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Bloodborne Pathogens:
Implications for Health Care
Industry Representatives
(A Continuing Education Self-Study Activity)
BLOODBORNE PATHOGENS
A Continuing Education Activity
Sponsored By
TO PARTICIPATE IN THIS ACTIVITY:
1. Review the introduction containing the overview,
course objectives, target audience, accreditation/credit
information and disclosures.
2. Study the education content.
3. Answer the Test Questions.
4. Complete the evaluation.
5. Complete the registration form.
6. View/print certificate of completion.
CONTACT INFORMATION:
2101 S. Blackhawk Street, Suite 220
Aurora, CO 80014-1475
Phone: 720-748-6144
Fax: 720-748-6196
Website: www.pfiedlerenterprises.com
© Pfiedler Enterprises - all rights reserved 2008
BLOODBORNE PATHOGENS: IMPLICATIONS FOR HEALTH
CARE INDUSTRY REPRESENTATIVES
A Continuing Education Self-Study Activity
Course Syllabus
OVERVIEW
This self-study activity has been developed specifically for the Health Care Industry
Representative who shares the responsibility for protecting themselves from disease
transmission through contact with bloodborne pathogens. Content will cover the risks of
exposure and the factors determining exposure. A section reviews regulations such as the
OSHA protective standards, Needle Stick Safety and Prevention Act (NSPA), as well as
guidelines put forth by the AORN and ACS related to the role of the Health Care Industry
Representative in the perioperative setting. Two scenarios are included that drive home the
rationale for protection and your role in the perioperative setting. A glossary of terms and
suggested reading provide additional information and resources.
OBJECTIVES
Upon completion of this self-study activity, the participant should be able to:
1. Identify the factors that affect the risk for occupational exposure to bloodborne
pathogens.
2. Describe the provisions in the Bloodborne Pathogens Standard that are applicable to
the Health Care Industry Representative.
3. Outline why education and training in infectious diseases and bloodborne pathogens
are important as presented in the AORN and ACS recommendations.
4. Explain what you, the Health Care Industry Representative, would do after reading the
two case scenarios.
INTENDED AUDIENCE:
This activity is for the Health Care Industry Representative who has a need for information
related to the risks associated with exposure to bloodborne pathogens.
CREDIT/CREDIT INFORMATION:
Pfiedler Enterprises has been approved as an Authorized Provider by the International
Association for Continuing Education and Training (IACET), 8405 Greensboro Drive, Suite
800, McLean , VA 22102 .
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IACET STATEMENT:
Pfiedler Enterprises has been accredited as an Authorized Provider by the International
Association for Continuing Education and Training (IACET), 1760 Old Meadow Road, Suite
500, McLean, VA 22102.
CEU STATEMENT:
As an IACET Authorized Provider, Pfiedler Enterprises offers CEUs for its programs that
qualify under ANSI/IACET Standard. Pfiedler Enterprises is authorized by IACET to offer 0.1
CEU(s) (1 contact hour) for this program.
RELEASE DATE
This self-study was released October 2008, Reviewed in October 2010 and can be used for
a period of two years. After October 2012 it can no longer be used unless it is updated and
contains a new release date.
EXPIRATION DATE:
This continuing education activity was planned and provided in accordance with IACET criteria.
This material was originally produced in October 2008, reviewed in October 2010 and can no
longer be used after October 2012 without being updated; therefore, this continuing education
activity expires October 31, 2012.
COPYRIGHT:
This self-study activity was developed, funded and copyright protected by Pfiedler Enterprises.
Inc.
DISCLAIMER:
Pfiedler Enterprises does not endorse or promote any commercial product that may be
discussed in this activity.
PLANNING COMMITTEE:
Judith Pfister, RN, BSN, MBA
Program Coordinator
Pfiedler Enterprises
Aurora, Colorado
Rose Moss, RN, MN, CNOR
Nurse Consultant
Del Norte, Colorado
EXPERT REVIEWER:
Julia A. Kneedler, RN, EdD
Program Coordinator
Pfiedler Enterprises
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Aurora, Colorado
DISCLOSURE STATEMENT
The planners/writers and reviewers contributing to an educational activity sponsored by
Pfiedler Enterprises are expected to disclose to the participants any real or apparent
financial affiliations related to the content.
Faculty Disclosure information:
1. Have you (or your spouse/partner) had any person financial relationship in the last
12 months with the manufacturer of the products or services that will be presented in
this continuing education activity (planner) in your presentation (speaker/author)?
2. Type of affiliation/financial interest with the name of the corporate organization.
3. Will your presentation include discussion of any off-label or investigational drug or
medical device?
