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Bloodborne Pathogens
COURSE OBJECTIVE: The purpose of this course is to provide information on bloodborne
diseases and the OSHA Bloodborne Pathogens Standard.
LEARNING OBJECTIVES
Upon completion of this course, you will be able to:
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List the basic components of OSHA’s bloodborne pathogens standard.
Describe two common bloodborne diseases and their modes of transmission.
Explain the purpose of the hepatitis B vaccine.
Identify several types of personal protective equipment (PPE), work practices, and
engineering controls that can help to decrease your risk of exposure.
Recognize warning labels.
Define an exposure incident and describe the follow-up required.
OSHA BLOODBORNE PATHOGENS STANDARD
The Occupational Safety and Health Administration of the U.S. Department of Labor
(OSHA) first published the Occupational Exposure to Bloodborne Pathogens Standard
in 1991 in Title 29 of the Code of Federal Regulations 1910.1030. In 2001, in response
to the Needlestick Safety and Prevention Act, OSHA revised the Bloodborne Pathogens
Standard. The standard details what employers must do to protect workers whose jobs
put them at risk for exposure to blood and other potentially infectious materials. OSHA
regularly inspects healthcare agencies for compliance and may fine employers if
infractions are identified.
In general, the standard requires employers to do the following:
1. Establish a written exposure control plan to eliminate or minimize employee
exposure to bloodborne pathogens
 The employer must prepare an exposure determination that contains a list of
job classifications in which workers have occupational exposure, along with a
list of the tasks and procedures performed by those workers that result in
their exposure.
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2. Update the plan annually to reflect changes in tasks, procedures, and positions
that affect occupational exposure, and also technological changes that eliminate
or reduce occupational exposure
 Employers must annually document in the plan that they have considered
and begun using appropriate, commercially available, effective safer medical
devices designed to eliminate or minimize occupational exposure.
 Employers must also document that they have solicited input from frontline
workers in identifying, evaluating, and selecting effective engineering and
work practice controls.
3. Implement the use of universal precautions
 Universal Precautions means treating all human blood and other potentially
infectious materials (OPIM) as if known to be infectious for bloodborne
pathogens.
4. Identify and use engineering controls
 These are devices that isolate or remove the bloodborne pathogens hazard
from the workplace. They include sharps disposal containers, self-sheathing
needles, and safer medical devices, such as sharps with engineered sharpsinjury protection and needleless systems.
5. Identify and ensure the use of work practice controls
 These are practices that reduce the possibility of exposure by changing the
way a task is performed, such as appropriate practices for handling and
disposing of contaminated sharps, handling specimens, handling laundry,
and cleaning contaminated surfaces and items.
6. Provide personal protective equipment (PPE), such as gloves, gowns, eye
protection, and masks
 Employers must clean, repair, and replace this equipment as needed.
Provision, maintenance, repair and replacement are at no cost to the
worker.
7. Make available hepatitis B vaccinations to all workers with occupational exposure
 This vaccination must be offered after the worker has received the required
bloodborne pathogens training and within 10 days of initial assignment to a
job with occupational exposure.
8. Make available post-exposure evaluation and follow-up to any occupationally
exposed worker who experiences an exposure incident
 An exposure incident is a specific eye, mouth, other mucous membrane,
nonintact skin, or parenteral contact with blood or OPIM.
 This evaluation and follow-up must be at no cost to the worker and includes
documenting the route(s) of exposure and the circumstance under which the
exposure incident occurred; identifying and testing the source individual for
HBV and HIV infectivity; collecting and testing the exposed worker’s blood, if
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the worker consents; offering post-exposure prophylaxis; offering
counseling; and evaluating reported illnesses.
 The healthcare professional will provide a limited written opinion to the
employer and all diagnoses must remain confidential.
9. Use labels and signs to communicate hazards
 Warning labels must be affixed to containers of regulated waste; containers
of contaminated reusable sharps; refrigerators and freezers containing blood
or OPIM; other containers used to store, transport, or ship blood or OPIM;
contaminated equipment that is being shipped or serviced; and bags or
containers of contaminated laundry.
 Facilities may use red bags or red containers instead of labels
10. Provide training to employees that covers all elements of the standard
 Employers must offer this training on initial assignment, at least annually
thereafter, and when new or modified tasks or procedures affect a worker’s
occupational exposure.
