Occupational Safety and Health Administration OSHA Occupational Safety and Health Administration

OSHA Establishes and enforces standards that protect workers from job-related illness and injuries.

OSHA STANDARDS The Occupational Exposure to Hazardous Chemicals Standard The Blood borne Pathogen Standard

The Occupational Exposure to Hazardous Chemicals Standards Requires the employers to inform employees of all chemicals and hazards in the workplace Must provide the MSDSs (Material Safety Data Sheets)

MSDSs provide Product identification information about the chemical Protection or precautions that should be used while handling the chemical Instructions for safe use of the chemical Procedures for handling spills, clean-up, and disposal Emergency first-aid procedures

Mandated training for MSDSs proper procedure and policies Identifying the types of chemicals Locating and using the MSDS manual Reading and interpreting chemical labels and signs Locating cleaning equipment and use of PPE (personal protective equipment) goggles, mask, gowns Reporting accidents and exposures

BLOODBORNE PATHOGEN STANDARD Protects health care providers from diseases caused by exposure to body fluids (i.e.. stool, urine, semen, salvia, mucus)

Bloodborne Pathogens Pathogenic micro- organisms present in human blood that can lead to diseases Human immuno- deficiency virus (HIV) Hepatitis B (HBV) Hepatitis C (HCV)

Other Bloodborne Pathogens Syphilis Malaria Brucellosis Babesiosis Leptospirosis Arborviral Infections Relapsing Fever Creutzfeld-Jacobs Disease--Mad-cow Viral Hemorrhagic Fever--Ebola

Potentially Infectious Materials –All Can Transmit Hepatitis B, C, and HIV Blood Semen Vaginal secretions Cerebrospinal fluid Pleural fluid Pericardial fluid Peritoneal fluid Amniotic fluid Saliva in dental proc. Any visibly contaminated body fluid Any body fluid where differentiation is difficult Any unfixed tissue or organ Aqueous and vitreous humors in the eyes

Other Body Fluids These body fluids do NOT have enough virus in them to transmit disease UNLESS they are contaminated with blood Urine Feces Tears Sweat Vomitus Spit

Modes of Transmission Stick or Cut Splash to mucous membranes of the eyes, nose, mouth Non-intact skin exposure

Universal Precautions Must be observed All blood and body fluids are treated as if known to be infected with HIV, HBV, HCV, etc. Do not come into contact with another person's blood or body fluids

Exposure Control Plan Employer's plan describing how compliance with the standard is achieved Describes what employees are covered Describes tasks that are covered Describes post-exposure follow-up procedures Must be reviewed and updated annually Must be accessible to employees Every employee should know the procedure to follow to obtain a copy

Exposure Control Plan Safer Medical Devices The Exposure Control Plan must be updated every 12 months to reflect evaluation, consideration, and selection of appropriate devices Document in the plan the devises evaluated and those currently used Front line employees must be involved in the selection of devices

Handwashing The single most important aspect of infection control Wash hands when contaminated with blood or body fluids and after removing personal protective equipment Use antiseptic hand cleaner clean paper/cloth towels or antiseptic towelettes when "in the field" Wash hands with soap and water asap

Needles/Sharp Objects Use sharps with sharps injury prevention or needleless systems for all procedures involving sharps Place in puncture resistant, labeled, leak-proof containers for transport, storage, and/or disposal Keep the container closed Do not bend, break, recap, or remove needles Do not pick up contaminated broken glass directly with the hands Do not reach by hand into containers where contaminated sharps are placed Do not overall sharps containers

Eating/Drinking Do not eat or drink in areas where there is exposure to blood or body fluids Do not store food in refrigerators, freezers, cabinets, on shelves or countertops where blood or other body fluids are present

Personal Protective Equipment (PPE) Wear PPE to prevent blood or body fluids from getting on your clothes, skin, underclothes, etc. Must be provided at no cost to the employee Employer must enforce the use Must be removed prior to leaving the work area and placed in designated area

PPE Parental exposure Mucous membrane Non-intact skin gloves gowns stick or cut Mucous membrane splash Non-intact skin spill or splash gloves gowns glasses/ goggles masks pocket masks shoe covers

Decontamination Clean and decontaminate all equipment and environmental and working surfaces after contact with blood and/or body fluids Decontaminate with appropriate disinfectant EPA registered tuberculocidal disinfectant EPA registered disinfectant with label stating it is effective against HIV and HBV Household bleach, diluted 1:10-1:100, made fresh daily

Contaminated Laundry Remove contaminated clothing when it becomes contaminated Place immediately in bag or container that is labeled Prevent leakage

Regulated Waste Sharps containers Red bags Needles Blades Broken glass Liquid or semi-liquid blood or OPIM Items caked with dried blood or OPIM Items that could release blood or OPIM Pathological waste Microbiological waste

HEPATITIS Hepatitis A HAV most common transmitted by feces, salvia, and contaminated food. Vaccine available Hepatitis B “serum hepatitis” is caused by HBV and is transmitted by blood, serum, and other body secretions. It affects the liver and cause scarring and destruction of liver cells. Infectious for life and vaccination available. Can cause liver cancer. Some people never have any sign and symptoms but are infectious.

