Persons working in a job where they might reasonably expect to be exposed to blood or Other Potentially Infectious Materials (OPIM) will directly benefit from this training.

OSHA

Beginning in 1991, OSHA (The Occupational Safety and Health Administration) announced a new standard entitled: Occupational Exposure to Bloodborne Pathogens.  It has since had several updates.  It applies to all occupational exposure to blood or other potentially infectious materials (OPIM).

 

Occupational Exposure means:
reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials (OPIM) that may result from the performance of an employee's duties.

The following list is an example of some of the employees and occupations typically covered:

• health care and dental personnel
• first responders, firefighters, police officers
• housekeepers in medical facilities, lab workers
• barbers, child care providers, funeral service workers
• employees whose job description requires them to provide first aid

 

First Aid Providers

The standard specifically applies to employees who are required by their job to administer first aid.  However, it does NOT apply to employees, trained in first aid, but whose job does NOT require them to render aid. 

Employers, however, are encouraged to offer follow-up services for “Good Samaritan” responders as well as for required trained responders.  It is an important guideline to be utilized for any potential occupational exposure to bloodborne pathogens.

 

Standard Requirements

Practices required by the standard in order to reduce or control occupational exposure include:

• Utilizing engineering and work practice controls
• Providing personal protective equipment (PPE)
• Implementing an exposure control plan

The standard also requires that employers:

• make Hepatitis B vaccination available for employees with occupational exposure to blood and OPIM
• specify procedures to be followed should an employee have an exposure incident
• provide training and maintain records

Key Facts:
Outcome 1:  Identify the types of jobs covered by OSHA’s Bloodborne Pathogens Standard.

 

 

 

Bloodborne pathogens are infectious materials found in the blood (bacteria, viruses, or other microorganisms) that can cause disease in humans.  Those posing the greatest present risk to workers in the United States include hepatitis B & C (HBV, HCV), and HIV.

Others include syphilis, brucellosis, babesiosis, relapsing fever, viral hemorrhagic fever (Ebola, Lassa Fever, etc.), hepatitis D, arboviral infections (diseases transmitted by mosquitoes, e.g.malaria, and ticks), and leptospirosis.  (Leptospirosis [lep-to-spy-RO-sis] is a potentially serious bacterial illness that is most common in the tropics.  Infected wild and domestic animals pass leptospirosis-causing bacteria in their urine).

Hepatitis

Hepatitis is an inflammation of the liver causing swelling and loss of function.  It may be caused by specific hepatitis viruses, bacteria, toxins, alcohol, or drugs.  Cirrhosis or cancer may subsequently develop. 

The most common types of viral hepatitis are hepatitis A, B, and C.  Hepatitis A, which is not bloodborne, is acute and usually self-limited.  Hepatitis B and C are both bloodborne, can be chronic, and are the most serious of the viruses affecting the liver.  We will discuss them in more detail. There are vaccines to prevent Hepatitis A and B, but not for Hepatitis C.

Trends & Statistics:  Hepatitis B (HBV):

• The hepatitis B virus can survive for 7+ days in dried blood.
• With the routine vaccination of children beginning in 1990, the annual number of new infections has declined from 260,000 in the 80’s to about 19,200 (11,000-47,100) currently. Of this number, many may not have symptoms and do not know they are infected.
• Currently it is estimated that there are between 850,000 and 2.2 million chronically infected Americans.
• Each year, about 1,800 people die in the US from chronic liver disease or liver cancer caused by HBV.

Trends & Statistics:  Hepatitis C (HCV):

• With the widespread screening of blood beginning in 1992, the annual number of new infections has declined from 240,000 in the 80’s to about 30,500 (24,200-104,200) currently. Of this number, many may not have symptoms and do not know they are infected.

• Currently it is estimated that there are approximately 3.2 million chronically infected Americans.
• Each year, about 19,700 people die in the US from chronic liver disease or liver cancer caused by HCV but current information indicates these represent a fraction of deaths attributable in whole or in part to chronic hepatitis C.

