1. Bloodborne Pathogens Standard Requirements

2. TOSHA believes the information in this presentation to be accurate and delivers this presentation as a community service. As such, it is an academic presentation which cannot apply to every specific fact or situation; nor is it a substitute for any provisions of 29 CFR Part 1910 and/or Part 1926 of the Occupational Safety and Health Standards as adopted by the Tennessee Department of Labor and Workforce Development or of the Occupational Safety and Health Rules of the Tennessee Department of Labor and Workforce Development.

3. 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)

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

5. 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

6. 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

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

8. 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

9. 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

10. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. Post-Exposure Follow-up
Post-exposure prophylaxis as indicated by CDC
“Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis” June 29, 2001, Vol 50, No. RR-11
“Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis,” September 30, 2005, Vol 54, RR-09
Counseling and Evaluation of reported illnesses

27. Written Opinion
The employee must be provided a copy of the Health Care Professional's Written Opinion for Post-Exposure Follow-up within 15 days of completion of the evaluation

29. Labels
Containers with contaminated items
Can substitute red

30. 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

31. 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?

32. Additional Training
Copy of the BBP standard, 29 CFR , 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

33. 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

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

35. 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

36. Resources www.osha.gov www.tennessee.gov/labor-wfd/tosha www.cdc.gov
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