Judith I. Pfister, RN BSN, MBA
1. No
2. Not Applicable
3. No
Rose Moss, RN, N, CNOR
1. No
2. Not Applicable
3. No
Julia A. Kneedler, RN, MS, EdD
1. No
2. Not Applicable
3. No
PRIVACY AND CONFIDENTIALITY POLICY
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following URL address into your browse: http://www.pfiedlerenterprises.com/Privacypolicy.
pdf or View the Privacy and Confidentiality Policy using the following link: http://www.
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In addition to this privacy statement, this Website is compliant with the guidelines for
internet-based continuing education programs.
The privacy policy of this Website is strictly enforced.
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CONTACT INFORMATION
If site users have any questions or suggestions regarding our privacy policy, please
contact us at:
Phone: 720-748-6144
Email:
[email protected]
Postal Address: 2101 S. Blackhawk Street, Suite 220
Aurora, Colorado 80014
Website URL: http://www.pfiedlerenterprises.com
CONTINUING EDUCATION INSTRUCTIONS
This educational activity is intended for use as a stand alone self-study activity. We
suggest you take the following steps for successful completion:
1. Read the overview and objectives to ensure consistency with your own learning
needs and objectives.
2. Review the content of the self-study activity, paying particular attention to those
areas that reflect the objectives.
3. Consult a dictionary for definitions of unfamiliar words.
4. Complete the Test Questions and compare your responses with the answers
provided.
5. For additional information on an issue or topic, consult the references.
6. To receive credit for this activity complete the evaluation and registration form.
7. A certificate of completion will be available for you to print at the conclusion.
Pfiedler Enterprises will maintain a record of your continuing education credits
and provide verification, if necessary, for 7 years.
If you have any questions, please call: 720-748-6144.
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BLOODBORNE PATHOGENS: IMPLICATIONS FOR HEALTH
CARE INDUSTRY REPRESENTATIVES
The Reality
Blood and other potentially infectious materials (OPIM) have long been recognized as a
potential threat to the health of employees who are exposed to them. Today, health care
workers are faced with additional challenges presented by newly recognized pathogenic
organisms, as well as those that have become resistant to treatment modalities.
These issues are especially significant for personnel working in the operating room
(OR) or other invasive procedure area. Healthcare industry representatives share the
responsibility of protecting themselves from disease transmission through contact with
bloodborne pathogens.
According to the statistics for 1997-1998 from the Centers for Disease Control and
Prevention (CDC), there were 384,325 percutaneous (needlestick and other sharps)
injuries in the hospital setting.1 For OR personnel, the statistics are remarkable. The
skin or mucous membranes of OR personnel may have contact with patient’s blood in
as many as 50% of operations.2 Cuts or needlesticks may occur in as many as 15%
of surgical procedures.3,4 But over half (57%) of percutaneous injuries due to a sharp
go unreported.5 Among OR personnel, the distribution of needlestick exposure is as
follows:6
Job Category
• Surgeons59.1%
• Scrub Nurses
• Anesthesiologist
• Circulators 6.0%
• Medical Students
3.1%
• Attendants
0.8%
• Other 5.7%
Total Needlestick Exposure (%)
19.1%
6.2%
The Risks7
Occupational exposure to blood and OPIM places one at risk of infection from
bloodborne pathogens such as Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and
Human Immunodeficiency Virus (HIV) while performing surgery and other procedurerelated tasks. Exposures occur through:
• Needlesticks or cuts from other sharps or instruments contaminated with an
infected patient’s blood; or
• Eye, nose, mouth, or skin contact with the patient’s blood.
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Various factors affect the overall risk for occupational exposures to bloodborne
pathogens, including the number of infected individuals in the patient population as well
as the type and number of blood contacts. Most exposures do not result in an infection.
After a specific exposure incident, the risk of infection is variable, based upon the
following factors:
•
•
•
•
The type of exposure
The amount of blood in the exposure
The pathogen involved
The amount of virus in the patient’s blood at the time of exposure
HBV
The annual number of occupational HBV infections has decreased 95% since the
hepatitis B vaccine became available in 1982 (from > 10,000 in 1982 to < 400 in 2001).
Healthcare workers who received the hepatitis B vaccine and have developed immunity
to the virus are practically at no risk for infection. For a person who is susceptible, the
risk from a single needlestick or cut exposure to HBV-infected blood ranges from 6 – 30%
and is dependent upon the hepatitis B e-antigen (HBeAg) status of the source individual. Hepatitis B surface antigen (HBsAg)-positive persons who are HBeAg positive have more
virus in their blood than those who are HBeAg negative. While the risk for HBV infection
from exposures of mucous membranes or nonintact skin exists, there is no known risk for
HBV infection from exposure to intact skin.
