1. Bloodborne Pathogens In The Workplace
This training is designed to provide a basic understanding of bloodborne pathogens, common routes of entry, methods of prevention, and other pertinent information.
OSHA standard - 29CFR requires an exposure control plan where an employer has an employee with “Occupational exposure - reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from performance of an employee’s duties”.
The exposure control plan includes an
-exposure determination - which jobs, tasks are potentially exposed.
-methods of compliance
-communication of hazards to employees
-recordkeeping
BBP exposure may occur from such jobs as:
-Medical treatment and services
-laboratory
-laundry services
-housekeeping and waste disposal
A list of references used is provided on the last note page.
For detailed information- reference source:
29 CFR BBP Standard….
Center for Disease Control (CD), Hepatitis A to E.

2. AGENDA What Are Bloodborne Pathogens Where Are They Found
What is Hepatitis
A Closer Look At Hepatitis and HIV
Routes Of Entry
Protecting Yourself
Should I Help An Injured Worker
What If I Am Exposed
Misconceptions
Response Kits
These topic will be covered in this training session.

3. What Are Bloodborne Pathogens?
Microorganisms in the bloodstream that can cause
disease. Bloodborne Pathogens primarily attack the
liver; however, they may attribute to many other
diseases such as malaria and syphilis.
OSHA defines Bloodborne Pathogen as “pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to hepatitis B (HBV) and human immunodeficiency virus (HIV).”

4. Where Are They Found? Blood and Potentially Infectious Materials:
In blood and blood products to include:
Semen
Vaginal Secretions
Breast Milk
Cerebrospinal Fluid
Synovial Fluid
Amniotic Fluid
and other body fluids
Human blood and body fluids have the potential to contain BBP materials.
This is defined as Potentially Infectious Materials

5. A Closer Look at Hepatitis and HIV
Hepatitis A, B, C, D, E and HIV
Hepatitis A (HAV) - 47% of Hepatitis cases
Hepatitis B (HBV) - 34% of Hepatitis cases
Hepatitis C (HCV) - 16% of Hepatitis cases
Hepatitis D (HDV) - 4% of Hepatitis HBV cases (co-infection)
Hepatitis E (HEV) - Rarely reported in the United States
Human Immunodeficiency Virus (HIV) - 0.4% chance of contracting HIV in a workplace environment.
Source - CDC, Acute Viral Hepatitis, by Type, United States,
Acute Viral Hepatitis, by Type, United States,
Of acute hepatitis cases in the United States from 1982 through 1993, 47% were attributable to hepatitis A, 34% to hepatitis B, 16% to hepatitis C, and 3% were negative for serologic markers of HAV, HBV, and HCV infection. An estimated 4% of acute HBV infections are coinfections with HDV. Hepatitis E has only rarely been reported in the United States, almost always in persons who had recently traveled to HEV endemic areas.
Viral hepatitis causes substantial morbidity and mortality in the United States. During the past decade, an estimated ,000 HAV infections, ,000 HBV infections, ,000 HCV infections, and 6-13,000 HDV infections have occurred each year (based on the estimated annual incidence for these types of viral hepatitis from ). As a result of acute infection with these viruses, approximately 285 deaths from fulminant hepatitis occur annually, 100 from hepatitis A, 150 from hepatitis B, and 35 from HBV- HDV coinfection or superinfection. In addition, persons infected with HBV, HCV, and HDV may develop chronic infection. In the United States, approximately million persons are chronically infected with HBV, 3.5 million with HCV, and 70,000 with HDV. An estimated 15,000 persons with chronic infection die each year as a result of chronic liver disease (cirrhosis and liver cancer), 5,000 with HBV infection, 8-10,000 with HCV infection, and 1,000 with HDV infection.
Source: CDC, Hepatitis A to E,

6. What Is Hepatitis? An inflammation of the liver, usually due to
acute viral infection, primarily of the liver,
occurring in three or more forms.
For example: Symptoms of Hepatitis B (HBV)
-Yellow Eyes & Skin (Jaundice)
-Abdominal pain
-Fever and Vomiting
-Dark Urine
-Fatigue

