THE OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) STANDARD Revised January 2011

 What is the bloodborne pathogens standard?  Who needs bloodborne pathogens (BBP) training?  What content needs to be included?

 Employers Duties  identify job risks and classify  provide appropriate training  provide exposure plan  provide appropriate equipment  Compliance  Employees Duties  follow employer’s plan  know job classification  complete training  use equipment provided by employer  Compliance

 Documents  General explanation of bloodborne pathogens  Hepatitis B immunization  Explanation of tasks that may involve exposure

 Disease-causing microorganisms that may be present in human blood or other potentially infectious material (OPIM)  Viruses – Hepatitis B (HBV), Hepatitis C (HCV), HIV  Bacteria - Syphilis  Parasites - Malaria

 Puncture wounds or cuts  Contact (touch, splash, or spray) with blood or OPIM on:  mucous membrane  non-intact skin  cuts, abrasions, burns  acne, rashes  paper cuts, hangnails  contaminated sharps

 Objective of BBP standard is to minimize or eliminate the hazard posed by work that may expose one to blood or OPIM  Effectively treat employees involved in an exposure to BBP

 If an exposure occurs one should know:  Is there a way to prevent infection  What are signs & symptoms of infection  availability of counseling  availability of post-exposure treatment & follow-up

 Occupational contact with blood or OPIM is considered an exposure incident  If an exposure occurs:  wash with soap & water  report incident  document incident  seek “immediate” medical evaluation  follow employer’s exposure control plan

 “Immediate” means prompt medical evaluation and prophylaxis  An exact timeline cannot be stated  Time limits on effectiveness of prophylactic measures vary depending on the infection of concern

 Date and time of incident  Job classification  Location in the worksite where incident occurred  Work practice being followed  Engineering controls in use  Procedure being performed  PPE in use Minimal Information to Report

 Entitled to confidential medical evaluation  Personal decision about blood testing  Blood may be tested only with consent  Blood may be stored for 90 days, while considering testing  Interpretation of any test results occurs with health care provider

 Blood may be tested for antibodies to:  Human Immunodeficiency Virus (HIV)  Hepatitis C Virus (HCV)  Hepatitis B Virus (HBV)  Other disease-causing organisms  Source blood may also be tested with consent  Results of tests of source blood will be made known to exposed person

 Definition  Signs and symptoms  Course of infection  Prevention and control  Post-exposure prophylaxis and follow-up care

 HBV is Hepatitis B Virus  It is a virus which affects the liver  Highest rate of disease in persons years of age  HBV carriers are people infected who never fully recovered.  30-40% of people with acute HBV have no idea how or when the became infected  HBV very durable, can survive in dried blood for up to 7 days

 Jaundice - yellow color to the skin and whites of eyes  Fatigue  Abdominal Pain  Loss of appetite  Nausea and vomiting  Joint pain  30% of infected persons have no signs & symptoms

 Incubation period ranges from a few weeks to several months  Some cases of HBV resolve without complications  Chronic liver disease may occur in 6 to 7% of those infected with HBV

 A vaccine does exist to prevent HBV infection  Employers are required to offer HBV vaccination to employees covered under BBP standard  Follow Universal Precautions any time you are dealing with blood or body fluids

 No cure for HBV infection  Post-exposure prophylaxis should begin within 24 hours; no later than 7 days after exposure  Unvaccinated exposed person should receive HBV vaccine  Treatment requires health care provider  OSHA requires treatment meet CDC’s most recent guidelines  HBV infection treatment may require liver transplant

 Employees with routine occupational exposure to blood/OPIM have the right to Hepatitis B vaccination at no personal expense  Employee refusal established by signing Hepatitis B vaccination declination form  Must be made available within 10 working days of initial assignment to job

 Vaccine given in 3 dose series over 6 months  1st - on initial assignment  2nd - 30 days later  3rd - 6 months after 1st dose  CDC recommends HBVantibody testing 1 to 2 months following 3rd dose  Employer cannot require employee to use health insurance to cover test cost  Pre-screening is not required  HBV is declining because of vaccine use!

 HCV is Hepatitis C Virus  There is no vaccine to prevent HCV  It infects liver cells resulting in acute & chronic liver disease  An estimated 3.9 million Americans have been infected with HCV  Up to 10,000 people per year die from HCV

 Jaundice - yellow color to skin and whites of eyes  Fatigue  Dark Urine  Abdominal Pain  Loss of appetite  Nausea

 Incubation period averages 6 to7 weeks  Chronic liver disease may occur in 70% of those infected with HCV  Transmission occurs when blood or body fluids from an infected person enters the body of a non -infected person  HCV is spread through sharing needles when using drugs, needle sticks or sharps exposures on the job or from an infected mother to baby during birth

 Please note: there is NO vaccine available to prevent HCV infection  HCV infection in workers is best prevented by following Universal Precautions  Do not shoot drugs  HCV may be spread by sex, but this is rare  Do not share personal care items  Toothbrushes  Razors  Nail clippers

 No cure for HCV  No post-exposure pro- phylaxis recommended  Tests for HCV anti-bodies & liver function recommended at time of exposure  Tests should be repeated 4-6 months post exposure  Treatment of HCV requires a health care provider  OSHA requires treatment that meets most recent CDC guidelines  HCV infection treatment may include liver transplant