HCV
The risk for infection after a needlestick or sharp exposure to HCV-infected blood is
approximately 1.8%. The risk after a blood exposure to the eye, nose, or mouth is
unknown, but is thought to be very small; however, HCV infection from a blood splash to
the eye has been reported. HCV transmission resulting from exposure to nonintact skin
has been reported, but there is no known risk from exposure to intact skin.
No exact estimates exist on the number of healthcare personnel who are occupationally
infected with HCV. Studies have shown that 1% of hospital healthcare workers have
evidence of HCV infection (approximately 3% of the U.S. population has evidence
of infection); the number of these workers who may have been infected through
occupational exposure is unknown.
HIV
The average risk of HIV infection following a needlestick or sharp exposure to HIVinfected blood is 0.3% (about 1 in 300); alternatively stated, 99.7% of needlestick or
cut exposures do not lead to infection. The risk following exposure of the eye, nose,
or mouth to HIV-infected blood is estimated to be 0.1% (1 in 1,000). The risk following
exposure of nonintact skin to HIV-infected blood is estimated to be less than 0.1%; a
small amount of blood on intact skin most likely poses no risk at all. There have been no
documented cases of HIV transmission due to an exposure involving a small amount of
blood on intact skin (i.e., a few drops of blood on skin for a short period of time).
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The CDC had received reports (as of December, 2001) of 57 documented cases and 138
possible cases of occupationally–acquired HIV infection among healthcare workers in the
U.S. since reporting began in 1985.
The Regulations
Federal Regulations: Bloodborne Pathogens Standard
The Occupational Safety and Health Administration (OSHA) is the federal agency
responsible for protecting the health of America’s workers. In support of this mission,
OSHA establishes protective standards, enforces those standards, and reaches out
to employers and employees through technical assistance as well as consultation
programs. OSHA addressed healthcare worker protection from bloodborne pathogens
by issuing its final rule, the Bloodborne Pathogens Standard, which took effect March 6,
1992; a synopsis of the provisions applicable to the health care industry representative
are outlined as follows:8
1. Exposure Control Plan: Each employer having an employee(s) with occupational
exposure shall establish a written Exposure Control Plan designed to eliminate or
minimize employee exposure. The Plan shall contain at least the following elements:
a. The exposure determination;
b. The schedule and method of implementation; and
c. The procedure for the evaluation of circumstances surrounding exposure
incidents.
2. Exposure Determination: Each employer who has an employee(s) with occupational
exposure shall prepare an exposure determination. This exposure determination
shall contain the following elements (and shall be made without regard to the use of
personal protective equipment [PPE]):
a. A list of all job classifications in which all employees in those job classifications
have occupational exposure;
b. A list of job classifications in which some employees have occupational exposure,
and
c. A list of all tasks and procedures or groups of closely related task and procedures
in which occupational exposure occurs.
3. Methods of Compliance: Universal precautions shall be observed to prevent contact
with blood or other potentially infectious materials. Under circumstances in which
differentiation between body fluid types is difficult or impossible, all body fluids shall
be considered potentially infectious materials.
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4. Engineering and Work Practice Controls: Engineering and work practice controls
shall be used to eliminate or minimize employee exposure. Where occupational
exposure remains after institution of these controls, personal protective equipment
shall also be used.
a. Employers shall provide handwashing facilities which are readily accessible to
employees.
b. Contaminated needles and other contaminated sharps shall not be bent,
recapped or removed unless the employer can demonstrate that no alternative is
feasible or that such action is required by a specific medical or dental procedure.
c. Immediately or as soon as possible after use, contaminated reusable sharps shall
be placed in appropriate containers until properly reprocessed.
d. Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact
lenses are prohibited in work areas where there is a reasonable likelihood of
occupational exposure.
e. Food and drink shall not be kept in refrigerators, freezers, shelves, cabinets or on
countertops or benchtops where blood or other potentially infectious materials are
present.
f. All procedures involving blood or other potentially infectious materials shall be
performed in such a manner as to minimize splashing, spraying, spattering, and
generation of droplets of these substances.