Signs and Symptoms:

• Early symptoms may include fatigue (tiredness), abdominal pain, loss of appetite (including a distaste for cigarettes), nausea, vomiting, and joint pain (especially with Hepatitis B). 
• After 3-10 days the urine darkens and stools lighten. This is followed by jaundice (yellowing of the skin and/or the whites of the eyes).  Hives and itching may develop. Lastly, there is a lessening of earlier symptoms and the patient begins to improve.
• Jaundice peaks in 1-2 weeks and then fades during the recovery phase of 2-4 weeks.  The liver is generally enlarged and often tender, but soft.  The spleen is enlarged 15-20% of the time.
• Symptoms from HCV (Hepatitis C) are generally, less severe than those for HBV (Hepatitis B).  HCV symptoms usually be-gin around 7 weeks following infection, but range from 2-24 weeks.  HBV symptoms can take 1 to 9 months following exposure before becoming noticeable.
• About 30% of persons infected with HBV and 80% of those with HCV have no signs and symptoms but can still transmit the virus to others.  This is known as the chronic carrier state.  Signs and symptoms are less common in children than in adults.  Only about 10% of children infected with HBV show any symptoms.  The numbers for HCV are even lower.

Vaccine:  
Hepatitis B vaccine has been available since 1982 and is recommended routinely for 0-18 year olds and for risk groups of all ages.  It is about 90% effective.  There is no vaccine at this time for HCV (Hepatitis C).  Research to develop a vaccine is underway.

 

HIV

The Human Immunodeficiency Virus (HIV) is a deadly bloodborne pathogen, although fragile, surviving only a few hours in a dry environment.  It causes a serious viral infection which damages the immune system (our body’s defense system), hindering its ability to protect against infections.  When, due to decreasing immune function, certain specific ‘opportunistic’ infections (tuberculosis, Kaposi’s sarcoma, etc.) become evident a diagnosis of AIDS (Acquired Immune Deficiency Syndrome) is made. 

About 1/4th of the HIV-infected persons in the U.S. are also infected with HCV (Hepatitis C), which further impacts their disease.

Trends and Statistics:

• HIV is a major health issue worldwide with 36.7 million persons living with HIV and 1.8 million new cases of HIV each year.
• In the United States, it is estimated that there are 1.1 million persons living with HIV/AIDS, with approximately 40,000 new cases and 15,000 deaths each year.
• It is estimated that 1/4th to 1/3rd of those infected are unaware that they have HIV.
• HIV progresses to AIDS at a rate of about 5% of person per year.  Without treatment the risk of developing AIDS is 50% by the 10th year.

Signs and Symptoms:

Although HIV disease is a continuum, HIV infection can generally be broken down into three distinct stages:

1. Acute HIV Infection - flu-like symptoms; lasts a few weeks
2. Chronic HIV Infection - Clinically asymptomatic and free from major symptoms, may have swollen glands; lasts about 10 years
3. AIDS - progression of disease to where it meets the criteria for an AIDS diagnosis with emergence of 'opportunistic' infections and cancers, multi-system disease.

Long Term Effects:
At this time, HIV infection is lifelong and almost all untreated HIV infected persons will eventually develop AIDS.  The average time from HIV infection to death without treatment is 10-12 years.

Treatment/Medical Management:
During the past 10 years several drugs have been developed to help fight both HIV infection and associated infections and cancers.  Combination therapy has become an important treatment option.  These drugs have significantly reduced the number of deaths from AIDS in this country, greatly improved the health of many people with AIDS and reduced the levels of circulating virus.

Key Facts
Outcome 2: Define bloodborne pathogens:
   Bloodborne pathogens are infectious materials found in the blood (bacteria, viruses, or other
   microorganisms) that can cause disease in humans.

Modes of Transmission

 

Bloodborne pathogens may be transmitted through contact with infected blood or other potentially infectious material (OPIM), such as:

• Semen
• Vaginal Secretions
• Breast milk
• Other body fluids from around the brain, spinal cord, joints, lungs, heart; or in the abdomen or the uterus around the baby
• Any body fluid visibly contaminated with blood (Some sources claim to have found very low amounts of bloodborne pathogens in saliva and tears, but these sources, along with sweat, urine and feces, are generally considered infectious only when they are visibly contaminated with blood)
• Any detached human body tissue or a viral culture
• Blood, organs and tissues from infected animals

Bloodborne pathogens are most commonly transmitted through:

• Sexual contact (oral, vaginal, anal)
• Sharing needles or other IV drug equipment
• Pregnancy or childbearing
• Breastfeeding
• Accidental workplace exposure

 

Accidental exposure in the workplace varies with your type of job.  Healthcare workers may be exposed through needle-stick injuries or splashes.  Child care workers may be exposed through an open sore or cut.  First aid providers may be exposed through an injury resulting in bleeding. Housekeeping workers may be exposed while cleaning up a contaminated site.  Many other workers have occupations that involve situations where there is potential for exposure to blood or OPIM.  Whatever your job, always be alert to possible exposure to body fluids.