7. Hepatitis A (HAV) Transmitted via contaminated food or water
which contains fecal matter. There is a vaccine
to prevent HAV.
Two types HAV -
Infectious (transmitted person to person by the fecal-oral route) or
Serum (transmitted by transfusion of blood products)
Hepatitis A is an acute (short term) infection. During the 1960s and 1970s, patients with viral hepatitis were classified based on epidemiologic studies as having either infectious (transmitted person to person by the fecal-oral route) or serum (transmitted by transfusion of blood products) hepatitis. When diagnostic tests for hepatitis A virus (HAV) and hepatitis B virus (HBV) infection were developed, HAV was found to be the major cause of infectious hepatitis and HBV was found to be the major cause of serum hepatitis.
HAV and HEV, the primary source of virus is in feces and the fecal-oral route is the predominant mode of transmission. HAV and HEV cause only acute infection,
Hepatitis A produces occasional mortality, with an estimated 100 deaths each year in the United States due to fulminant hepatitis A. The overall case-fatality rate is approximately 0.4%; the highest case-fatality rate is among persons >49 years of age
Close personal contact is the most common mode of HAV transmission as demonstrated by high rates of infection among household and sex contacts of persons with hepatitis A and among children in day care center outbreaks. Contaminated food and water can also serve as vehicles of HAV transmission; the vehicles of transmission in foodborne outbreaks are most often uncooked foods or foods touched by human hands after cooking… Waterborne outbreaks have also been reported both in association with drinking fecally contaminated water and with swimming in contaminated swimming pools and lakes. In addition, HAV transmission can occur as a result of blood exposures such as injecting drug use or blood transfusion because viremia can occur prior to onset of illness in infected persons; however, such transmission is rare.

8. Hepatitis B (HBV) Transmitted by injections transporting a
virus-bearing serum, most often during
blood transfusions and by contaminated
needles and syringes.
Hepatitis B is transmitted primarily through "blood to blood" contact.
Hepatitis B virus is very durable, and it can survive in dried blood for up to seven days. This virus is the primary concern for housekeepers, custodians, laundry personnel and other employees who may come in contact with blood or potentially infectious materials in a non first-aid or medical care situation.
In the US, approximately 300,000 people are infected with HBV annually. Of these cases, a small percentage are fatal.
"Hepatitis" means "inflammation of the liver," and, as its name implies, Hepatitis B is a virus that infects the liver. Hepatitis B is transmitted primarily through "blood to blood" contact. Hepatitis B initially causes inflammation of the liver, but it can lead to more serious conditions such as cirrhosis and liver cancer. The primary measure for prevention of hepatitis B is immunization; hepatitis B can be prevented using either preexposure prophylaxis with hepatitis B vaccine or postexposure prophylaxis with hepatitis B immune globulin (HBIG) and hepatitis B vaccine
There is no "cure" or specific treatment for HBV, but many people who contract the disease will develop antibodies which help them get over the infection and protect them from getting it again. It is important to note, however, that there are different kinds of hepatitis, so infection with HBV will not stop someone from getting another type.
The Hepatitis B virus is very durable, and it can survive in dried blood for up to seven days. For this reason, this virus is the primary concern for employees such as housekeepers, custodians, laundry personnel and other employees who may come in contact with blood or potentially infectious materials in a non first-aid or medical care situation.
Symptoms: The symptoms of HBV are very much like a mild "flu". Initially there is a sense of fatigue, possible stomach pain, loss of appetite, and even nausea. As the disease continues to develop, jaundice (a distinct yellowing of the skin and eyes), and a darkened urine will often occur. However, people who are infected with HBV will often show no symptoms for some time. After exposure it can take 1-9 months before symptoms become noticeable. Loss of appetite and stomach pain, for example, commonly appear within 1-3 months, but can occur as soon as 2 weeks or as long as 6-9 months after infection.
Source:

9. Hepatitis C (HCV) Transmitted in blood or body fluids. No
vaccination exists for HCV.
Chronic liver disease develops in about 70% of persons who become infected with HCV and nearly all (85%-100%) persons with acute HCV infection become persistently infected; these persons are at risk for developing cirrhosis and liver cancer
During the past decade, two additional viruses have been discovered: hepatitis C virus (HCV) and hepatitis E virus (HEV). HCV is the major cause of parenterally transmitted (piercing the skin barrier… needle sticks, human bites, cuts and abrasions) non-A, non-B hepatitis.
No products are available to prevent hepatitis C, and development of immunoprophylaxis for this disease is proving to be difficult. Thus, the primary strategies for hepatitis C prevention are blood donor screening and risk behavior modification.
The ability of HCV to undergo rapid mutation ... allows it to escape immune surveillance by the host; thus, most persons infected with HCV develop chronic infection.
About 30% to 40% of persons with acute infection develop symptomatic illness and 20% to 30% have jaundice. Chronic liver disease develops in about 70% of persons who become infected with HCV and nearly all (85%-100%) persons with acute HCV infection become persistently infected; these persons are at risk for developing cirrhosis and liver cancer. Study findings suggest that viral hepatitis may be responsible for at least 50% of all chronic liver disease in the United States.
No protective antibody response has been identified following HCV infection.
Source : Center for Disease Control:

10. Hepatitis D (HDV) One of the newer types. Transmitted
primarily through injected drug use and sexual contact.
Prevention:
Education to reduce risk behaviors for those with chronic HBV infection
In general, the global pattern of HDV infection corresponds to the prevalence of chronic HBV infection
HDV infection occurs most commonly among injecting drug users and persons with hemophilia. In countries with moderate and high levels of chronic HBV prevalence, the prevalence of HDV infection is highly variable.
Because HDV is dependent on HBV for replication, HBV-HDV coinfection can be prevented with either pre- or postexposure prophylaxis for HBV. However, no products exist to prevent HDV superinfection of persons with chronic HBV infection. Thus, prevention of HDV superinfection depends primarily on education to reduce risk behaviors.

11. Hepatitis E (HEV) Transmitted in contaminated drinking water.
Most cases in U.S. are from persons returning from areas with high exposure.
Currently no treatment for HEV.
Symptoms of acute hepatitis E are similar to those of other types of viral hepatitis and include abdominal pain, anorexia, dark urine, fever, hepatomegaly, jaundice, malaise, nausea, and vomiting.
HAV and HEV, the primary source of virus is in feces and the fecal-oral route is the predominant mode of transmission
For hepatitis E, no products are available for prevention. The primary measure to prevent hepatitis E is to ensure the safety of drinking water.
In most hepatitis E outbreaks, the highest rates of clinically evident disease have been in young to middle-age adults.... No evidence of chronic infection has been detected in long-term follow-up of patients with hepatitis E.
HEV is transmitted primarily by the fecal-oral route and fecally contaminated drinking water is the most commonly documented vehicle of transmission. Although hepatitis E is most commonly recognized to occur in large outbreaks, HEV infection accounts for >50% of acute sporadic hepatitis in both children and adults in some high endemic areas.
Most cases in US are from persons returning from areas with high exposure.
Prevention of hepatitis E relies primarily on the provision of clean water supplies. Prudent hygienic practices that may prevent hepatitis E and other enterically transmitted diseases among travelers to developing countries include avoiding drinking water (and beverages with ice) of unknown purity, uncooked shellfish, and uncooked fruits or vegetables that are not peeled or prepared by the traveler. No products are available to prevent hepatitis E.
Source:

