1. Bloodborne Pathogens
This presentation is designed to assist trainers conducting OSHA 10-hour General Industry outreach training for workers. Since workers are the target audience, this presentation emphasizes hazard identification, avoidance, and control – not standards. No attempt has been made to treat the topic exhaustively. It is essential that trainers tailor their presentations to the needs and understanding of their audience.
This presentation is not a substitute for any of the provisions of the Occupational Safety and Health Act of 1970 or for any standards issued by the U.S. Department of Labor. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Department of Labor.
This presentation does not fulfill the employer’s training obligations under 29 CFR

2. Natural Defenses
Intact skin and mucous membranes in eyes, nose and mouth keeps germs out.
Mucous membranes trap & force out germs.
Mucous membrane less effective than skin at keeping germs out of the body.
Inside body germs detected & surrounded white blood cells, which release antibodies to fight infection.

3. Natural Defenses Germs sub-classified as:
- bacteria (tetanus) which are non-dependant
& treated with antibiotics.
- virus (measles) which are dependent & few
medications available.
Germs overwhelm immune system and infection develops.

4. What is a BB Pathogen?
Microorganisms (e.g., bacteria & viruses) carried in blood and causing diseases:
- Malaria
- Brucellosis
- Syphilis
- Hepatitis B(HBV)
- Hepatitis C(HCV)
- Human Immunodeficiency Virus (HIV)

5. Statistics and Standards
Annually millions of workers at risk of exposure to bloodborne pathogens – human immunodeficiency virus (HIV – virus causes AIDS), hepatitis B virus (HBV), & hepatitis C virus (HCV)
OSHA’s Bloodborne Pathogens standard ( ) prescribes exposure safeguards to reduce exposure risks.
Hepatitis A not included, not carried in blood.
No MSHA or OSHA-Construction standard
29 CFR
“Bloodborne pathogens” means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include among others hepatitis B virus (HBV), which causes hepatitis B; human immunodeficiency virus (HIV), which causes AIDS; hepatitis C virus and other pathogens, such as those that cause malaria.
“Other potentially infectious materials” means:
The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between bodily fluids;
Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and
HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.

6. Exposure Determination
Employees “reasonably anticipated” in job performance to contact blood and other potentially infectious materials.
Designated first-aid and CPR trained employees
“Good Samaritan” acts such as assisting a co-worker with a nosebleed would not be considered occupational exposure.
OSHA’s Bloodborne Pathogens standard, 29 CFR , does not apply to construction, agriculture or maritime.
The term “reasonably anticipated” contact means potential contact as well as actual contact with blood or other potentially infectious materials.

7. BB Pathogen Spread All four of the following must be met:
- pathogen Present,
- pathogen Quantity sufficient to cause disease,
- pathogen through correct Entry site, &
- person Susceptible.
PQES
OSHA’s Bloodborne Pathogens standard, 29 CFR , does not apply to construction, agriculture or maritime.
The term “reasonably anticipated” contact means potential contact as well as actual contact with blood or other potentially infectious materials.

8. Infection Risk
Risk of infection from accidental bloodborne exposure varies with:
- pathogen involved,
- exposure type,
- route of infection,
- immune status of recipient,
- amount of involved blood,
- amount of virus in blood, & - ability of organism to produce disease.
OSHA’s Bloodborne Pathogens standard, 29 CFR , does not apply to construction, agriculture or maritime.
The term “reasonably anticipated” contact means potential contact as well as actual contact with blood or other potentially infectious materials.

9. Pathogen Transmission
Direct contact with infected human blood, unfixed tissues, & other potentially infectious bodily fluids such as:
- Saliva
- Vomit
- Urine
- Semen or vaginal secretions,
- Blood transfusion, &
- Bodily fluid visibly contaminated with blood.
OSHA’s Bloodborne Pathogens standard, 29 CFR , does not apply to construction, agriculture or maritime.
The term “reasonably anticipated” contact means potential contact as well as actual contact with blood or other potentially infectious materials.

10. Pathogen Transmission
Indirect contact with infected human blood, unfixed tissues, & other potentially infectious bodily fluids on:
- soiled dressing,
- equipment or working surfaces,
- PPE,
- other first-aid items.
OSHA’s Bloodborne Pathogens standard, 29 CFR , does not apply to construction, agriculture or maritime.
The term “reasonably anticipated” contact means potential contact as well as actual contact with blood or other potentially infectious materials.