5. Personal Protective Equipment (PPE):
a.Provision. When there is occupational exposure, the employer shall provide,
at no cost to the employee, appropriate personal protective equipment such
as, but not limited to, gloves, gowns, laboratory coats, face shields or masks
and eye protection, and mouthpieces, resuscitation bags, pocket masks, or
other ventilation devices. Personal protective equipment will be considered
“appropriate” only if it does not permit blood or other potentially infectious
materials to pass through to or reach the employee’s work clothes, street clothes,
undergarments, skin, eyes, mouth, or other mucous membranes under normal
conditions of use and for the duration of time which the protective equipment will
be used.
b.Use. The employer shall ensure that the employee uses appropriate personal
protective equipment unless the employer shows that the employee temporarily
and briefly declined to use personal protective equipment when, under rare and
extraordinary circumstances, it was the employee’s professional judgment that in
the specific instance, its use would have prevented the delivery of health care or
public safety services or would have posed an increased hazard to the safety of
the worker or co-worker.
c.Accessibility. The employer shall ensure that appropriate personal protective
equipment in the appropriate sizes is readily accessible at the worksite or is
issued to employees. Hypoallergenic gloves, glove liners, powderless gloves, or
other similar alternatives shall be readily accessible to those employees who are
allergic to the gloves normally provided.
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d. Cleaning, Laundering, and Disposal. The employer shall clean, launder, and
dispose of personal protective equipment at no cost to the employee.
e. Repair and Replacement. The employer shall repair or replace personal protective
equipment as needed to maintain its effectiveness, at no cost to the employee. If
a garment(s) is penetrated by blood or other potentially infectious materials, the
garment(s) shall be removed immediately or as soon as feasible. All personal
protective equipment shall be removed prior to leaving the work area. When
personal protective equipment is removed, it shall be placed in an appropriately
designated area or container for storage, washing, decontamination or disposal.
f.Gloves. Gloves shall be worn when it can be reasonably anticipated that
the employee may have hand contact with blood, other potentially infectious
materials, mucous membranes, and non-intact skin.
g. Masks, Eye Protection, and Face Shields. Masks in combination with eye
protection devices, such as goggles or glasses with solid side shields, or chinlength face shields, shall be worn whenever splashes, spray, spatter, or droplets
of blood or other potentially infectious materials may be generated and eye, nose,
or mouth contamination can be reasonably anticipated.
h. Gowns, Aprons, and Other Protective Body Clothing. Appropriate protective
clothing such as, but not limited to, gowns, aprons, lab coats, clinic jackets, or
similar outer garments shall be worn in occupational exposure situations. The type
and characteristics will depend upon the task and degree of exposure anticipated.
Surgical caps or hoods and/or shoe covers or boots shall be worn in instances
when gross contamination can reasonably be anticipated (e.g., orthopaedic
surgery).
6. Housekeeping: Employers shall ensure that the worksite is maintained in a clean
and sanitary condition. The employer shall determine and implement an appropriate
written schedule for cleaning and method of decontamination based upon the
location within the facility, type of surface to be cleaned, type of soil present, and
tasks or procedures being performed in the area. All equipment and environmental
and working surfaces shall be cleaned and decontaminated after contact with
blood or other potentially infectious materials. Contaminated work surfaces shall
be decontaminated with an appropriate disinfectant after completion of procedures;
immediately or as soon as feasible when surfaces are overtly contaminated or after
any spill of blood or other potentially infectious materials; and at the end of the work
shift if the surface may have become contaminated since the last cleaning.
7. Other Regulated Waste Containment: Regulated waste shall be placed in containers
which are closable; constructed to contain all contents and prevent leakage of fluids
during handling, storage, transport or shipping; labeled or color-coded as noted
below; closed prior to removal to prevent spillage or protrusion of contents during
handling, storage, transport, or shipping.
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8. Communication of Hazards to Employees: Labels - Warning labels shall be affixed
to containers of regulated waste, refrigerators and freezers containing blood or other
potentially infectious material; and other containers used to store, transport or ship
blood or other potentially infectious materials Labels required by this section shall
include the following legend:
These labels shall be fluorescent orange or orange-red or predominantly so, with
lettering and symbols in a contrasting color. Labels shall be affixed as close as feasible
to the container by string, wire, adhesive, or other method that prevents their loss or
unintentional removal.
9. Information and Training: Employers shall ensure that all employees with
occupational exposure participate in a training program which must be provided at
no cost to the employee and during working hours. Annual training for all employees
shall be provided within one year of their previous training. Employers shall provide
additional training when changes such as modification of tasks or procedures or
institution of new tasks or procedures affect the employee’s occupational exposure.
The additional training may be limited to addressing the new exposures created.
10. Hepatitis B Vaccination: Hepatitis B vaccination shall be made available after the
employee has received the training required and within 10 working days of initial
assignment to all employees who have occupational exposure, unless the employee
has previously received the complete hepatitis B vaccination series, antibody
testing has revealed that the employee is immune, or the vaccine is contraindicated
for medical reasons. The employer shall not make participation in a prescreening
program a prerequisite for receiving hepatitis B vaccination. If the employee initially
declines hepatitis B vaccination, but at a later date while still covered under the
standard, decides to accept the vaccination, the employer shall make available
hepatitis B vaccination at that time. The employer shall assure that employees who
decline to accept hepatitis B vaccination offered by the employer sign the required
statement.
