1. MIOSHA Part 554 Bloodborne Infectious Diseases Train the Trainer Program Module 1 Presented By: Consultation Education & Training (CET) Division Michigan Occupational Safety & Health Administration Michigan Department of Energy, Labor & Economic Growth www.michigan.gov/miosha (517) 322-1809

2. Welcome Welcome to the MIOSHA Bloodborne Infectious Diseases Online Training Program. This program is designed to provide an overview of the MIOSHA bloodborne standard. It does NOT fullfill all the training requirements in the Bloodborne Standard nor is it intended to replace facility specific training.

3. Intended Use: “Train the Trainer” Provide bloodborne infectious diseases information to those who provide training to employees who are at risk of occupational exposure. Provide additional resources to assist trainers in becoming more knowledgeable in topics related to bloodborne infectious diseases.

4. Module 1will provide an overview of the MIOSHA Bloodborne Infectious Diseases Standard Rules 1-9.

5. Overview of the Bloodborne Standard Rule 1 Scope Rule 2 Definitions Rule 3 Exposure determination Rule 4 Exposure control plan Rule 5 Universal precautions Rule 6 Engineering controls Rule 7 Work practices Rule 8 Protective work clothing and equipment Rule 9 Housekeeping Rule 10 Regulated waste Rule 11 Laundry Rule 12 HIV and HBV research laboratories and production facilities Rule 13 Vaccinations and postexposure follow-up Rule 14 Communication of hazards to employees Rule 15 Recordkeeping Rule 16 Information and training Appendices Module 1:Module 2:

6. Rule 1 Scope These rules apply to all employers that have employees with occupational exposure to blood and other potentially infectious materials.

7. Rule 2 Definitions Bloodborne Pathogens: pathogenic microorganisms present in human blood including HBV, HIV and [HCV]. Contaminated: presence or the reasonably anticipated presence of blood or other potentially infectious materials (OPIM).

8. Rule 2 Definitions Continued * NOT included: Vomit Urine Feces Sweat Tears Spit Materials included:  Semen  Vaginal secretions  Amniotic fluid  Synovial fluid  Saliva in dental procedures Other Potentially Infectious Materials (OPIM) *Unless visually contaminated with blood or OPIM

9. Rule 2 Definitions Continued Contaminated Sharps: contaminated object that can penetrate the skin, including:   Needles   Scalpels   Broken glass   Broken capillary tubes   Exposed ends of dental wires

10. Rule 2 Definitions Continued Engineering Controls: controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogen hazard from the workplace.

11. Rule 2 Definitions Continued Exposure: reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or [OPIM] that may result from the performance of an employee’s duties. Exposure Incident: specific eye, mouth, other mucous membrane, nonintact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties.* * Does not include incidental exposures which may take place on the job, which are neither reasonable nor routinely expected

12. Assessing Risk Exposed person without HBV immunity (vaccine) via needlestick from confirmed HBV source:   6-30% acquire HBV if no post-exposure follow-up   Post-exposure administration of Hepatitis B immune globulin and vaccine is >90% effective in preventing HBV infection. HIV exposure via needlestick from positive source is average of 0.3% become HIV + * NIOSH Alert Publication No. 2000-108 Preventing Needlestick Injuries in Health Care Settings (External link)(External link)

13. Rule 2 Definitions Continued Needleless Systems: means a device that does not use needles for:   Collection or withdrawal of bodily fluids   Administration of medication or fluids   Other procedure involving potential for occupational exposure Sharps with engineered sharps injury protections: [devices that have] built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.

14. Examples of Safer syringes Self-Sheathing Retractable Attached to syringe needle

15. Examples of Phlebotomy Safer Devices Attached to blood tube holder

16. Examples of Retracting lancets with safety features Before During After In use After use

17. Rule 2 Definitions Continued Regulated Waste: Liquid or semiliquid blood or [OPIM] Contaminated items that would release blood or [OPIM] if compressed. Items which are caked with dried blood or [OPIM] Contaminated sharps Pathological and microbiological waste that contains blood or [OPIM] Note: If material is dripping or caked (with dried blood), it must be disposed as regulated waste.

18. The next slide will provide questions to assist with reviewing the Bloodborne Infectious Diseases Standard Rule 2 Definitions

19. Rule 2 Definitions Questions and Answers: True or False: 1. 1. Hepatitis C is a bloodborne pathogen. True 2. 2. Blood exposure on intact skin is considered an exposure incident. False. Rule 2 (o) Definition for exposure incident includes nonintact skin. 3. 3. Fecal material is classified as an “other potentially infectious material.” False, unless visually contaminated with blood. Rule 2(s)(J) Questions and answers will appear below. There will be delays to allow time to answer the questions.

20. Rule 3 Exposure Determination Evaluate routine and reasonably anticipated tasks to determine employee exposure to blood or [OPIM] Classify employees as either category A or B

21. Rule 3 Exposure Determination Category “A” involves exposure or reasonably anticipated exposure during routine and nonroutine required tasks. Includes emergency/1st aid responders. Category “B” do not require tasks that involve exposure to blood or other potentially infectious material. Determine without regard to protective equipment. Determine/document rationale. Maintain list of all “A” job classifications.