11. Maintain employee medical and training records including a sharps injury log
(OSHA, 2011a)
THE PATHOGENS
Bloodborne pathogens are microorganisms present in human blood or other
potentially infectious materials (OPIM) that can cause disease in individuals who are
exposed to the blood containing the pathogen. Many are relatively rare, such as
malaria and syphilis. Others are common, such as the hepatitis virus and the human
immunodeficiency virus (HIV), which causes acquired immune deficiency (AIDS).
In addition to blood, potentially infectious materials include any body fluid that might
be infected, such as:
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Semen
Vaginal secretions
Cerebrospinal fluid
Pleural (lung) fluid
Saliva
Tears
Synovial (joint) fluid
Amniotic (uterine) fluid
Peritoneal fluid (fluid that fills the abdominal cavity)
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Two bloodborne pathogens are specifically addressed by OSHA standards because they
are the most common and pose the greatest threat to employees who may be
exposed. They are hepatitis B (HBV) and human immunodeficiency virus (HIV).
Hepatitis
Hepatitis means inflammation of the liver. Several strains of the hepatitis virus have
been identified; hepatitis A, hepatitis B, and hepatitis C are the most common.
(Hepatitis A is not a bloodborne pathogen and will not be discussed here.)
The liver is an organ located at the top of the abdomen, just below the diaphragm. The
liver performs several vital functions that serve to detoxify the blood cells, inactivate
many chemical compounds, store glucose as glycogen, synthesize triglycerides and
cholesterol, and produce plasma proteins. Diseases that inflame or damage the liver
adversely affect the body’s ability to perform these vital functions, leading to acute or
chronic illness and sometimes death.
HEPATITIS B (HBV)
Hepatitis B is an infection of the liver caused by the hepatitis B virus. Acute hepatitis B
refers to the first 6 months after someone is exposed to the hepatitis B virus. The
illness can range in severity from very mild with few or no symptoms to a serious
condition requiring hospitalization. Some people are able to fight the infection and
clear the virus. For others, the infection remains and leads to a chronic, or lifelong,
illness. Chronic hepatitis B refers to the illness that occurs when the hepatitis B virus
remains in a person’s body. Over time, the infection can cause serious health
problems.
In the United States, approximately 1.2 million people have chronic hepatitis B.
Unfortunately, many people do not know they are infected. The number of new cases
of hepatitis B has decreased more than 80% over the last 20 years. An estimated
40,000 people now become infected each year. Many experts believe this decline is a
result of widespread vaccination of children.
Approximately 15%–25% of people with chronic hepatitis B develop serious liver
problems, including liver damage, cirrhosis, liver failure, and liver cancer. Every year,
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approximately 3,000 people in the United States and more than 600,000 people
worldwide die from hepatitis B–related liver disease (CDC, 2010a).
Transmission
Hepatitis B is transmitted through activities that involve percutaneous (i.e., puncture
through the skin) or mucosal contact with infectious blood or body fluids (e.g., semen
or saliva), including:
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Sex with an infected partner
Injection drug use that involves sharing needles, syringes, or drug-preparation
equipment
Birth to an infected mother
Contact with blood or open sores of an infected person
Needle sticks or sharp instrument exposures
Sharing items such as razors or toothbrushes with an infected person
Hepatitis B is not spread through breastfeeding, sharing eating utensils, hugging,
kissing, holding hands, coughing, or sneezing. Unlike some forms of hepatitis, hepatitis
B is not spread by contaminated food or water.
The hepatitis B virus is very resilient, and it can survive in dried blood for up to 7 days
(CDC, 2011a). For this reason, the virus is a concern for medical personnel such as
nurses and paramedics, as well as custodians, laundry personnel, and other employees
who may come in contact with blood or potentially infectious materials.
Diagnosis and Treatment
People who are infected with HBV often show no symptoms for a period of time. After
exposure it can take up to 9 months before symptoms become noticeable. The
symptoms of hepatitis B are often much like a mild flu. Initially there is fatigue,
possible stomach pain, fever, loss of appetite, and nausea. As the disease continues to
develop, jaundice (a distinct yellowing of the skin and eyes) and darkened urine usually
occurs.