11. Pathogen Transmission
HBV, HCV and HIV most commonly transmitted through:
- sexual contact,
- needles or other sharp instruments,
- mothers to babies at/before birth,
- contact between broken/damaged skin &
infected bodily fluids, &
- contact between mucous membranes &
infected bodily fluids.
OSHA’s Bloodborne Pathogens standard, 29 CFR , does not apply to construction, agriculture or maritime.
The term “reasonably anticipated” contact means potential contact as well as actual contact with blood or other potentially infectious materials.

12. Pathogen Transmission
Infected blood or bodily fluid enters through:
- open sores,
- cuts,
- abrasions,
- acne, or
- any sort of damaged or broken skin (e.g.
sunburn or blisters).
OSHA’s Bloodborne Pathogens standard, 29 CFR , does not apply to construction, agriculture or maritime.
The term “reasonably anticipated” contact means potential contact as well as actual contact with blood or other potentially infectious materials.

13. Pathogen Transmission
Through mucous membrane of:
- eyes,
- nose, &
- mouth.
Example – blood/fluids splash to eyes.
HBV, HCV & HIV share common transmission mode but risk differs.
Most exposures do not result in infection.
No evidence mosquitoes can transfer virus from person to person.
OSHA’s Bloodborne Pathogens standard, 29 CFR , does not apply to construction, agriculture or maritime.
The term “reasonably anticipated” contact means potential contact as well as actual contact with blood or other potentially infectious materials.

14. HBV Infection Risk
No risk following receipt of vaccine & immunity development.
Post exposure treatment 24 hours – 7 days.
Susceptible person after cut exposure to blood:
- single exposure 6-30%, &
- positive antigen status means more virus.
Possible risk from exposure of mucous membrane or nonintact skin.
No known risk from exposure to intact skin.
OSHA’s Bloodborne Pathogens standard, 29 CFR , does not apply to construction, agriculture or maritime.
The term “reasonably anticipated” contact means potential contact as well as actual contact with blood or other potentially infectious materials.

15. HCV Infection Risk Susceptible person after cut exposure to blood:
- approximately 1.8%.
Unknown following exposure to eyes, nose or mouth; believed to be very small.
Reported infection from:
- blood splash to eye, &
- nonintact skin exposure.
No known risk from exposure to intact skin.
OSHA’s Bloodborne Pathogens standard, 29 CFR , does not apply to construction, agriculture or maritime.
The term “reasonably anticipated” contact means potential contact as well as actual contact with blood or other potentially infectious materials.

16. HIV Infection Risk After cut exposure to blood: - approximately 0.3%.
After exposure to eyes, nose or mouth:
- estimated on average at 0.1%.
After exposure to nonintact skin:
- less than 0.1%.
From needle stick:
- estimated on average at 0.3 – 0.4%.
No cases with small blood amount on intact skin.
OSHA’s Bloodborne Pathogens standard, 29 CFR , does not apply to construction, agriculture or maritime.
The term “reasonably anticipated” contact means potential contact as well as actual contact with blood or other potentially infectious materials.

17. Vaccinations HBV: - available since 1982,
- series of 3 shots over 6 months,
- provides protection for 9 or more years,
% effective within 1 week of exposure, &
% effective
- chronic infection in 6% persons after age 5.
- death from liver disease in 15-25% of persons.

18. Vaccinations HCV: - treatment thru medications* and therapy, and
- no vaccine currently available.
HIV:
- treatment thru medications, and

19. Hepatitis B (HBV)
Durable virus, able to survive in dried blood up to 7 days.
Initial inflammation of the liver, but can lead to serious conditions (e.g., cirrhosis & cancer).
1 – 9 months before symptoms are noticeable.
Mild flu symptoms – fatigue, appetite loss, nausea, joint pain & stomach pain.
Progresses to jaundice & darkening of urine.

20. Hepatitis B (HBV)
300,000 U.S. individuals (8,700 health care workers) infected annually; 1 – 2% fatal
Infection does non prevent infection of HAV or HCV.
Medications available for chronic HBV; only work for some patients.

21. Hepatitis C (HCV)
Most common chronic bloodborne infection in the United States.
Acute or Chronic
Chronic – insidious, slow & without symptoms for 2 or more decades.
Symptoms include: jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea, vomiting.
May lead to chronic liver disease, transplant & death.