22. Rule 4 Exposure Control Plan Exposure Determination (Category A or B) Summary of the training program. Procedures for evaluating exposure incidents Task specific Standard Operating Procedures (SOPs) to include:   Employee recognition of exposure   Personal Protective Equipment (PPE) selection, use, maintenance, and disposal   Contingency Plans Task-specific SOPs for management of inadvertent exposures such as needlesticks

23. Rule 4 Exposure Control Plan Continued Review at least annually: Tasks and procedures Changes in technology that eliminate or reduce exposure Document consideration and implementation of medical devices that are:   Appropriate: does not cause death, injury or illness in the patient   Commercially available   Effective: reduces or eliminates potential for employee exposure to blood and OPIM

24. Rule 4 Exposure Control Plan Employer shall solicit input from non- managerial employees involved in direct patient care in the:   Identification;   Evaluation; and,   Selection of effective engineering and work practice controls. Must document in the plan

25. The next slide will provide questions to assist with reviewing the Bloodborne Infectious Diseases Standard: Rule 3 Exposure Determination Rule 4 Exposure Control Plan

26. Rule 4 Exposure Control Plan Questions and Answers: True or False: 1. 1. Annual review of the exposure control plan is required. True. Rule 4(d) 2. 2. Non-managerial employees are to be involve in the selection of effective engineering controls. True. Rule 4(h) 3. 3. The exposure control plan must include task specific standard operating procedures. True. Rule 4(b)(v) Questions and answers will appear below. There will be delays to allow time to answer the questions.

27. Rule 6 Engineering Controls SHALL be used in combination with work practice controls to minimize or eliminate employee exposure Provide hand washing facilities which are readily accessible to employees… [or] appropriate antiseptic hand cleanser with clean cloth

28. Rule 7 Work Practices PPE shall be removed before leaving the work area Garment penetrated with blood or [OPIM] shall be removed immediately Wash hands immediately after removing gloves or other protective clothing* Wash hands after contact with blood or [OPIM] *If blood or OPIM are present, hands must be washed. If no contact with blood or OPIM, waterless cleansers may be used. See Federal OSHA documentation (External link).External link

29. Rule 7 Work Practices Continued Needles shall not be sheared, bent or broken, recapped, resheathed or *removed unless no alternative is feasible Eating, drinking, smoking, applying cosmetics or lip balm, or handling contact lenses is prohibited where there is reasonable anticipation for exposure. *Reuse of tube holders is prohibited. See Federal OSHA document (External link).External link

30. Rule 7 Work Practices Continued Food and drink shall not be stored in refrigerators, freezers, shelves….or in areas of possible contamination All procedures shall be performed in a manner that minimizes splashing, spraying and aerosolization of blood or [OPIM] Mouth pipetting is prohibited.

31. The next slide will provide questions to assist with reviewing the Bloodborne Infectious Diseases Standard: Rule 6 Engineering Controls Rule 7 Work Practices

32. Rule 6-7 Engineering and Work Practice Controls Questions and Answers: True or False: 1. 1. Use of engineering controls is optional. False. Rule 6 (1) states that engineering controls shall be used. 2. 2. Employees are required to wash hands following exposure to blood. True. Rule 7(2)(d) 3. 3. Blood collection needles may be removed from blood collection tube holders before disposal. False. Review Rule 7 and Federal OSHA Document (External link) (External link) Questions and answers will appear below. There will be delays to allow time to answer the questions.

33. Rule 8 Protective work clothing and equipment PPE shall be provided and used Employer shall ensure that an employee uses PPE Assure appropriate PPE readily accessible at no cost Provide for cleaning, laundering, or disposal of PPE Repair or replacement of PPE Gloves shall be worn

34. Rule 9 Housekeeping An employer shall assure that the worksite is maintained in a clean and sanitary condition. Work surfaces Coverings Equipment Bins, pails, etc Broken glassware Specimens Reusable items

35. Appropriate Disinfectants One to ten through one to one hundred concentration of household bleach to water (made fresh within 24 hours & not stored in glass containers) Environmental Protection Agency (EPA) registered disinfectants effective against Mycobacterium spp. (Tuberculocides)

36. EPA Lists All on the following EPA lists are appropriate:  List A: Sterilants  List B: Tuberculocides  List D: Against HBV & HIV-1  List E: TB, HIV-1 and HBV NOT LIST C (Effective against HIV-1 only) EPA Approved Disinfectants (External Link)External Link)

37. The next slide will provide questions to assist with reviewing the Bloodborne Infectious Diseases Standard: Rule 8 Protective work clothing and equipment Rule 9 Housekeeping

38. Rule 8-9 PPE and Housekeeping Questions and Answers: 1. 1. The employer is required to ensure employees wear personal protective equipment. True. Rule 8(1)(b) 2. 2. Bleach is the only appropriate disinfectant. False. Rule 9 (1)(a) states that an appropriate disinfectant be used. EPA registered disinfectants at least effective against HIV and HBV are appropriate. Questions and answers will appear below. There will be delays to allow time to answer the questions.

39. Contact MIOSHA for Additional Information Questions: www.michigan.gov/askmioshawww.michigan.gov/askmiosha Consultation Education and Training Division: (517) 322-1809 General Industry Safety and Health Division (Compliance): (517) 322-1831 Link to additional online resources.additional online resources Return to the MIOSHA homepage.MIOSHA homepage

40. Thank you for participating Continue to Bloodborne Infectious Diseases Training program Module-2