1. 1 Blood-Borne Pathogens 29 CFR 1910.1030 (Subpart Z) Bureau of Workers’ Comp PA Training for Health & Safety (PATHS) PPT-003-02

2. 2 Introduction Approximately 5.6 million workers are at risk of exposure to blood-borne pathogens. These include: Human Immunodeficiency Virus, or HIV (the virus that causes AIDS) Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) Those at risk include health care, emergency response/public safety and other workers. PPT-003-02

3. 3 Definitions Blood-borne pathogens are pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus, or HBV, and human immunodeficiency virus, or HIV. Occupational exposure - Reasonably anticipated skin, eye, mucous membrane or parenteral contact with blood or other potentially infectious materials, or OPIM, that may result from the performance of an employees’ duties. PPT-003-02

4. 4 OSHA Training Requirements Make accessible the regulatory text of the standard Explanation of its contents. General discussion on blood-borne diseases and their transmission Explanation of the exposure control plan and how to obtain a copy. Tasks and other activities that may involve exposure Exposure Control Plan PPT-003-02

5. 5 OSHA Training Requirements (cont.) Engineering and work practice controls and personal protective equipment Information on the hepatitis B vaccine Response to emergencies How to handle exposure incidents The post-exposure evaluation and follow-up program Signs/labels/color coding PPT-003-02

6. 6 Human Immunodeficiency Virus (HIV) HIV is the virus that leads to acquired immunodeficiency syndrome, or AIDS. It destroys the body's ability to fight infections and certain cancers. The body also becomes susceptible to opportunistic infections caused by microbes such as viruses or bacteria that usually do not make healthy people sick. PPT-003-02

7. 7 Human Immunodeficiency Virus (cont.) HIV is spread by contact with any of the following bodily fluids: Blood Semen Vaginal secretion Breast milk Contact with saliva, tears or sweat has not been shown to result in the transmission of HIV. PPT-003-02

8. 8 Hepatitis B (HBV) Disease caused by a virus that attacks the liver caused by the Hepatitis B virus, or HBV Occurs when blood from an infected person enters the body of a person who is not infected Symptoms include: jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea, vomiting PPT-003-02

9. 9 Hepatitis B (HBV) May lead to chronic liver disease, liver cancer, and death HBV can survive for at least one week (7 days) in dried form Vaccination available since 1982 PPT-003-02

10. 10 Hepatitis C (HCV) Disease of the liver caused by the Hepatitis C virus, or HCV Hepatitis C is the most common chronic blood- borne infection in the United States Occurs when blood from an infected person enters the body of a person who is not infected PPT-003-02

11. 11 Hepatitis C (HCV) Symptoms include: jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting May lead to chronic liver disease and death There is no vaccine to prevent Hepatitis C PPT-003-02

12. 12 Potentially Infectious Bodily Fluids Blood Saliva, vomit, urine Semen or vaginal secretions Skin, tissue, cell cultures Other bodily fluids “Universal precautions” assume that all bodily fluids are contaminated with infectious blood. PPT-003-02

13. 13 Transmission Contact with another person’s blood or bodily fluid Mucous membranes (eyes, mouth, nose) Non-intact skin Open sores Cuts Abrasions Acne Any sort of damaged or broken skin such as sunburn or blisters Cuts from contaminated sharps (needle sticks, scalpels, broken glass, etc.) PPT-003-02

14. 14 Not Transmitted There are also many ways that blood-borne pathogens are not transmitted. Touching an infected person Coughing or sneezing Using the same equipment, materials, toilets, water fountains or showers PPT-003-02

15. 15 Who is covered by the standard? All employees who could be “reasonably anticipated” to face contact with blood and other potentially-infectious materials as a result of performing their job duties. “Good Samaritan” acts, such as assisting a co- worker with a nosebleed, would not be considered occupational exposure. PPT-003-02

16. 16 Potential Exposure Identify jobs, tasks and activities that could expose employees to potentially-infected blood or bodily fluids, such as: Industrial accident Administering first aid Post-accident cleanup Janitorial or maintenance work Cleaning up urine, vomit, etc. Plumbing repairs PPT-003-02