12. Human Immunodeficiency Virus (HIV)
The virus that causes AIDS. HIV attacks the
immune system, making the body less able to
fight off infections. No vaccine exist, and most
cases prove fatal.
It is primarily of concern to employees providing first aid or medical care in situations involving fresh blood or other potentially infectious materials. It is estimated that the chances of contracting HIV in a workplace environment are only 0.4%.
Human Immunodeficiency Virus (HIV)
AIDS is caused by the human immunodeficiency virus (HIV), a retrovirus that was unknown until the early 1980's, but since that time has been spread around the world to infect millions of persons. The result of HIV infection is relentless destruction of the immune system. All HIV infected persons are at risk for illness and death from opportunistic infectious ... complications as a result of the inevitable manifestations of AIDS. The variant of HIV that is the cause for almost all infections is known as HIV-1.
Once a person has been infected with HIV, it may be many years before AIDS actually develops. HIV attacks the body's immune system, weakening it so that it cannot fight other deadly diseases. AIDS is a fatal disease, and while treatment for it is improving, there is no known cure.
Estimates on the number of people infected with HIV vary, but some estimates suggest that an average of 35,000 people are infected every year. By the year 2002, it is possible that 2%-9% of the American population will be infected, or 5 to 15 million people. Many people who are infected with HIV may be completely unaware of it.
The HIV virus is very fragile and will not survive very long outside of the human body. It is primarily of concern to employees providing first aid or medical care in situations involving fresh blood or other potentially infectious materials. It is estimated that the chances of contracting HIV in a workplace environment are only 0.4%. However, because it is such a devastating disease, all precautions must be taken to avoid exposure.
AIDS infection essentially occurs in three broad stages. The first stage happens when a person is actually infected with HIV. After the initial infection, a person may show few or no signs of illness for many years. Eventually, in the second stage, an individual may begin to suffer swollen lymph glands or other lesser diseases which begin to take advantage of the body's weakened immune system. The second stage is believed to eventually lead to AIDS, the third and final stage, in all cases. In this stage, the body becomes completely unable to fight off life-threatening diseases and infections.
Symptoms: Symptoms of HIV infection can vary, but often include weakness, fever, sore throat, nausea, headaches, diarrhea, a white coating on the tongue, weight loss, and swollen lymph glands.
Source:
Because it is such a devastating disease, all precautions must be taken to avoid exposure.

13. Disease Be Transmitted In the
How Can A Bloodborne
Disease Be Transmitted In the
Workplace?
Bloodborne pathogens such as HBV and HIV can be transmitted through contact with infected human blood and other potentially infectious body fluids ….
Bloodborne pathogens such as HBV and HIV can be transmitted through contact with infected human blood and other potentially infectious body fluids ….
HIV infects definable population subgroups ("risk groups"). The transmission of HIV is a function of where the virus appears in the body and how it is shed. HIV can be present in a variety of body fluids and secretions, but the presence of HIV in genital secretions and in blood, and to a lesser extent breast milk, is significant for spread of HIV. However, the appearance of HIV in saliva, urine, tears, and sweat is of no major clinical importance, as transmission of HIV through these fluids does not routinely occur, primarily because of the low concentration of HIV in these fluids.
HIV is primarily spread as a sexually transmissible disease
HIV can be transmitted by parenteral exposure (piercing the mucuous membrane or skin barrier), which is the most highly efficient method of HIV transmission--close to 90%. There are many more peripheral blood mononuclear cells capable of either harboring or becoming infected by HIV in blood than are present in other body fluids or secretions. The primary risk group for HIV transmission via blood is intravenous drug users sharing infected needles. Health care workers with percutaneous exposures to HIV-containing blood, however, are infected fewer than 1 in 300 times.

14. People infected with these pathogens may appear healthy and not even know they’re infected. They can still infect others. Although HBV, HCV and HIV are mainly transmitted through sexual contact and sharing needles, any situation in which blood is present in the work environment is an area of concern.
It is important to know the ways exposure and transmission are most likely to occur in your particular situation, be it providing first aid to a co- worker, handling blood samples in a clinic, responding to an accidental injury in the workplace, or cleaning up blood from a hallway.

15. Routes Of Entry Blood or other infectious material could enter
your system through these routes of entry:
Unprotected opening in the skin
Unprotected mucus membrane openings
Penetration of the skin
Mishaps in the workplace can spread bloodborne
pathogens. Depending on the mishap, an injured
worker’s blood could contaminate broken glass, a
work surface, tools or clothing. If you have contact
with a contaminated object, you could become
infected.
Accidental puncture from contaminated needles and other sharps can result in transmission of bloodborne pathogens.

