Infection Control, DA103 Bloodborne Pathogens Standard 1991

Key Federal Agencies Involved OSHAregulates and passes laws to protect employees Occupational Safety and Health Administration CDCrecommends guidelines for infection control Centers for Disease Control FDAregulates medical and dental device manufacturers Food and Drug Administration EPAregulates actions and materials that affect the environment Environmental Protection Agency

The beginnings… Early 1980’s Infection control focused on protecting patient from hospital- acquired infections Little or no emphasis on healthcare workers AIDS epidemic Led to awareness of transmission of Bloodborne Pathogens HBV was actually higher occupational risk to healthcare workers CDC’s Guideline for Infection Control in Hospital Personnel 1983 First protocols designed to protect healthcare workers

Later… Mid-1980’s Various healthcare worker groups petitioned OSHA to take action by creating formal laws to Reduce risk to employees from exposure to various infectious agents Protect employees from occupational exposure to HBV Environmental Protection Agency (EPA) (1989) Rules about tracking and managing medical wastes

Finally! 1991 OSHA published “Occupational Exposure to Bloodborne Pathogens Standard” To eliminate or minimize occupational exposure to HBV, HIV, and other bloodborne pathogens effective in March CDC revised Guidelines for infection control in healthcare personnel to include methods to reduce transmission of infections from patient to healthcare personnel and from personnel to patients. Advancements in Healthcare Technology Food and Drug Administration (FDA) regulates medical and dental devices 2001 OSHA published Needlestick Safety and Prevention Act

Who is affected by OSHA’s Bloodborne Pathogens Standard? Any type of facility in which employees might be exposed to blood and other body fluids Dental and medical offices Hospitals, emergency medical services, nursing homes Funeral homes Some states also have their own specific OSHA regulations Must be at least as strict as the Federal regulations

Examples of Bloodborne Pathogens Known to be in blood: HBV (Hepatitis B) HCV (Hepatitis C) Other Non-A, Non-B Hepatitis (Hepatitis E) HIV (Human Immunodeficiency Virus) Other potentially infectious material (OPIM) Saliva and other body fluids which might contain blood

Major Provisions Exposure Control Plan (ECP) Engineering and Work Practice Controls - Personal Protective Equipment (PPE) Vaccination, Post-Exposure Follow-up Labeling and Training Recordkeeping

Exposure Control Plan written action plan to minimize potential occupational exposures to infectious microorganisms specific to the individual place of employment Includes Exposure determination Details “infection control procedures” Administrative steps Implementation date Recordkeeping (employee training and medical) Training

Exposure Determination made without regard to use of PPE 1. List of job classifications where all employees have exposure potential. Category I Dentist, dental hygienist, dental assistant HIGH RISK 2. List of job classifications where some employees have exposure. Category II Office staff who may help out in clinical area INTERMEDIATE RISK 3. List of job classifications which have NO exposure. NO RISK (financial secretary, insurance secretary)

Compliance includes Universal Precautions work practices which require everyone to assume that all blood and body substances are potential sources of infection, independent of perceived risk. Engineering Controls devices that remove the exposure hazard from the workplace. Work Practice Controls altering the manner in which a task is performed to reduce risk of exposure to bloodborne pathogens

Universal Precautions Not possible to identify individuals who are infectious Same precautions used for all patients

Engineering Controls Sharps containers Readily accessible – kept in or near work area Puncture resistant / leak-proof Labeled or color coded biohazardous waste Ability to close Replaced as soon as full – no pushing down to make more room What items go into a sharps container? Burs, scalpels, matrix bands, wires Other examples of engineering controls are Eyewash Stations Ultrasonic Cleaner Needle Recapping Device

Work Practice Controls Hand washing One handed scoop (needle recapping) No eating, drinking or smoking in clinical area Minimize spatter: Using suction Dental Dams Proper waste disposal methods Bloody gauze, tissue specimens, extracted teeth Specimens in a leak proof container (biopsy tissue) Decontaminate equipment before shipping or servicing; if not possible, label item as a biohazard Use of PPE

Compliance also involves: House keeping: Written schedule for cleaning and disinfections Contaminated surfaces and equipment must be cleaned at once Use protective barriers whenever possible Regulated containers of disposable infectious hazardous waste Must be closeable and leak proof Must be labeled and color coded (red, biohazard) Must be placed in a secondary container (must also be labeled) Dispose according to state regulations Medical or hazardous waste hauler, must be a hired, contracted company

Additional Compliance Methods: Laundry: Employee does NOT take laundry home This is the employers responsibility Handling should be kept to a minimum Transport in labeled or color coded bags Can be washed on site (using PPE) or by a professional service

Vaccinations and Post-exposure Follow-up Hepatitis B vaccination: Recommended for all healthcare workers 3 injections: 1 st, 2 nd one month after, 3 rd five months after first injection Note: some people do not respond to first series and must have a second series of injections; if those don’t “take”, they probably have a natural immunity Employer must offer vaccination series within 10 days of employment; must pay for the series Employee can refuse to have the series, but may be asked to sign a declination waiver Employee can change mind and have vaccination series at a later time If CDC determines that a booster injection is recommended (in the future) the employer must also make that available to the employee

Why HBV? Virus transmitted in blood Healthcare workers are at high risk to exposure In 2005, about 51,000 people became infected with HBV People who are infected with HBV can spread it to others, even if they don’t appear sick. About 5-10% become “carriers” Acute (short-term) illness. Flu-like symptoms OR no symptoms Seem to recover but actually develop … Chronic (long-term) infection. liver damage (cirrhosis) liver cancer death Each year about 3,000 to 5,000 people die from cirrhosis or liver cancer caused by HBV.

Post-Exposure Follow-up After you complete this lecture, please read the article entitled: Steps to Follow After a Stick Incident and answer the questions for credit

Sharps Injuries All sharps injuries must be recorded in a Sharps Injuries Log Used to help employer and staff determine situations where sharps injuries might occur AND to make engineering and work practice control changes to prevent injuries Sharps injuries can be greatly reduced with a no-recapping policy for needles Needle re-capping is allowed in dental offices but we must use proper precautions, such as recapping devices

Labeling and Training Labels: Biohazard: symbol and words must be visible Fluorescent orange or orange red in color Red bags or containers substitute for labels Labels must be placed on: Regulated waste (gauze, teeth, tissue, etc) Refrigerators or freezers with OPIM or blood inside Transport or storage containers Contaminated equipment

Information and Training: Includes all employees with possible occupational exposure (full time, part time, temps, and students) New employees must train within 10 days of start date Entire staff annually (at least) Additional training when tasks modified or new ones added Questions and answer period should be included Review all of the Bloodborne Pathogens Standard Document training, and keep it for 3 years Date, trainer, who attended and subjects covered

Record-keeping Medical Records: Kept on each occupational exposed : Vaccination status and dates Any post-exposure documentation Must be kept separate and confidential Maintain for 30 years after employment ends Training Records Documentation of dates, trainer, who attended, subject matter Maintain for 3 years

Employee Responsibility: Cooperate and follow office policies Training Universal Precautions Use PPE Use safe work practices and engineering controls Report unsafe situations to employer Keep work area neat and clean Know your job classifications and risks Get immunized against HBV, if you are able to