17. 17 OSHA’s BBP Standard Protects employees at risk of exposure to Blood Other potentially-infectious materials Requires employers to develop a written exposure control plan. Identify potential exposure and define work practices for preventing exposure Provide training to employees Protect the health and safety of their workers PPT-003-02

18. 18 Exposure Control Plan Blood-borne Pathogens Standard Model Exposure Control Plan http://www.osha.gov/Publications/osha3186.html PPT-003-02

19. 19 Exposure Control Plan (cont.) Describes how the employer will: Use engineering and work practice controls Ensure use of PPE Provide training Provide medical surveillance Provide hepatitis B vaccinations Use signs and labels PPT-003-02

20. 20 Exposure Control Plan (cont.) Accessible to employees Review and update at least annually Reflect changes in technology Document annually consideration and implementation of appropriate commercially available and effective safer medical devices Solicit input from non-managerial employees PPT-003-02

21. 21 Some Workers Who are at Risk Physicians, nurses Orderlies, housekeeping personnel and laundry workers Dentists and other dental workers Laboratory and blood-bank technicians Medical examiners Morticians PPT-003-02

22. 22 More Workers Who are at Risk Law-enforcement personnel Firefighters Paramedics and EMTs Anyone providing first-response medical care Medical waste treatment employees Home health care workers PPT-003-02

23. 23 Who should be trained? All employees with occupational exposure to blood or other potentially-infectious material, or OPIM Employees who are trained in first aid and CPR PPT-003-02

24. 24 When should employees be trained? At the time of initial assignment to a job with occupational exposure; annually thereafter Additional training needed when existing tasks are modified or new tasks included Maintain training records for three years PPT-003-02

25. 25 Methods of Compliance Universal precautions Engineering and work practice controls Personal protective equipment, or PPE Appropriate housekeeping measures PPT-003-02

26. 26 Definitions Universal precautions is an approach to infection control. All human blood and certain human bodily fluids are treated as if known to be infectious for HIV, HBV and other blood-borne pathogens. Work Practice Controls means 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 two-handed technique). PPT-003-02

27. 27 Universal Precautions Treat all human blood and certain bodily fluids as if they are infectious. Must be observed in all situations where there is a potential for contact with blood or other potentially-infectious materials. PPT-003-02

28. 28 Engineering and Work Practice Controls These are the primary methods used to control the transmission of HBV and HIV. When occupational exposure remains after engineering and work practice controls are put in place, personal protective equipment, or PPE, must be used. PPT-003-02

29. 29 These controls reduce employee exposure by either removing the hazard or isolating the worker. Examples: Engineering Controls Sharps disposal containers Self-sheathing needles Safer medical devices Needleless systems Sharps with engineered “sharps injury protections” PPT-003-02

30. 30 Safer Medical Devices Needleless systems: A device that does not use needles for the collection or withdrawal of body fluids or for the administration of medication or fluids. Sharps with engineered sharps injury protections: A non-needle sharp or a needle device used for 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. PPT-003-02

31. 31 Work Practice Controls Reduce the likelihood of exposure by altering how a task is performed. Examples: Wash hands after removing gloves and as soon as possible after exposure Do not bend or break sharps No food or smoking in work areas PPT-003-02

32. 32 Personal Protective Equipment Personal protective equipment, or PPE, is 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. PPT-003-02

33. 33 Personal Protective Equipment ( cont.) Must be properly cleaned, laundered, repaired and disposed of at no cost to employees. Must be removed when leaving area or upon contamination. PPT-003-02

34. 34 Personal Protective Equipment (cont.) Gloves Gowns Face shields Eye protection Mouthpieces and resuscitation devices PPT-003-02

35. 35 Personal Protective Equipment (cont.) Bleeding control—latex gloves (Latex, nitrile, rubber or other water-impervious materials). Double gloving can provide an additional layer of protection. Spurting blood—latex gloves, protective clothing (smocks or aprons), respiratory mask, eye/face protection (goggles, glasses, or face shield). PPT-003-02

36. 36 Types of Controls Engineering Controls Work Practice Controls Controls that isolate or remove the blood-borne pathogens hazard from the workplace. Controls that reduce the likelihood of exposure by altering the manner in which a task is performed. Examples: Sharps disposal containers, self-sheathing needles, safer medical devices. Example: Prohibiting recapping of needles by a two-handed technique. PPT-003-02