Hepatitis B is diagnosed with specific blood tests that are not part of blood work
typically done during regular physical exams. The hepatitis B surface antigen (HBsAg), a
protein on the surface of HBV, can be detected in high levels in serum during acute or
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chronic HBV infection. The presence of HBsAg indicates that the person is infectious.
The body normally produces antibodies to HBsAg as part of the normal immune
response to infection. HBsAg is the antigen used to make hepatitis B vaccine.
HBsAg will be detected in an infected person’s blood from 1 to 9 weeks after exposure
to the virus. About half will no longer be infectious by 7 weeks after onset of
symptoms, and all persons who do not remain chronically infected will be HBsAgnegative by 15 weeks after onset of symptoms (CDC, 2011a).
There is no cure for HBV, but there are medications available to treat long-lasting HBV
infection. Adefovir dipivoxil, interferon alfa-2b, pegylated interferon alft-2a,
lamivudine, entecavir, and telbivudine are six medications used for the treatment of
persons with chronic hepatitis B (CDC, 2011a). Many people who contract the disease
develop antibodies that help them get over the infection and protect them from
getting it again. It is important to note that infection with HBV will not prevent
someone from getting another type of hepatitis.
Vaccine
The hepatitis B vaccine is the best protection from the disease.
All employees who are exposed to blood or other potentially infectious materials as
part of their job duties are eligible to be vaccinated against the hepatitis B virus. The
OSHA Bloodborne Pathogen Standard requires employers to offer the vaccination
series to all workers who have occupational exposure. Examples of workers who may
have occupational exposure include, but are not limited to, healthcare workers,
emergency responders, morticians, first-aid personnel, correctional officers, and
laundry workers in hospitals and commercial laundries that service healthcare or
public safety institutions. The vaccine and vaccination must be offered at no cost to
the employee and at a reasonable time and place (OSHA, 2011b).
The hepatitis B vaccine is a noninfectious, yeast-based vaccine that is usually given in a
series of three intramuscular injections in the arm. It is prepared from recombinant
yeast cultures rather than human blood or plasma. Thus, there is no chance of
developing HBV from the vaccine.
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The vaccination consists of a series of three injections. The second injection should be
given 1 month after the first, and the third injection 6 months after the initial dose. To
ensure immunity, it is important to receive all three injections. The vaccine causes no
harm to those who are already immune or to those who may be HBV carriers.
Although employees may opt to have their blood tested for antibodies to determine
need for the vaccine, their employers may not make such screening a condition of
receiving vaccination, nor are employers required to provide screening. For employees
at risk for exposure, an antibody titer can be drawn 1 to 2 months after the vaccination
series is completed to determine vaccine effectiveness. If a second vaccine series is
indicated, it must be offered free of charge.
Employees who decide to decline vaccination must complete a declination form. An
employee may opt to take the vaccine at any time even after initially declining it.
HEPATITIS C (HCV)
Hepatitis C is a serious infection of the liver caused by the hepatitis C virus, a
bloodborne pathogen. An estimated 3.2 million people in the United States have
chronic hepatitis C. Most are unaware of their infection. Each year, about 17,000
Americans become infected with hepatitis C (CDC, 2010b).
Transmission of the virus occurs when blood or body fluids from an infected person
enter the body of a person who is not infected. Today, most people become infected
with hepatitis C by sharing needles or other equipment to inject drugs. Before
widespread screening of the blood supply began in 1992, hepatitis C was also
commonly spread through blood transfusions and organ transplants. Although
uncommon, outbreaks of hepatitis C have occurred from blood contamination in
medical settings (CDC, 2010b).
Hepatitis C is a progressive disease that varies from person to person. It is
characterized as either acute or chronic. Acute hepatitis C is a short-term illness that
occurs within the first 6 months after someone is exposed to the hepatitis C virus. The
acute infection can range in severity from a very mild illness with few or no symptoms
to a serious condition requiring hospitalization. For reasons that are not known, some
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of those infected recover from the virus without treatment and show no signs of
further disease.
Approximately 75%–85% of people who become infected with the Hepatitis C virus
develop chronic infection. Chronic hepatitis C is a long-term illness that occurs when
the hepatitis C virus remains in a person’s body. Over time, it can lead to serious liver
problems, including liver damage, cirrhosis, liver failure, or liver cancer (CDC, 2010b).
