BLR’s Safety Training Presentations Bloodborne Pathogens 29 CFR 1910.1030 I. Speaker’s Notes: OSHA has regulated occupational exposure to bloodborne pathogens for several years. If it is possible that you could be exposed to blood or other potentially infectious materials, you need to be aware of this standard. This program is designed to make you aware of the regulatory requirements and help you make an informed decision on whether the standard applies to you.

Regulatory Requirements OSHA Standard 29 CFR 1910.1030 Covers all employers who require employees to perform duties that may expose them to bloodborne pathogens Requires a written exposure control plan (ECP) Requires specific training Requires specific recordkeeping I. Speaker’s Notes: It is important to remember that unless a company has required duties that may expose their employees to bloodborne pathogens, they are not required to have a written program. However, if it does apply to your company or facility, you must have a written exposure control plan as outlined in the Standard 29 CFR 1910.1030. Following implementation of the written plan, appropriate training must be conducted, and records associated with the program must be maintained.

Bloodborne Pathogens “Pathogenic microorganisms that are present in human blood and can cause disease in humans.” I. Speaker’s Notes: A bloodborne pathogen is defined as a pathogenic microorganism that is present in human blood and can cause disease in humans. Therefore, semen and some other body fluids are also known to carry BBPs. If blood is not present, bloodborne pathogens cannot be present. Remember, though, that sometimes the blood may be in microscopic quantities, difficult to see with the naked eye.

Pathogens of Primary Concern Hepatitis B Virus (HBV) Human Immune Deficiency Virus (HIV) I. Speaker’s Notes: These two viruses present very emotional issues, especially HIV, the virus that causes AIDS. Because we will not usually know upfront who has the virus(es), it is important that we minimize contact with blood-containing body fluids.

Ways to Reduce the Risk Engineering or work practice controls Use of personal protective equipment Training Medical surveillance Hepatitis B vaccinations Signs and labels I. Background for the Trainer Have on hand and show examples of available PPE at this time. II. Speaker’s Notes: There are several proactive ways to reduce the risk of exposure to bloodborne pathogens. If all or most of these methods are used, the likelihood of contracting a bloodborne virus is greatly reduced. Because of the nature of exposure incidents, it is imperative that you use the appropriate personal protective equipment, such as goggles, glasses or face shield, latex gloves, smocks or aprons, etc.

Definition of ‘Occupational Exposure’ “A reasonably anticipated skin, eye, mucous membrane or parenteral contact with blood or other potentially infectious material (OPIM) that may result from the performance of an employee’s duties” I. Speaker’s Notes: Keep in mind that for a company to be responsible for an exposure incident, the exposure must have resulted from the required duties performed within the company.

Definition of ‘Exposure Incident’ “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.” I. Speaker’s Notes: Just what is an exposure incident? OSHA defines it as “A specific eye, mouth, or other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that result from the performance of an employee’s duties.” Just because a person contacts body fluids containing blood does not mean it was an exposure incident. If precautions are taken, the PPE is not damaged (e.g., a hole in a glove), and there are no infiltrations of mucous membrane or open skin surfaces, it is not considered an occupational exposure.

Examples of Infectious Body Materials Blood Semen Vaginal Secretions Cerebrospinal Fluid Synovial Fluid Pleural Fluid Unfixed skin or tissue (living or dead) I. Speaker’s Notes: Here are examples of all body fluids that could be infected with BBPs. Should any of these fluids contain blood, they should be considered infectious, to avoid further risk. It is extremely dangerous to wait until after the fact and then wish appropriate protective measures had been taken.

Examples of Infectious Body Materials (cont.) Pericardial fluid Peritoneal fluid Amniotic fluid Saliva Cell or tissue cultures I. Speaker’s Notes: These are more fluids that may be infectious if contaminated with blood.

Treat all blood and body fluids as if they are contaminated! Rules to Live By Always follow universal precautions: Treat all blood and body fluids as if they are contaminated! I. Speaker’s Notes: The appropriate precautionary methods will enable a worker to avoid contact with infectious materials. By avoiding contact, there is no exposure, thus we can avoid contracting a bloodborne disease. Universal precautions means treating all body fluids as contaminated and, therefore, using personal protective equipment and other protective measures to ensure that contact with bloodborne pathogens is avoided.

Types of Facilities Covered Under the BBP Standard Health care Laboratories Medical and dental equipment service Infectious waste disposal Emergency response groups I. Speaker’s Notes: The dangers of bloodborne pathogens do not exist only in medical or patient care facilities. Any type of facility that may have potential exposures to bloodborne pathogens must be included in a written program. This slide lists several. The greatest potential is in industries such as health care; however, any of these have potential for exposures.