 HIV is Human Immunodeficiency Virus  HIV can cause acquired immune deficiency syndrome (AIDS)  Risk of HIV infection from a puncture injury or cut exposure to HIV infected blood is very low - 0.3% (1/300 )  Stated another way, 99.7% of needlestick/cut exposures do not lead to infection

 Signs and symptoms include:  Weight loss  Night sweats or fever  Gland swelling or pain  Muscle and/or joint pain  Flu-like symptoms  Cannot rely on signs and symptoms to confirm if one is infected

 HIV infection progresses in stages  Course of infection varies from person to person  Acute seroconversion may occur 6-12 weeks after exposure  Progressive disease in untreated persons is characterized by a steady decline in specific white blood cell counts  Increased susceptibility to infections

 NOTE : There is NO vaccine to prevent HIV infections  HIV infection in workers is best prevented through following Universal Precautions  Post-exposure prophylaxis with anti-viral medication can reduce risk of infection

 No cure for HIV infection  Testing schedule for HIV antibodies  at time of exposure  at 3 months  at 6 months  HIV antibodies usually become detectable within 3 months of infection  Treatment requires health care provider  OSHA requires treatment that meets most recent CDC guidelines  Treatment may include antiviral medications and a protease inhibitor

Average Risk from a single needle stick  HBV: 30% (unless vaccinated)  HCV: 1-3%  HIV: 0.3% Average risk from mucous membrane exposure  HBV: 10% (unless vaccinated)  HCV: 1%  HIV: 0.1%

 Engineering Controls  Work Practice Controls  Personal Protective Equipment  Universal Precautions

 Design safety into work tools and work space organization  Engineering controls can:  Decrease risk of exposure to hazards  Eliminate hazards  Isolate hazards

 Hand and eye washing facilities  Sharps container use  Biohazard labeling  Self-sheathing needles  Needleless IV systems

 Label liquid or semi-liquid blood or OPIM  Label item(s) contaminated with blood or OPIM  Label sharps contaminated with blood or OPIM  Label containers holding contaminated equipment for storage, handling and transport

 closable and puncture resistant  leak proof  labeled or color coded  functional  sufficient in number  easily accessible and maintained in upright position  replaced per agency policy  NOT be overfilled

 Reusable sharps require proper handling (mechanical means) and decontamination  Retractable needles  Needleless systems

 Behaviors using engineering controls safely and effectively  Work Practice Controls include:  using sharps containers  using an eyewash station  WASHING HANDS after using PPE  cleaning work surfaces  proper laundering

 break, shear, bend or recap needles  reach into used sharps containers  pick up contaminated items, such as broken glass with bare hands  use a vacuum cleaner to clean up contaminated items  open or empty sharps containers  pipette or mouth suction blood or OPIM  store beverages or food in refrigerators, freezers, or cabinets where blood or OPIM are present  eat, drink, smoke, apply cosmetics, or handle contact lenses in areas of potential occupational exposure

 Readily available facilities  Washing after removing PPE  Using antiseptic hand cleanser when a sink isn’t readily available

 First roll out paper towel or have towel readily available so as not to touch other surfaces to reach it

 Turn on tap water and adjust temperature  Use plenty of soap

 Wash hands using friction on all surfaces for at least 30 seconds  Sing happy birthday to yourself twice = 30 seconds

 Dry hands thoroughly  DO NOT turn off the water yet

 Turn off tap with a dry part of the towel  DO NOT touch surfaces with clean hands

 Clean work surfaces according to employer’s exposure control plan  Use PPE and EPA-approved solution  10% bleach and water must be replaced weekly  Place contaminated laundry in color-coded laundry bag, use PPE, and handle as little as possible  DO NOT take contaminated materials home to launder

 Specialized clothing/equipment used for protection when risk of exposure exists  Must prevent blood or OPIM from contaminating clothing or skin  Must be available at no cost to employee  Must be in appropriate sizes  Must be in good working condition  Must be properly maintained  Employee must be trained in proper use

 Gloves  Masks  Eye shields  Gowns/aprons  Resuscitation devices

 Medical products containing latex must be labeled  Allergies to latex are increasing  Substitutes for latex-containing materials must be made available

 Universal Precautions is a method of infection control in which All blood and body fluids is treated as if infectious for HIV, HBV, HCV or other bloodborne pathogens

Universal Precautions always applies to:  Blood  Semen  Vaginal secretions  Cerebrospinal, synovial or pleural fluid  Body fluids containing visible blood  Any unidentifiable body fluid  Saliva from dental procedures

Bloodborne pathogen transmission is unlikely from contact with lower-risk body fluids, such as  Feces  Nasal secretions  Sputum  Tears  Urine  Vomit However, Universal Precaution still applies

 Site specific plan provided by employers to protect employees with occupational exposure risk  Lists job classifications with exposure risk  Identifies engineering controls, work practice controls, PPE and Universal Precautions  Identifies who will be trained and trainer  Includes record keeping provisions and is reviewed annually

 CDC website for Infection Control in Healthcare Settings:  Occupational Safety and Health Administration rules 29 CFR  A “Bloodborne Pathogens” training resource page: l_safety/bbp/index.cfm l_safety/bbp/index.cfm