Many people with hepatitis C do not have symptoms and do not know they are
infected. Symptoms for both acute and chronic hepatitis C can include fever, fatigue,
loss of appetite, nausea, vomiting, abdominal pain, dark urine, grey-colored stools,
joint pain, and jaundice.
Treatment is not always effective for HCV, and all infected persons are not candidates
for treatment. The therapy for chronic hepatitis C has evolved steadily since alpha
interferon was first approved for use in this disease more than 15 years ago. At the
present time, the optimal regimen appears to be a 24- or 48-week course of the
combination of pegylated alpha interferon and ribavirin (NIH, 2010a).
Although there is currently no vaccine to prevent Hepatitis C, research is being
conducted to develop one. At this time, there is no recommendation for the use of
antiviral agents upon exposure to HCV. Adherence to Universal Precautions and Body
Substance Isolation (BSI) is the most effective way for healthcare workers to prevent
exposure to the virus.
Human Immunodeficiency Virus (HIV)
As noted earlier, the human immunodeficiency virus (HIV) causes acquired immune
deficiency syndrome, or AIDS. HIV attacks the body's immune system, weakening it so
that it cannot fight other deadly diseases. Though a person has been infected with HIV,
it may be many years before AIDS develops. AIDS is a fatal disease, and while
treatment for it is improving, there is no known cure.
The CDC estimates that more than 1 million people are living with HIV in the United
States. One in five (21%) of those people living with HIV are unaware of their infection.
An estimated 56,300 Americans become infected with HIV each year (CDC, 2010c).
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HIV is spread by sexual contact with an infected person; by sharing needles and/or
syringes with someone who is infected; and less commonly, through transfusions of
infected blood or blood clotting factors. Babies born to HIV-infected women may
become infected before or during birth or through breastfeeding after birth. HIV is not
spread through contaminated food or by casual contact.
In the healthcare setting, personnel have been infected with HIV after being stuck with
needles containing HIV-infected blood or, less frequently, after infected blood gets
into a worker’s open cut or a mucous membrane such as the eye, mouth, or nostril.
Through December 2001, there were 57 documented cases of occupational HIV
transmission to healthcare workers in the United States, and only one reported case
has been confirmed since 2001 (CDC, 2011b).
The symptoms of HIV infection vary but often include weakness, mild viral illness
within 6 weeks, fever, sore throat, nausea, headaches, diarrhea, a white coating on the
tongue, weight loss, and swollen lymph glands.
HIV/AIDS infection occurs in three broad stages. In the first stage, the person is
actually infected with HIV. After the initial infection, the infected individual may show
few, or no, signs of illness for many years. During the second stage, the individual may
suffer swollen lymph glands or other lesser diseases that begin to take advantage of
the body’s weakened immune system. The second stage is believed to lead eventually
to AIDS. In the third and final stage, that of AIDS itself, the body becomes completely
unable to fight off life-threatening diseases and infections.
The HIV virus is fragile and does not survive long outside the human body. It is
primarily of concern to employees providing first aid or medical care in situations
involving fresh blood or other potentially infectious materials. It is estimated that the
chances of contracting HIV in a workplace environment are minimal. However,
because it is such a devastating disease, all precautions must be taken to avoid
exposure.
There is no vaccine to prevent HIV infection. Adherence to Universal Precautions is the
most effective means of protection.
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A plan for post-exposure management of healthcare personnel is an important
element of workplace safety. The Centers for Disease Control has issued guidelines for
the management of healthcare worker exposures to HIV and recommendations for
post-exposure prophylaxis (PEP). The guidelines outline a number of considerations in
determining whether healthcare workers should receive PEP and in choosing the type
of PEP regimen. For most HIV exposures that warrant post-exposure prophylaxis, a
basic 4-week, two-drug regimen is recommended (CDC, 2011b).
MODES OF TRANSMISSION
Bloodborne pathogens such as hepatitis B and HIV can be transmitted through contact
with infected blood and other potentially infectious body fluids such as semen and
vaginal secretions, cerebrospinal fluid, pleural and peritoneal fluid, amniotic fluid,
saliva in dental procedures, and any body fluid that is visibly contaminated with blood.