Elements of an Exposure Control Plan (ECP) General statement about the program Jobs expected to incur exposure Procedures for handling infectious materials Labeling system Availability of hepatitis B vaccination I. Speaker’s Notes: If there are potential exposures to bloodborne pathogens arising from an employee’s occupational duties, the employer must implement a written ECP—exposure control program. The elements listed on the next two slides are required by 29 CFR 1910.1030.

Elements of the ECP (cont.) Exposure records Training records Name of responsible person I. Speaker’s Notes: These are additional items that must be included in an ECP.

Regulated Waste Liquid or semi-liquid blood or OPIM (other potentially infectious materials) Contaminated items that would release blood or OPIM when compressed Items caked with dried blood or OPIM that are capable of releasing such Contaminated sharps Pathological and microbiological waste containing blood or OPIM I. Speaker’s Notes: As a rule of thumb, items such as band-aids or tissues that we would typically throw in the wastebasket are not regulated wastes unless it is a medical facility where the amount of this type of waste is extensive. Otherwise, unless you could literally “wring out” the blood, it would not be regulated biowaste. A good rule to follow is, when in doubt, treat it as regulated waste to avoid violating any Environmental Protection Agency laws for proper disposal of biohazard wastes. Make sure all sharps, including needles and broken glass, go in the appropriate sharps container to avoid contamination through impalement or laceration on the sharps.

Hepatitis B Vaccination Must be offered to all occupationally exposed employees Must be offered within 10 days of initial assignment Post-exposure evaluation and follow-up must be offered after exposure incident Must be provided at no cost to employees I. Speaker’s Notes: The hepatitis B vaccination is a series of three injections that is effective in preventing infection with hepatitis B. OSHA issued a letter of interpretation in 1994 that stated that employees exposed as a collateral duty can be offered the vaccinations on a “post-exposure” basis. If you decline the hepatitis B vaccination, you will be asked to sign a form that states you waived your opportunity to receive the vaccination.

Communication of Hazards Signs Labels Training I. Speaker’s Notes: Because you can never be sure when the next exposure incident will happen, it is important that a continual system to communicate hazards is in place. This includes signs with appropriate words of warning, labels with biohazard symbols, and any other appropriate visual warnings. You must also be trained in accordance with the regulatory requirements. This training must take place prior to working with potential exposures and at least annually thereafter.

Label Requirements Attached to containers of waste Attached to refrigerators or freezers containing blood or OPIM Attached to containers used to store transport, or ship blood or OPIM Labels must include universal biohazard symbol and the term “Biohazard” I. Speaker’s Notes: Any container that may store potentially infectious materials must be adequately labeled. Refrigerators should be labeled and employers must make certain that no food items are placed in refrigerators that contain biohazards. All wastes must be labeled in accordance with EPA requirements for biohazard wastes.

Recordkeeping Two types of records Medical records must include: Training Medical records must include: Employee name and SSN Hepatitis B vaccination status Post-exposure evaluation and follow-up results Health care professional’s written opinion Health care specific information I. Speaker’s Notes: All medical and training records related to bloodborne pathogens must be maintained. Medical records include physician’s evaluations of employees, exposure incident reports and medical follow-up. Training records should include all levels of training relative to bloodborne pathogens.

Recordkeeping (cont.) Training records must include: Training dates Contents of the training Name and qualifications of trainer Name of job titles of trainee I. Speaker’s Notes: It is important that the relevant records contain the appropriate information as documented in these two slides. Failure to document this information could result in possible fines for regulatory violations.

Record Retention Medical records must be kept confidential Medical records must be maintained for employment plus 30 years Medical records must be available to employees upon request Medical records must be available to authorized persons (e.g., OSHA, NIOSH) I. Speaker’s Notes: Record retention is a difficult task because of its complexity and the sheer volume of records that are generated throughout the years. It is a good idea to cycle records in accordance with these requirements so that the only records in your active files are those that meet the current regulatory requirements. For instance, since you have to keep training records for only three years, only have the last three years in the active file. A records retirement system should be established for records that are no longer active.

Record Retention (cont.) Training records must be kept for three years Medical and training records must be transferred to successor employers If no successor employer, current employer must notify the director of NIOSH I. Background for the Trainer: Keep in mind that if an existing company is sold, the records associated with bloodborne pathogens must be transferred to the successor employer. If a company is dissolved, make sure that NIOSH is contacted, so the appropriate records can be handled in accordance with recordkeeping requirements of the bloodborne pathogen standard.