16. Protecting Yourself
OSHA 29 CFR (d) describes “universal precautions” that should be taken to prevent possible contact with BBP.
Universal precautions is an approach to infection control. …..All human blood and certain body fluids possibly contaminated with blood are treated as if known to be infectious for HIV, HBV, and other BBP.
Work practice controls … reduce the likelihood of exposure by altering the manner in which a task is performed .
Engineering controls … sharps containers, handwashing facilities etc...

17. Should I Help An Injured Worker? YES, BUT BE AWARE OF THE PRECAUTIONS.
Protect yourself and the injured worker from potential exposure….
Should I Help An
Injured Worker?

18. “Universal Precautions” Can Help You LIVE!!!
“Universal precautions” mean always treating
everyone’s blood and other body fluids as
infectious. This precaution is governed by
the Occupational Safety and Health
Administration
Bloodborne Pathogen Standard
applies to any worker potentially exposed to BBP.
29 CFR describes UNIVERSAL PRECAUTIONS…
Treat all human blood and certain body fluids as infectious…
includes blood and body fluids:
Semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, salvia in dental procedures and body fluid that is visibly contaminated with blood, and in situations where it is difficult to differentiate between body fluids….
Any unfixed tissue or organ…..
Protection may involve:
Engineering controls … controls that isolate or remove the bloodborne pathogen hazard from the workplace… examples… sharps containers, self-sheathing needles,……. disposal containers
Work practice controls controls that reduce the likelihood of exposure by altering the task …example… prohibiting recapping of needles by a two-handed technique ….. Disposal procedures
Personal Protective Equipment (PPE) …appropriate to prevent BBP from passing through to reach worker’s eyes, mouth, skin, or clothing, …. Under normal circumstances….
PPE may include: gloves, gowns, lab coats, face shields / masks / eye protection, resuscitation bags,

19. Bloodborne Pathogen Response Kits Response kits are located _____.
They contain all protective items
needed to clean up area where blood or body
fluids are present. Know the location of the
response kits for your work center.
NOTE: The kits are identified with the wording
“Bloodborne Pathogen Response Kit”.
Response kits may be available in workplace where potential accidental injury could occur and if workers may respond to the injury…..

20. If you are inadvertently exposed to blood or
What If I’m Exposed?
If you are inadvertently exposed to blood or
other bodily fluids:
1. Wash the exposed area immediately with soap
and running water for 20 minutes.
2. If cut by an item which has blood on it, try to
save the item for contamination testing.
3. Promptly report the incident to your supervisor.
4. Seek medical attention during normal duty hours
at ________________.
During non-duty hours, seek medical attention at the emergency room at __________________.

21. Misconceptions The increasing incidence of AIDS has
caused fears that have developed
into misconceptions. HIV cannot be
passed on by casual contact. There-
fore, you cannot get HIV by:
- Sharing food, drinking glasses or towels
- From sinks or toilets
- Sharing PPE such as goggles or respirators
- Insect bites such as mosquitoes
Note: Respirator cleaning and disinfecting are required by OSHA standard
29 CFR (b)(3) “….Respirators used by more than 1 worker shall be thoroughly cleaned and disinfected after every use.”
Some employees feel more comfortable and are more likely to wear PPE if it is individually issued.
The best practice (if practical) is to issue PPE to the individual worker, that way there is no question about sharing equipment.
Proper hygiene practices, such as disinfecting a respirator after use should be a standard work practice.
There is no documented evidence showing HIV having been transmitted through dried blood; however, HBV can be.

22. Presentation created by: TSgt White, 633 AMSS Safety, USAF
DELETE THIS SLIDE IF YOU WANT TO…….
THIS SLIDES PROVIDES INFORMATION ON WHERE THIS PRESENTATION CAME FROM…….
Thanks to TSgt White, USAF for creating the original presentation.
Additional information on requirements of 29CFR and Instructor note pages added March 1999.
The author makes no claims that this presentation meets all the requirements for communication of hazard information required by 29 CFR
References for this presentation:
- OSHA Standard 29 CFR
- Center for Disease Control Internet sites, and
- University of Utah Internet site:
-Oklahoma State University Internet site:
Presentation created by:
TSgt White, 633 AMSS Safety, USAF
Revised for U.S. Army, March 1999 by:
Dennis Keplinger, CSP, USASC, Tng Div