Transmission of a bloodborne pathogen can occur through:
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Sexual contact without a condom
Sharing of hypodermic needles
From mothers to their babies at or before birth
Accidental puncture from contaminated needles, broken glass, or other sharps
Contact between broken/damaged skin and infected body fluids
Contact between mucous membranes and infected body fluids
Unbroken skin forms an impervious barrier against bloodborne pathogens. However,
infected blood and body fluids can enter one’s system through open sores, cuts and
abrasions; acne; any damaged or broken skin; or the mucous membranes of eyes,
nose, or mouth if splashed with contaminated fluid.
Healthcare personnel are at high risk due to routine exposure to blood and other
potentially infectious body fluids. Thus, it is important to know the ways exposure and
transmission are most likely to occur in a work situation. Any time there is blood-toblood contact with infected blood or body fluids, there is a risk. In most situations,
transmission likely occurs because of accidental puncture from contaminated needles
or other sharps, contact between broken skin and infected body fluids, or contact
between mucous membranes and infected body fluids.
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PREVENTION
Exposure Control Plan
Employers are required to develop and make available an exposure control plan (ECP).
The plan is in place to protect employees from health hazards associated with
bloodborne pathogens and provide appropriate treatment and counseling if an
exposure incident occurs. Employees should know where their facility’s exposure
control plan is located and what it includes.
The exposure control plan includes detailed information about ways an employer
provides a safe and healthful work environment, including:
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Who is responsible for implementing the plan
Determination of employee exposure
Methods of exposure control, such as Universal Precautions, engineering and
work practice controls, personal protective equipment (PPE), and housekeeping
Hepatitis B vaccination
Postexposure evaluation and follow-up, as well as the procedures for evaluating
the circumstances surrounding an exposure incident
Communication of hazards to employees
Training and recordkeeping
Employers are required to implement these preventive measures to reduce or
eliminate the risk of exposure to bloodborne pathogens.
Universal Precautions
Universal Precautions is the term used to describe a prevention strategy in which all
blood and potentially infectious materials are treated as if they are actually infectious,
regardless of the perceived status of the source individual. In other words, whether or
not one thinks the blood/body fluid is infected with bloodborne pathogens, treat it
as if it is. This approach is used in all situations where exposure to blood or potentially
infectious materials is possible. In addition, it means that certain engineering and work
practice controls shall always be utilized in situations where exposure may occur.
OSHA’s Bloodborne Pathogen Standard allows for healthcare facilities to use
acceptable alternatives to Universal Precautions. Alternative concepts in infection
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control are called Body Substance Isolation (BSI) and Standard Precautions. These
methods define all body fluids and substances as infectious. These methods
incorporate not only the fluids and materials covered by the Bloodborne Pathogens
Standard but expand coverage to include all body fluids and substances (OSHA, 2011c).
Personal Protective Equipment (PPE)
Wearing gloves, gowns, masks, and eye protection can significantly reduce health risks
for employees exposed to blood and other potentially infectious materials. Employers
are required to provide, clean, and maintain appropriate personal protective
equipment (PPE) and clothing free of charge to employees. Latex-free PPE must be
made available on request.
Personal protective equipment must be readily accessible to employees and available
in appropriate sizes. It is important to know what type of personal protective
equipment is available at work and where it is stored. To protect oneself, a healthcare
provider must have a barrier between them and any potentially infectious material.
TYPES OF PPE
Gloves
Nonsterile, disposable; worn when soiling of the hands with
blood or body fluids is likely
Utility gloves
To prevent injuries during extrication or when working in other
hazardous environments where broken glass or sharps may be
present
Gowns
Outerwear impervious to fluids; worn when soiling of exposed
skin or clothing is likely
Tyvek suit
One-piece, impervious outerwear with zipper; may have hood
and booties attached; worn when gross contamination with
blood and body fluids is anticipated
Face shield
One-piece face protection; worn while performing invasive
techniques, including IV therapy, suctioning, and intubations, or
any time there is an opportunity for blood or body fluids to be
splashed, sprayed, or splattered; not to be used for TB
protection
Goggles
Eye protection that includes shielding front, sides, and top;
goggles/safety glasses with side and top shields as well as fullface shielding are all acceptable; prescription glasses are
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acceptable if side shields are added
Mask
(surgical)
Disposable; to be placed over the mouth and nose; worn when
splashing of blood or body fluids is likely; worn with eye
protection
Head
coverings
Cap that covers hair; worn when splashing of blood or body
fluids is likely
Booties
Outerwear used to cover shoes/boots when exposed to blood
and body fluids
Turnout gear
Fire-resistant coat and pants; may provide protection during
extrication
Steel-toed
shoes/boots
Protective footwear
Hard hats
Protective head covering; worn during extrication
Body armor
Bulletproof vest; worn for protection in potentially hostile
situations
GLOVES: THE FIRST DEFENSE
Gloves are to be worn when contact with blood or other potentially infectious
materials or contaminated surfaces is anticipated. Gloves should be made of latex or
other water-impervious materials. If the glove material is thin or flimsy, double gloving
can provide an additional layer of protection. Those who allergic to standard gloves
must be provided with an alternative at no charge.