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11. Post-exposure Evaluation and Follow-up. Following a report of an exposure incident,
the employer shall make a confidential medical evaluation and follow-up immediately
available to the exposed employee.
Federal Regulations: Needlestick Safety and Prevention Act
After implementation of the original Bloodborne Pathogens Standard, healthcare workers
continued to be at risk of contracting bloodborne diseases through percutaneous injury
with contaminated needles and other sharps. To address these issues, HR 5178, the
Needlestick Safety and Prevention Act (NSPA), was signed into law on November 6,
2000, which required that OSHA make specific changes in the Bloodborne Pathogens
Standard, including:9
1. Expansion of the definition of engineering controls to include “needleless
systems” and “sharps with engineered sharps injury protections.”
2. Documentation in employers’ Exposure Control Plans of consideration and
implementation of appropriate commercially available and effective “safer medical
devices” designed to eliminate or minimize occupational exposure to bloodborne
pathogens
3. Solicitation of input from non-managerial employees responsible for direct patient
care, who are potentially exposed to injuries from contaminated sharps in the
identification, evaluation, and selection of effective engineering and work practice
controls.
Professional Association Guidelines and Recommended Practices
Both the Association of periOperative Registered Nurses (AORN) and the American
College of Surgeons (ACS) have published guidelines, statements, and recommended
practices regarding the healthcare industry representative’s presence in the OR or
invasive procedure area that incorporate knowledge of the OSHA Bloodborne Pathogens
Standard, as well as practices to protect patients and health care workers from
transmission of potentially infectious agents.
AORN Guidance Statement: The Role of the Health Care Industry Representative in the
Perioperative Setting10
A health care industry representative may be present during a surgical procedure
under the conditions outlined by the health care organization, in compliance with local,
state, and federal regulations, and also in accordance with accreditation requirements.
Every facility should develop a system which documents that the health care industry
representative has completed instruction in the principles of asepsis, fire and safety
protocols, infection control practices, bloodborne pathogens, and patients’ rights. Based
on the community standards, this may range from maintaining current documentation
supplied by the representative’s employer to providing facility-specific training. The
health care industry representative must be aware of and follow the regulations of the
federal Health Insurance Portability and Accountability Act (HIPAA) and the Bloodborne
Pathogens Standard.
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ACS Statements of the College: Statement on Health Care Industry Representatives in
the Operating Room11
The ACS also recognizes that healthcare industry representatives provide technical
assistance to the surgical team. The purpose of this statement is to supply guidelines
to health care facilities and members of the perioperative health care team to ensure
an optimal surgical outcome, as well as the patient’s safety, right to privacy, and
confidentiality when a health care industry representative is present during a surgical
procedure. The statement also outlines that facility requirements and procedures for
industry representatives to be present in the OR should include education and training in
infectious disease and blood borne pathogens.
AORN: Recommended Practices for Prevention of Transmissible Infections in the
Perioperative Practice Setting12
The intent of these recommended practices is to protect both patients and health care
workers from potentially infectious agent transmission in today’s rapidly changing health
care environment. Selected recommendations are summarized as follows:
• Recommendation I – Healthcare workers should use standard precautions when
caring for all patients in the perioperative setting.
o Standard precautions should be applied across all aspects of health
care delivery; at a minimum, standard precautions should be used for all
surgical patients.
o Standard precautions apply to exposure of the potential for exposure to
blood and all body fluid secretions and excretions (except perspiration)
whether or not they contain visible blood; nonintact skin; and mucous
membranes.
• Recommendation II – Hand hygiene should be performed before and after each
patient contact.
o Hand hygiene should be performed with an appropriate alcohol-based
hand antiseptic:
At the beginning of a work shift;
Before and after patient contact;
After removing gloves;
Before and after eating;
Any time there is a possibility that there has been contact with blood
or OPIM; and
Any time when hands may have been soiled or any time the
practitioner believes his or her hands may have been soiled.
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• Recommendation III – Protective barriers must be used to reduce the risk of skin
and mucous membrane exposure to potentially infectious materials.
o Personal protective barriers are required when it can be reasonably
anticipated that a health care worker will be exposed to blood and body
fluids or OPIM. Protective barriers include:
Gloves;
Masks;
Protective eye wear; and
Fluid-resistant attire.
• Recommendation IV – Health care practitioners should double-glove during
invasive procedures.