Lifestyle risks:
Multiple partners, you or your partner
Unprotected sex
IV drug use by you or your partner

Work risks: 
Providing first aid or medical care
Cleaning or working with infectious fluids

It is not enough to simply be aware of your risks, you should consider what positive steps you can take to reduce your risk both in your personal lifestyle and your on-the-job decisions.

Key Facts:
Outcome 4: List the three most common non-blood fluids that may transmit bloodborne pathogens:

1. Semen
2. Vaginal Secretions
3. Breast milk

 

Exposure Control Plan
Any employer with employees who have occupational exposure (i.e., reasonably anticipated skin, eye, mucous membrane, or piercing of the skin, contact with blood or OPIM that may result from the performance of an employee's duties) from the assigned duties is required to have an Exposure Control Plan that details how they will eliminate or minimize employee exposure to bloodborne pathogens.

The Plan shall include at least the following:

• an exposure determination
• a schedule and methods of implementation for all required tasks
• the procedure for evaluation of circumstances surrounding exposure incidents (i.e., actual eye, mouth, other mucous membrane, non-intact skin or skin piercing contact with blood or OPIM while performing your work duties)

The schedule and methods of implementation for all required tasks includes such things as:

• Methods of Compliance: Necessary engineering and workplace controls and personal protective equipment (PPE) are to be available and used.
• Written Protocols: Each employer must insure that written housekeeping protocols are developed and effective disinfectants are purchased.

• Medical Requirements: Appropriate medical action must be taken in the event of an exposure and records maintained.
• Required Training: Initial and annual training must be provided and documented.

A copy of the Exposure Control Plan should be accessible to the employees.

The Exposure Control Plan should be reviewed and updated annually or whenever there are applicable changes, to include new job classifications or tasks and consideration of new technologies.

Input from employees at risk should be solicited and documented as part of any review, identification, evaluation and selection of new and effective engineering and work practice controls.

OSHA Exposure Control Plan Sample

Exposure Determination
In doing an exposure determination the employer considers which employee jobs have occupational exposure and where the exposure may occur.  The exposure determination should include the following:

• A list of Job Classifications where:
  • All employees in that classification have occupational exposure
  • Some employees in that classification have occupational exposure
• A list of all Tasks and Procedures with exposure in these job classifications.

Exposure is to be determined without regard for the use of personal protective equipment (PPE). View an Employee Exposure Determination Sample.

Consider some of the following ways people can be exposed to BBPs

• Handling syringes or other sharps (includes needles, syringes, lancets, auto injectors, infusion sets, connection needles/sets, scalpels, razors or other blades, broken glass or plastic containers). The risk of infection from a contaminated sharp for HIV is about 1 in 300, for hepatitis C it is about 5.4 in 300. It is much higher for hepatitis B, ranging from 69-186 in 300. Preventing sharps injuries is the best way to protect oneself from infection.
• Cleaning up broken containers containing blood or OPIM
• Transferring a body fluid
• Performing surgery or any other healthcare task involving exposure to body fluids
• Handling contaminated laundry
• Restraining and infected and combative person
• Cleaning contaminated surfaces
• Disposing of BBP hazardous waste
• Providing emergency first-aid

Standard Precautions are based on the principle that ALL blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes may contain potentially transmissible infectious agents.

Standard Precautions address such issues as: hand hygiene, the use of personal protective equipment (PPE), respiratory hygiene, patient placement, safe injection practices and care of the environment. 

Standard Precautions primarily pertains to the healthcare setting, but workers in many different occupations are at risk for exposure to bloodborne pathogens. 

The OSHA Bloodborne Pathogens Standard details what any employer must do to protect workers whose job puts them at a reasonable risk of coming into contact with blood and other potentially infectious materials.  In the OSHA Standard, besides the general Universal Precautions, noted earlier, the following three specific methods of compliance are indicated:

• Engineering and Work Practice Controls
• Personal Protective Equipment (PPE)
• Housekeeping Practices

Engineering and Work Practice Controls
Engineering and work practice controls are to be used to eliminate or minimize employee exposure to BBPs.

