDENTIFY and DISCUSS: Workplace scenarios
• TEST: Written Exam
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