• Recommendation V – Contact precautions should be used when providing
care for patients who are known or suspected to be infected or colonized with
microorganisms that are transmitted by direct or indirect contact with patients
or items and surfaces in patients’ environments (e.g., herpes simplex, impetigo,
infectious diarrhea, smallpox, methicillin-resistant Staphylococcus aureus
[MRSA], and vancomycin-resistant enterococci [VRE]). o Contact precautions include several of the same elements found in
standard precautions, including:  Wearing gloves when caring for patients or coming in contact with
items that may contain high concentrations of microorganisms (e.g.,
fecal material, blood, wound drainage); gloves should be changed
after contact with body fluids;
 Wearing gowns when it is anticipated that clothing will have contact
with infectious patients or items in the patients’ environment;
 Wearing a mask when it is anticipated that aerosolized exposure to
infectious microorganisms is possible;
 Using face protection (e.g., goggles, face shield) when it is
anticipated that splash or sneezing exposure to microorganisms is
possible;
 Ensuring that precautions are maintained during transport; and
 Adequately cleaning and disinfecting patient care equipment and
items before use with each patient.
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• Recommendation VI – Droplet precautions should be used when caring for
patients who are known or suspected to be infected with microorganisms that can
be transmitted by infectious large particle droplets (i.e., larger than 5 microns in
size) and generally travel short distances of three feet or less (e.g., diphtheria,
pertussis, influenza, mumps, pneumonic plague).
o Droplet precautions include:
Wearing a mask when within three feet of infectious patients;
Positioning patients at a distance of at least three feet from other
patients; and
Placing surgical masks on patients during transport.
• Recommendation VII – Airborne precautions should be used when caring for
patients who are known or suspected to be infected with microorganisms that can
be transmitted by the airborne route (e.g., rubeola, varicella, tuberculosis [TB],
and smallpox).
o Airborne precautions include:
Wearing a National Institute of Occupational Safety and Health
(NIOSH)- approved N95 mask;
Placing surgical masks on patients during transport;
Airborne isolation rooms with special air handling; and
Ventilation for areas outside the surgical suite.
• Recommendation VIII – Health care workers should be immunized against
epidemiologically important agents according to CDC recommendations.
o All health care workers must receive HBV immunizations unless
medically contraindicated.
o Health care workers should be immunized against other communicable
and infectious agents.
• Recommendation IX – Work practices must be designed to minimize risk of
exposure to pathogens.
o Activities involving hand-to-hand, hand-to-skin, hand-to-nose, handto-mouth, or hand-to-eye action can contribute to direct or indirect
transmission via inanimate surfaces and should be prohibited in the
work area; these activities include, but are not limited to:
Eating;
Drinking;
Smoking;
Applying cosmetics or lip balm; and
Handling contact lenses.
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o Food and drink should not be stored where the potential for exposure
to blood or OPIM could occur (e.g., refrigerators, shelves, countertops,
cabinets).
o Food and drink should not be present in the restricted and semirestricted
areas of the surgical suite.
• Recommendation X – Personnel must take precautions to prevent injuries caused
by needles, scalpels, and other sharp instruments.
o Sharps with engineering controls must be used when deemed
applicable.
o Work practice controls must be in place to minimize health care worker
exposure when handling sharps.
o All sharps must be handled, removed, and disposed of properly.
o Reusable sharps must be handled, removed, and sequestered at
the end of the procedure in a labeled, puncture-resistant, closed
transportation container.
• Recommendation XI – Activities of personnel with infections, exudative lesions,
nonintact skin, and/or bloodborne diseases should be restricted when these
activities pose a risk of transmission of infection to patients and other health care
workers. Identification, evaluation by a physician, and assessment of fitness for
work performance in the perioperative setting should be required.
o Health care workers infected with a bloodborne disease (e.g., HIV, HBV,
HCV) should use measures to protect themselves and others.
o Health care workers who have exudative lesions or weeping dermatitis
should refrain from providing direct patient care or handling medical
devices used in performing invasive procedures.
The Bottom Line
As a health care industry representative, you provide vital services (e.g., instruction,
training, technical assistance) to the staff in the OR and invasive procedure areas for the
provision of safe and effective patient care. You share the responsibility with health care
workers to protect both yourselves and the patients from the transmission of potentially
infectious agents in the perioperative/invasive procedure settings via exposure to blood
or OPIM. Through knowledge of and adherence to the OSHA Bloodborne Pathogens
Standard, as well as professional association recommendations, you can safeguard your
own health, as well as that of others.
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SCENARIOS
The scenarios presented below will provide an opportunity for you to synthesize the
information you have just learned about blood borne pathogens and apply it to situations
you may encounter.