Cuts or sores on one’s hands should be covered with a bandage or similar protection
as an additional precaution before donning gloves. Always inspect gloves for tears or
punctures before putting them on. If a glove is damaged, don't use it.
When taking contaminated gloves off, do so carefully. Make sure not to touch the
outside of the gloves to bare skin, and be sure to dispose of the gloves in a proper
container so that no one else will come in contact with them.
PPE RULES TO FOLLOW
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Know how to use the equipment.
Always wear PPE in exposure situations.
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Remove and replace PPE that is torn, punctured, or has lost its ability to
function.
Remove clothing that becomes contaminated with blood or body fluids as soon
as possible.
Remove PPE before leaving the work area.
Handle contaminated laundry as little as possible.
Place contaminated PPE in appropriately labeled bags or containers until
disposed of, decontaminated, or laundered.
Know where these bags or containers are located in the work area.
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The order in which personal protective equipment is removed is not as important as
the principle behind choosing such an order. The key principle is that, when removing
personal protective equipment, one should avoid contact with blood, body fluids,
secretions, excretions, and other contaminants. When hands become contaminated,
they should be washed or decontaminated.
HOW TO REMOVE PPE
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Using gloved hands, untie the gown string and remove shoe covers.
Remove gloves (fingers under cuff of second glove to avoid contact
between skin and outside of gloves) and discard in an appropriate
manner.
Wash hands.
Remove gown without contaminating clothing underneath.
Touch only inside of gown while removing. Place in appropriate disposal
bag.
Remove goggles, mask, and cap and place in an appropriate container.
Remove boots (if worn) and place in appropriate container.
Wash hands up to wrists thoroughly.
Work Practice Controls
Work practice controls refer to the processes and procedures used to ensure that work
is conducted in a safe and healthy manner. Work practice controls are an essential
component of a safe work environment.
Work practices to learn and follow include: proper and timely handwashing;
minimizing splashing or spraying of any potentially infectious material; proper
decontamination and sterilization of equipment and supplies; cleanup, care, and
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maintenance of supplies and equipment; proper disposal of used supplies and
equipment; keeping all food and drink away from areas where blood or potentially
infectious materials are present; and no eating, drinking, smoking, applying cosmetics
or lip balm, or handling contact lenses where there is a risk of contamination.
DECONTAMINATION
To minimize exposure to bloodborne pathogens, effective decontamination is
essential. Use either a 10% household bleach solution, Lysol, or another EPA-registered
disinfectant. Check the label of all disinfectants to be sure they meet this requirement.
When cleaning up a blood spill, carefully cover the spill with rags or paper towels. Pour
disinfectant solution over the rags or towels and let it sit for 10 minutes, or follow the
manufacturer’s recommendations.
HANDWASHING
Handwashing is one of the most important—and easiest—practices used to prevent
transmission of bloodborne pathogens. Hands or other exposed skin should be
thoroughly washed as soon as possible following an exposure incident. Hands should
also be washed immediately or as soon as feasible after removing gloves or other PPE.
Use soft antibacterial soap, if possible. Avoid harsh abrasive soaps, as these may open
fragile scabs or other sores. Because handwashing is so important, it is wise to be
familiar with the nearest handwashing facilities. Public restrooms, janitor closets, and
so forth may be used for handwashing if they are normally supplied with soap.