37. 37 Housekeeping Clean and decontaminate all equipment after contact with blood or other potentially-infectious materials. Contaminated work surfaces, such as counters, fume hoods or biosafety cabinets, should be decontaminated with an appropriate disinfectant as follows: After completing procedures Immediately, or as soon as possible, if they are heavily contaminated At the end of the work shift PPT-003-02

38. 38 Regulated Waste Must be placed in closeable, leak-proof containers built to contain all contents during handling, storing, transporting or shipping and be appropriately labeled or color coded. PPT-003-02

39. 39 Laundry Handle contaminated laundry as little as possible and use PPE Must be bagged or containerized at location where used No sorting or rinsing at location where used Must be placed and transported in labeled or color-coded containers PPT-003-02

40. 40 Hepatitis B Vaccination Requirements Must make available, free of charge and at a reasonable time and place, to all employees at risk of exposure within 10 working days of initial assignment unless: Employee has had the vaccination Antibody testing reveals immunity The vaccination must be given by a licensed health care professional. PPT-003-02

41. 41 Hepatitis B Vaccination Requirements (cont.) Must be provided even if employee initially declines but later decides to accept the vaccination. Employees who decline the vaccination must sign a declination form. Employees are not required to participate in antibody prescreening program to receive vaccination series. Vaccination booster doses must be provided if recommended by the U.S. Public Health Service. PPT-003-02

42. 42 Response to Emergencies Involving Blood or Bodily Fluids Wear appropriate personal protective equipment, or PPE. Cover the spill with an absorbent material. Decontaminate the area of the spill. Wait 10 minutes to ensure adequate decontamination and then carefully wipe up the spilled material. PPT-003-02

43. Response to Emergencies Involving Blood or Bodily Fluids Be alert for broken glass or sharps in or around the spill. Disinfect all mops and cleaning tools after the job is done. Dispose of all contaminated materials appropriately. Wash your hands thoroughly with soap and water. 43PPT-003-02

44. 44 What to do if an Exposure Occurs? Wash exposed area with soap and water. Flush splashes to nose, mouth or skin with water. Irrigate eyes with water or saline. Report the exposure. Direct the worker to a health care professional. PPT-003-02

45. 45 Post-Exposure Follow-Up Document routes of exposure and how exposure occurred. Record injuries from contaminated sharps in a sharps injury log, if required. Obtain consent from the source individual and the exposed employee and test blood as soon as possible after the exposure incident. PPT-003-02

46. 46 Post-Exposure Follow-Up (cont.) Provide risk counseling and offer post-exposure protective treatment for disease when medically indicated. Provide written opinion of findings to employer and copy to employee within 15 days of the evaluation. PPT-003-02

47. 47 Biohazard Warning Labels 1910.1030(g)(1) Warning labels required on: Containers of regulated waste. Refrigerators and freezers containing blood and other potentially-infectious materials. Other containers used to store, transport or ship blood or other potentially-infectious materials. Red bags or containers may be substituted for labels. PPT-003-02

48. 48 Medical Recordkeeping Requirements Employee’s name and Social Security Number. Employee’s Hepatitis B vaccination status. Results of examinations, medical testing and post-exposure evaluation and follow-up procedures. Health care professional’s written opinion. PPT-003-02

49. 49 Medical Recordkeeping Requirements (cont.) Information provided to the health care professional. Employee medical records must be kept confidential and not reported without the employee’s written consent (unless required by law). Maintained for duration of employment plus 30 years, according to OSHA’s rule governing access to employee exposure and medical records. PPT-003-02

50. 50 Sharps Injury Log Employers must maintain a “sharps injury log” for the recording of injuries from contaminated sharps. The log must be maintained in a way that ensures employee privacy and must contain, at a minimum: Type and brand of device involved in the incident Location of the incident Description of the incident PPT-003-02

51. 51 Summary Protect workers against the health hazards from exposure to blood and other potentially-infectious materials, and to reduce their risk from this exposure Exposure control plan Universal precautions PPE and safe work practices Exposure incident PPT-003-02

52. Questions 52 PPT-003-02