Scenario # 1 – PPE
Ms. EF is a new representative for a company that manufactures gastrointestinal (GI)
endoscopes. She has completed her company’s comprehensive sales training program,
including a review of the OSHA Bloodborne Pathogens Standard. She is visiting one
of her facilities to discuss scope repair issues and loaners with the OR Director. As she
is waiting to talk with the Director, she is observing in the scope processing area and
discussing some of the issues with the technician, Ms. RD, who is assigned in the scope
room today. As she is cleaning the scopes, she notices that Ms. RD is not wearing a
mask, protective eyewear, or any type of gown. On the counter next to the automated
endoscope reprocessor, there is a cup of coffee and a sweet roll. Ms. EF asks Ms. RD
about the food and lack of PPE; she replies, “We’re careful in here; we’ve never had any
problems.” When Ms. EF talks to the OR Director later that morning, she mentions her
concerns about the practices she observed. The OR Director replies, “Yes, I know that
goes on – Ms. RD is bad about using PPE.”
Points to Consider:
• What are the major violations in this scenario?
• Was Ms. EF right in mentioning her observations to the OR Director?
• What are the implications of these practices?
Discussion of Points to Consider:
• Ms. RD is not wearing appropriate PPE (e.g., gloves, gowns, face shields or
masks and eye protection) while performing a task in which there is a potential for
occupational exposure; the OR Director (the employer) is not ensuring that Ms.
RD is using appropriate PPE.
• Yes.
• The practices violate the OSHA Bloodborne Pathogens Standard (a federal
regulation); they also increase the risk for an potential exposure incident for Ms.
RD.
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Scenario # 2 – The Instrument Trays
Mr. GR is an orthopaedic device manufacturer representative. Mr. GR has just finished
providing technical support for two total hip arthroplasty procedures and is on his way
to Central Processing to check on the status of the instrument trays that he must take
with him for surgery at another facility tomorrow. On his way, Ms. HB, the Lead Central
Processing Technician, approaches him in a panic and tells him that they will not be able
to process the trays right away, since one of the washer-sterilizers went down and a load
is already running in the other. Mr. GR cannot wait for the trays to be processed, as he
has a 3 hour drive to the next facility, where he is scheduled to do an inservice for the
afternoon staff. He tells Ms. HB that he will just take the trays, without being processed.
Points to Consider:
• What are the exposure implications of transporting contaminated instruments?
• What must Mr. GR do to properly prepare the trays for transport?
Discussion of Points to Consider:
• The instrument trays are considered contaminated and thus pose a risk for an
exposure incident to blood and OPIM.
• The OSHA Bloodborne Pathogen Standard requires that contaminated
instruments be contained in leak-proof containers that are closable and
constructed to contain all contents; the containers must be labeled with the
required Biohazard label (below), affixed as close as feasible to the container by
a method that prevents its loss or unintentional removal.
Care must also be taken to avoid contaminating the outside of the transport container.
Upon arrival to the next facility, Mr. GR should inform the Central Processing staff of the
contamination status of the trays (in addition to the communication via the labels) so that
they can handle them properly and avoid an exposure incident.
17
GLOSSARY
Airborne Precautions
Precautions that reduce the risk of an airborne
transmission of infectious airborne droplet nuclei
(i.e., small particle residue 5 microns or smaller. Aerosolization
The production of an aerosol: a fine mist or spray
containing minute particles
Blood Human blood, human blood components, and
products made from human blood
Bloodborne PathogensPathogenic microorganisms that are present
in human blood and can cause disease in
humans. These pathogens include, but are not
limited to, hepatitis B virus (HBV) and human
immunodeficiency virus (HIV).
Contact Precautions
Precautions designed to reduce the risk of
transmission of epidemiologically important
microorganism by direct or indirect contact.
Contaminated The presence or the reasonably anticipated
presence of blood or other potentially infectious
materials on an item or surface.
Direct Contact
Person-to-person contact resulting in physical
transfer of infectious microorganism between an
infected or colonized person and a susceptible
host.
Droplet Precautions Precautions that reduce the risk of large particle
droplet (i.e., 5 microns or larger) transmission of
infectious agents.
Engineering Controls
Controls (e.g., sharps disposal containers, safer
medical devices, such as sharps with engineered
sharps injury protections and needleless systems)
that isolate or remove the bloodborne pathogens
hazard from the workplace.
Exposure Incident
A specific eye, mouth, other mucous membrane,
non-intact skin, or parenteral contact with blood or
other potentially infectious materials that results
from the performance of an employee’s duties.
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Indirect Contact
Contact of a susceptible host to a contaminated
object (e.g., instruments, bed rails, linens,
equipment).
Needleless systems Devices that do not use needles for:
• The collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established;
• The administration of medication or fluids; or
• Any other procedure involving the potential for
occupational exposure to bloodborne
pathogens due to percutaneous injuries from
contaminated sharps.