22. Human Immunodeficiency Virus (HIV)
HIV virus leading to AIDS.
Depletes immune system (white blood cells).
Opportunistic infections (e.g., TB, pneumonia).
Very fragile & not survive long outside body.
Primary concern to individuals providing first air or medical care involving fresh blood or potentially infectious materials.
No threat of contraction through casual contact.

23. Infection Prevention Universal Precautions:
- Treat all blood and bodily fluids as infectious,
- Use of proper PPE,
- Personal hygiene,
- Proper cleanup and decontamination, &
- Proper disposal of all contaminated material.
(d)(1)
Universal Precautions is an approach to infection control used to protect employees from exposure to all human blood and other potentially infectious materials.
Alternative concepts in infection control are called Body Substance Isolation (BSI) and Standard Precautions. These methods define all body fluids and substances as infectious. These concepts are acceptable alternatives to Universal Precautions provided that facilities using them adhere to all other provisions of this standard.

24. Engineering & work Practice Controls & PPE
Engineering & work practice controls primary methods used for transmission control (e.g., sharps containers),
Work practices:
- Blood and bodily fluids treated as infectious,
- Remove jewelry,
- Personal hygiene, &
- etc.
PPE used in conjunction with engineering & work place controls.
(d)(1)
Universal Precautions is an approach to infection control used to protect employees from exposure to all human blood and other potentially infectious materials.
Alternative concepts in infection control are called Body Substance Isolation (BSI) and Standard Precautions. These methods define all body fluids and substances as infectious. These concepts are acceptable alternatives to Universal Precautions provided that facilities using them adhere to all other provisions of this standard.

25. Personal Hygiene Important factor in minimizing exposure
Confine loose clothing or hair
Maintain nail length < ¼ inch long
Hand washing is one of the most important practices in transmission prevention.
Treatment should begin as soon as possible after exposure, preferably within 24 hours, and no later than 7 days.

26. Hand Washing Wash hands immediately after removing PPE.
Use a soft antibacterial soap
Min. 15 sec. including nails
Rinse thoroughly
Antiseptic cleanser, 70% ethyl alcohol, but wash with soap and water ASAP.
Frequently sanitize hands and exposed skin.

27. PPE Anything protecting a person from exposure Gloves (latex, nitrile)
- double glove
Face shields
Eye protection
Mask or Respirator
Mouthpieces & resuscitation devices
The employer must ensure that appropriate PPE in the appropriate sizes is readily accessible at the worksite or is issued to employees. Hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives must be readily accessible to those employees who are allergic to the gloves normally provided.

28. PPE Rules to Remember Ensure always available
Always wear in exposure situations or when there are skin openings (breaks, cuts).
Check for age, defects or tears before using
Remove & replace if torn or defective, or lost ability to function as barrier.
Remove ASAP to prevent contamination.
Cover skin openings prior to donning.
Remove properly & do not reuse

29. Recommended PPE
Recommended PPE Against HBV, HCV & HIV Transmission
Activity/ Task
Disposable Gloves
Gown
Disposable Mask
Protective Eyewear
Bleeding w/ spurting blood
Yes
Bleeding w/ minimal blood No
Handle/Clean contaminated items
No, unless soiling

30. Glove Removal Technique

31. Glove Removal Technique

32. Exposure Incident
Flush site of blood or OPIM contact (e.g., splash to nose, mouth, or skin).
Irrigate eyes with water or saline
Note specifics of contact with blood or OPIM
Notify supervisor and Safety
No infiltrations of mucous membranes or open skin surfaces, not considered exposure.
Medical evaluation within 1 to 2 hours according to current medical guidelines!
Post-exposure medical evaluations

33. Post-exposure Evaluation
Confidential medical evaluation
Document route of exposure
Identify source individual
Hepatitis B vaccination status
Test source individuals blood
Provide results to exposed employee

34. Summary
OSHA’s Bloodborne Pathogens standard prescribes safeguards to protect against blood and OPIM exposures, & reduce their risk from this exposure.
Implementation will not only will prevent HBV cases, but also significantly reduce risk of contracting HIV, HCV, or bloodborne diseases.
Given our line of work, first aid and CRP responders are potentially exposed.
For more information on Bloodborne Pathogens, see OSHA’s web site at

35. Conclusions BB pathogen rules in place for your health
Precautions use will remove 1 of 4 PEQS
transmission conditions.
Condition missing, infection not occurring