Hepatitis C caused by hepatitis C virus or HCV and is transmitted in blood and blood containing body fluids. 50% of people infected develop chronic hepatitis. Maybe present for years before patient is aware of it while destroying the liver. Leading cause for liver transplant. Hepatitis D is like A but not prevalent in this country

Signs and Symptoms May mimic the flu Fatigue Malaise Headache Sore throat Sensitivity to light Cough Nausea Vomiting Jaundice stage dark color urine, clay colored stool, and skin is yellow

PREVENTION FOR HEALTHCARE WORKERS Vaccination for A and B Use standard precautions Pay close attention to sharps Do not use illegal drugs Practice safe sex

Hepatitis B Vaccination the HBV vaccination must be offered after the employee has received training and within 10 working days of job assignment At no cost Provided by PLHCP According to US Public Health Service most current recommendations “Immunization of Health Care Workers: Recommendations of ACIP and HICPAC,” MMWR, Vol. 46, No. RR-18

HBV Vaccination Employees who do not take the shots must sign a declination statement Highly recommended Few contraindications Three-shot series—titer 1-2 months after last shot No booster currently recommended Each person must have a health care professional's written opinion A copy must be provided to the employee within 15 days of completion of the evaluation An employee can decline now, take the shots later

Written Opinion Each person must have a health care professional's written opinion for hepatitis B vaccination A copy must be provided to the employee within 15 days of completion of the evaluation

AIDS Acquired immunodeficiency syndrome is a worldwide epidemic caused by human immunodeficiency virus (HIV). Must have an HIV blood test performed to know if HIV positive. Attacks the immune system Spread thru :sexual secretions, blood, or from mother to fetus during pregnancy, sharing intravenous needles. CANNOT GET thru: casual contact, sharing toilet, telephones, closed mouth kissing, mosquitoes, or tattooing. Not everyone who comes in contact with will become infected.

Disease progression Determined by the effect of the virus on the protective white cells known as CD4 (T cells). When number drops below 200cells/mm3 person diagnosed with AIDS Symptoms: acute flulike, fever, night sweats, fatigue, swollen lymph nodes, sore throat

Post-Exposure Follow-up After exposure incident Stick or cut Splash Non-intact skin exposure At no cost Begin ASAP after exposure incident Report exposure incident to your supervisor or designated personnel immediately

Post-Exposure Follow-up Investigation of the incident ID source individual, obtain consent, and test their blood to determine HBV, HCV, and HIV infectivity ASAP Results of source individual's test given to exposed person Obtain and test exposed person's blood for HBV, HCV, and HIV serological status

Labels Containers with contaminated items Can substitute red

Training For all employees listed in the Exposure Determination At no cost to employees During working hours At the time of initial assignment Annually--within 1 year of last training date Must be opportunity for interactive questions and answers Train employees on adopted safer needle devices before implementation

Training Five Easy Questions What is universal precautions? What do you do when there is a blood spill? Personal protection Clean-up and disposal procedures Disinfection (hazard communication applies) What do you do with contaminated sharps and laundry? Have you been offered the HBV vaccination free of charge? Where is the Exposure Control Plan?

Additional Training Copy of the BBP standard, 29 CFR 1910.1030, must be accessible to you Explanation of methods of recognizing tasks that may involve exposure to blood and/or body fluids Information on types, use, location, removal, handling, decontamination, and disposal of ppe Basis of selection of ppe Actions to take and persons to contact in a bloodborne emergency that you do not know how to handle Procedure to follow if exposure incident occurs Opportunity for interactive Q & A

Records Medical records Name and social security number HBV vaccination status Results of exposure incident follow-up Health care professional's written opinions Info provided to health care professional Confidential

Records Training Dates Contents Names and qualifications of trainers Names and titles of persons attending

Records Sharps Injury Log Per the Tennessee Sharps Injury Prevention law Keep a log of all sharps injuries with Type and brand of device involved in the incident Department or work area where the incident occurred Explanation of how the incident occurred

Resources www.osha.gov www.tennessee.gov/labor-wfd/tosha www.cdc.gov www.cdc.gov/niosh Memphis Office 901-543-7259 Jackson Office 701-423-5641 Nashville Office 615-741-2793 1-800-249-8510 Knoxville Office 865-594-6180 Kingsport Office 423-224-2042 Chattanooga 423-634-6424 Consultative Services 1-800-325-9901