Engineering controls are devices that isolate or remove the hazards of bloodborne pathogens from the workplace.  These include:

• A physical guard:  Sharps disposal containers
• Safer medical devices: Needleless systems, engineered injury protection, self-blunting and self-sheathing needles
• Environmental Controls:  Ventilation hoods with barrier protection, centrifuge shields, autoclaves
• Barriers:  Biological safety units to protect lab workers

Work Practice Controls reduce the likelihood of exposure by altering the manner in which a task is performed.  Examples of work practice controls are:

Personal Habits:
Hand washing:  reducing exposures
Personal Activities:  avoiding unnecessary exposure

Hand Washing:
Employers should provide facilities for hand washing and ensure immediate hand washing after removal of gloves or other PPE, and washing of skin and/or flushing of mucous membranes after potential exposure to a BBP. 

Where no sink is immediately available, suitable waterless hand washing products should be used. Current CDC hand hygiene recommendations allow the use of waterless antiseptic hand rubs as the sole means of hand hygiene as long as the hands are not visibly soiled, otherwise you still need to wash your hands with running water as soon as possible.

The Technique:

1. Use soap with warm (not hot) water, with lots of friction.
2. Lather top, bottom and all sides of hands and fingers. Hum two verses of Row, Row, Row Your Boat during lathering. When done, rinse.
3. Rinse from the fingertips down to the wrists so water runs off the wrists.

*This all should take 15-20 seconds.  Then...

1. Dry hands on a paper towel which can be used to turn off the water and open the door.

 

Black Light Germ Juice Handwashing training kits can be obtained for under $50.  These can be fun and educational. www.blacklightworld.com

Personal Activities:

• Employees are prohibited from
  • Eating
  • Drinking
  • Smoking
  • handling contact lenses or
  • applying cosmetics or lip balm (in an area where there is a reasonable likelihood of occupational exposure)
• Food and drinks should NEVER be stored in areas where potentially infectious materials may be present.

 

 

. Identify the types of jobs covered by OSHA’s Bloodborne Pathogens Standard.

• Employees whose job description and duties potentially expose them to blood or OPIM are covered by the BBP standard. For example:
  • Health-care personnel
  • First responders
  • Housekeepers in medical facilities
  • Employees assigned to provide first aid
• Employees, trained in first aid, but whose job does not require them to render aid, are not covered; though the follow-up services are encouraged.

Review 2

2. Define bloodborne pathogens

3. Name the three most common bloodborne pathogens

4. List the three most common non-blood fluids that may transmit bloodborne pathogens:

• Bloodborne pathogens are infectious materials in blood that can cause serious disease in humans.
• Most commonly they are Hepatitis B, Hepatitis C, and HIV
• The three most common non-blood fluids that transmit BBP are semen, vaginal secretions and breast milk.

Review 3

5. Identify the five most common modes of transmission of bloodborne pathogens:

• Sexual contact (oral, vaginal, anal0
• Sharing needles or other IV drug equipment
• Pregnancy or childbearing
• Breastfeeding
• Accidental Workplace Exposure

Review 4

6. Name three primary methods of compliance in the standard and give specific examples of each.

• Engineering and Work Practice Controls
  • Safer medical devices; sharps containers
  • Personal Habits: hand washing, minimizing personal activities exposure
  • Work Habits: safer handling of sharps, safer methods for procedure
• Personal Protective Equipment (PPE) – gloves masks, face shields, etc.
• Housekeeping Practices
  • General Cleanliness: scheduled cleaning
  • Decontamination: use appropriate disinfectant
  • Regulated Waste: appropriate containers and handling
  • Laundry: minimal handling, wearing appropriate PPE

Review 5

7. List the three primary steps in handling and exposure incident:

• Stop
• Wash
• Report

8. identify the two requirements in the standard:

• Hepatitis B vaccination
• Post-exposure evaluation and follow-up

Review 6

9. Evaluate your company’s Exposure Control Plan:

• The plan shall include at least the following:
  • An exposure determination
  • A schedule and methods of implementation for all required tasks
  • The procedure for evaluation of circumstances surrounding exposure incidents
• The schedule and methods of implementation for all required tasks included such things as
  • Use of Standard Precautions (Methods of Compliance)
  • Written housekeeping protocols available
  • Compliance with medical requirements
  • Required training (initial and annual) provided

 

 

 

not bloodborn- 4

 

not covered- 3

 

contain BP- 4

 

Wash- False

 

SP, except sweat= true

 

BP enter= 3

 

eat/drink- false

 

not considered PPE- 1

 

Vac cines Heo B/C- false

 

Biohazard- 3