Needlestick Injury
A penetrating stab wound from a needle (or other
sharp object) that may result in exposure to blood
or other body fluids.
Occupational Exposure Reasonably anticipated skin, eye, mucous
membrane, or parenteral contact with blood or
other potentially infectious materials that may
result from the performance of an employee’s
duties.
Other Potentially Infectious • The following human body fluids:
Materials (OPIM) semen, vaginal secretions, cerebrospinal fluid,
synovial fluid, pleural fluid, pericardial fluid,
peritoneal fluid, amniotic fluid, saliva in dental
procedures, any body fluid that is visibly
contaminated with blood, and all body fluids in
situations where it is difficult or impossible to
differentiate between body fluids;
• Any unfixed tissue or organ (other than intact
skin) from a human (living or dead); and
• HIV-containing cell or tissue cultures, organ
cultures, and HIV- or HBV-containing culture
medium or other solutions; and blood, organs,
or other tissues from experimental animals
infected with HIV or HBV.
Parenteral Piercing mucous membranes or the skin barrier
through such events as needlesticks, human
bites, cuts, and abrasions.
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Personal Protective Equipment
(PPE) Specialized clothing or equipment worn by
an employee for protection against a hazard.
General work clothes (e.g., uniforms, pants, shirts
or blouses) not intended to function as protection
against a hazard are not considered to be
personal protective equipment.
Sharps with Engineered Sharps Nonneedle sharps or needle devices used for
Injury Protections withdrawing body fluids, accessing a vein or
artery, or administering medications or other
fluids, with a built-in safety feature or mechanism
that effectively reduces the risk of an exposure
incident.
Standard Precautions
The primary strategy for successful infection
control and reduction of worker exposure.
Precautions used for care of all patients,
regardless of their diagnosis or presumed
infectious status.
Transmission-based Precautions
Second tier of precautions designed to be
used with patients known or suspected to be
infected or colonized with highly transmissible or
epidemiologically important pathogens for which
additional precautions are needed to prevent
transmission in the practice setting.
Work Practice Controls Controls that reduce the likelihood of exposure by
altering the manner in which a task is performed
(e.g., prohibiting recapping of needles by a twohanded technique).
20
REFERENCES
1.
CDC. NIOSH Alert: Preventing Needle-stick Injuries in Health Care Settings.
National Surveillance System for Hospital Healthcare Workers (NaSH). 2000.
Available at: http://www.cdc.gov/niosh/2000-108.html. Accessed October 13,
2008.
2.
Gerberding JL, Littell C, Tarkington A, et al. Risk of exposure of surgical personnel
to patients’ blood during surgery at San Francisco General Hospital. N Engl J Med.
1990;322:1788-1793.
3.
Quebbeman EJ, Telford GL, Hubbard S, et al. Risk of blood contamination and
injury to operating room personnel. Ann Surg.1991; 214:614-620.
4.
Gerberding JL, Littell C, Tarkington A, et al. Risk of exposure of surgical personnel
to patients’ blood during surgery at San Francisco General Hospital. N Engl J Med.
1990; 322:1788-1793.
5.
Quebbeman EJ, Telford GL, Hubbard S, et al. Risk of blood contamination and
injury to operating room personnel. Ann Surg.1991; 214:614-620.
6.
Perry J, Jagger J. Slash sharps risks for surgical personnel. OR Insider
(supplement to Nurs Man). 2005;36 (11):28-29.
7.
Centers for Disease Control and Prevention. Exposure to blood: What healthcare
personnel need to know. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/bbp/
exp_to_blood.pdf. Accessed October 13, 2008.
8.
U.S. Department of Labor; Occupational Safety & Health Administration. Bloodborne pathogens – 1910.1030. Available at: http://www.osha.gov/pls/
oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051.
Accessed October 13, 2008.
9.
Public Law 106-430. Needlestick Safety and Prevention Act. Available at:
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=106_cong_public_
laws&docid=f:publ430.106. Accessed October 13, 2008.
10. Association of periOperative Registered Nurses (AORN). AORN guidance
statement: The role of the health care industry representative in the perioperative
setting. Denver, CO: AORN, Inc.; 2008: 180-182.
11. American College of Surgeons (ACS). [ST-33] Statement on health care industry
representatives in the operating room. Available at: http://www.facs.org/fellows_
info/statements/st-33.html. Accessed October 13, 2008.
12. Association of periOperative Registered Nurses (AORN). Recommended practices
for the prevention of transmissible infections in the perioperative practice setting.
Denver, CO: AORN, Inc.; 2008: 619-629.
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