When one is working in an area without access to such facilities, an antiseptic cleanser
may be used in conjunction with clean cloth/paper towels or antiseptic hand wipes. If
these alternative methods are used, hands should be washed with soap and running
water as soon as feasible (OSHA, 2003).
Engineering Controls
Engineering controls isolate or remove bloodborne pathogens hazards from the
workplace. They include any physical device or equipment used or installed to prevent
occupational hazard exposure, illness, or injury. Examples of engineering controls
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include sharps disposal containers, self-sheathing needles, and safer medical devices,
such as needleless systems.
Employers must select and implement appropriate engineering controls to reduce or
eliminate employee exposure. It is important for workers to learn and use the
engineering controls available in the work environment.
SHARPS HANDLING
Sharps are anything that can puncture the skin, such as needles, blades, scissors, or
broken glass. A needle stick or a cut from a contaminated sharp can lead to infection
from a bloodborne pathogen. Proper handling and disposal of sharps greatly reduces
this risk. Sharps containers should be closable, puncture-resistant, and leak-proof on
the sides and the bottom. They must be labeled or color-coded.
HOW TO HANDLE SHARPS
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Never recap, break, or shear needles.
To move or pick up needles, use a mechanical device or tool, such as
forceps, pliers, or broom and dustpan.
Dispose of needles in labeled sharps containers only.
When transporting sharps containers, close the containers immediately
before removal or replacement to prevent spillage or protrusion of
contents during handling or transport.
Fill a sharps container up to the fill line, or two thirds full. Do not overfill
the container.
WARNING LABELS
Warning labels need to be affixed to containers of regulated waste; refrigerators and
freezers containing blood or OPIM; and other containers used to store, transport, or
ship blood or OPIM. These labels are fluorescent orange, red, or orange-red. Bags used
to dispose of regulated waste must be red or orange-red, and they too must have the
biohazard symbol readily visible upon them.
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Biohazard warning label.
Regulated waste refers to any liquid or semi-liquid blood or other OPIM, contaminated
items that would release blood or OPIM in a liquid or semi-liquid state if compressed,
items that are caked with dried blood or OPIM and are capable of releasing these
materials during handling, and contaminated sharps.
EXPOSURE INCIDENT
If you experienced a needle stick or other sharps injury or were exposed to the blood
or other body fluids of a patient during the course of your work, immediately follow
these steps:
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Wash needle sticks and cuts with soap and water.
Flush splashes to the nose, mouth, or skin with water.
If your eyes were involved in the exposure, irrigate your eyes with clean water,
saline, or sterile irrigation solution.
Report the incident to your supervisor—including how, when, where, and
who—and describing events in as much detail as possible.
Immediately seek medical treatment.
Post-exposure Follow-Up
Your employer must provide you with a written report telling you how a bloodborne
pathogen might have entered your body and a description of what happened when
you were exposed. Your employer must identify the source individual (the person who
might have infected you) unless the source individual is unknown or state or local law
prohibits disclosure. If the source person is known, many states require that the
person be tested for HBV and HIV and notified of the results. Your blood must also be
collected and tested after you have agreed to the test.
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Medical care will be provided by your employer at no charge to you. All test records
are confidential. You must be given a copy of the healthcare professional's written
opinion with 15 days after your medical evaluation is finished. You will be given
postexposure prophylaxis if medically necessary, as recommended by the U.S. Public
Health Service. If you wish, you will be given counseling that includes
recommendations for transmission and prevention of HIV.
FREQUENTLY ASKED QUESTIONS
If I accidentally get a patient’s blood on my hands, do I need to treat the
incident as an exposure?
Yes. Wash the area with soap and water and report the occurrence to your
supervisor as soon as possible. Your supervisor will determine the type of follow-up
needed.
How great is my risk for hepatitis B?
One out of 20 people living in the United States will get infected with HBV at
some time during their lives. Your risk is higher if you have a job that involves contact
with human blood.
How do I know if I have hepatitis?
A blood test is the only way to diagnose hepatitis.
When should I get the hepatitis B vaccine?
The vaccination must be offered within 10 days of initial assignment to a job
where exposure to blood or other potentially infectious materials can be
anticipated.
If I decline to take the vaccination, can I change my mind later?
Yes, you can decide to begin the vaccination series at any time.
If I think I’ve been infected with HIV, how soon can I find out?
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You will usually develop antibodies against the HIV virus within 6 to 12 weeks
after becoming infected. Tests will not reveal whether you had been infected before
that time.
Can I get HBV, HIV, or AIDS from being bitten by an infected mosquito?
No. There is no evidence that the HBV or HIV virus is transmitted through insects
such as mosquitoes.
If dried blood were to get wet, could the HIV virus become active again?
No. Once a virus is no longer active, it cannot be “reconstituted” by adding
water.
Can I catch HIV from being in the same room or vehicle with someone who has the
infection if they cough or sneeze?
No. HIV cannot be transmitted through sneezing or coughing (you cannot catch it
like the common cold), or by shaking hands, hugging, sharing the water fountain, or
sharing the rest room or work equipment.
If the chances of being exposed to a patient with a contagious disease are low,
why do I need to take precautions all the time?
Universal Precautions are the most effective way to safeguard against exposure
to bloodborne pathogens. It is not always possible to predict when an exposure will
occur. Bloodborne pathogens are not visible, and you don’t know whether the patient
you are working with is infected.
Can I refuse to do a job that will expose me to potential infection?
No. Universal Standards do not allow you to refuse to take an assignment.
However, your employer is required to provide you with the appropriate personal
protective equipment and training to minimize your risk.
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RESOURCES
Centers for Disease Control and Prevention (CDC), Viral Hepatitis
http://www.cdc.gov/hepatitis/index.htm
Centers for Disease Control and Prevention (CDC). HIV
http://www.cdc.gov/hiv/
Occupational Safety and Health Administration (OSHA), Bloodborne Pathogen Standard
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10
051
REFERENCES
Centers for Disease Control and Prevention (CDC). (2011a). Hepatitis B FAQs for health
professionals. Retrieved April 4, 2011, from
http://www.cdc.gov/hepatitis/HBV/HBVfaq.htm#overview.
Centers for Disease Control and Prevention (CDC). (2010a). Hepatitis B fact sheet, Publication
No. 21-1073. Retrieved April 3, 2011, from
http://www.cdc.gov/hepatitis/HBV/PDFs/HepBGeneralFactSheet.pdf.
Centers for Disease Control and Prevention (CDC). (2010b). Hepatitis C fact sheet, Publication
No. 21-1075. Retrieved April 3, 2011, from
http://www.cdc.gov/hepatitis/HCV/PDFs/HepCGeneralFactSheet.pdf.
National Institutes of Health (NIH). (2010a). Chronic hepatitis C: Current disease management,
NIH Publication No. 10–4230. Retrieved April 5, 2011, from
http://digestive.niddk.nih.gov/ddiseases/pubs/chronichepc/chronichepc.pdf.
National Institutes of Health (NIH). (2010b). The ABCs of hepatitis, NIH Publication No. 211076. Retrieved April 6, 2011, from
http://www.cdc.gov/hepatitis/Resources/Professionals/PDFs/ABCTable.pdf.
Occupational Safety and Health Administration (OSHA), U.S. Department of Labor. (2011a).
OSHA fact sheet: OSHA’s Bloodborne Pathogen Standard. Retrieved on April 4, 2011, from
http://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdf.
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Florida Heart CPR*
Bloodborne Pathogens Post Test:
1. If a surface with dried blood containing the HIV virus becomes wet, will the virus
become active again?
a. Yes
b. No
2. Name three modes of transmission for HIV and Hepatitis B
a.
_________________________________
b. _________________________________
c.
_________________________________
3. How can you help to avoid getting a blood borne disease?
a.
Use gloves on every patient you touch
b. Have protected sex every time
c.
Wear goggles and mouth protection
d. Know your partner’s HIV/HBV status.
e. All of the above
4. After an on the job exposure, your employer will keep your records confidential but you
must pay for treatment yourself.
a.
True
b. False
5. The most common way to get Hepatitis C is by sharing needles and drugs
a.
True
b. False
6. Infants born to HIV infected mothers are ALWAYS infected with HIV.
a.
True
b. False
7. The most common way to get Hepatitis by is by occupational exposure
a.
True
b. False
8. It is the employees responsibility to implement proper engineering controls to reduce
the risk of contracting a bloodborne disease
a.
True
b.
False
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