OSHA BBP Standard §Reason : Concern for employees who are occupationally exposed to blood and other body fluids and could acquire certain disease through.

OSHA BBP Standard

Reason: Concern for employees who are occupationally exposed to blood and other body fluids and could acquire certain disease through exposure

Purpose: To minimize risk for employees with occupational exposure to blood and body fluids

Location: BCDP and BEOH, also at www.osha.gov

Requires: Exposure Control Plan

Blood Borne Pathogens Training

Blood Borne Pathogens Training

Overview of BBP StandardTypes of pathogensExposure Control Plan

Blood Borne Pathogens

Human immunodeficiency virus (HIV)

Hepatitis B virus (HBV)

Hepatitis C virus (HCV)

Blood Borne Pathogens

Can acquire from blood body fluids containing visible blood other potentially infectious material

(OPIM)• cerebral spinal fluid (CSF), synovial fluid,

pleural fluid, peritoneal fluid, amniotic fluid

Blood Borne PathogensFeces, nasal secretions, saliva (except in dental settings), sputum, sweat, tears, urine, and vomitus are not considered infected with blood borne pathogens unless they contain visible blood.

Blood Borne Pathogens

Occupational exposure occurs by: percutaneous injury (needlestick or cut) contact with mucous membranes contact with non-intact skin

in which there is blood, body fluids with visible blood, OPIM

Blood Borne Pathogens

HIV virus that causes AIDS incubation period 1

to 3 months person is infectious from onset of infection throughout life all persons are susceptible

Blood Borne Pathogens

HIV risk of transmission

• needlestick: 0.3%• splash/spray to mucuous

membranes: 0.09%• non-intact skin: less than

mucous membrane exposure

Blood Borne Pathogens

HBV virus that causes hepatitis B incubation period 45 to 180 days person is infectious if test for antigen

(HBsAG) is positive unvaccinated persons are susceptible

• vaccination is recommended for persons with occupational exposure

Blood Borne PathogensHBV

risk of transmission• needlestick: 22-31%

if source is HBeAG +• needlestick: 1-6%

if source is HBeAG -• direct or indirect contact with non-intact

skin or mucous membranes is an important source of occupational exposure

Blood Borne Pathogens

HCV virus that causes hepatitis C incubation period 6 to 9 weeks most persons are infectious for life all are susceptible

Blood Borne Pathogens

HCV risk of transmission

• needlestick: 1.8%• mucous

membranes: rare• non-intact skin:

very rare

DPH Exposure Control Plan

universal/standard precautions• hand hygiene

• PPE engineering controls work practice controls HBV vaccination post-exposure management training

DPH Exposure Control Plan

available to employees copies available in

BCDP and BEOH

reviewed, updated annually

use of safe medical devices included

DPH Exposure Control PlanExposure Determination

Any DPH employee who performs or may perform phlebotomies, fingersticks, administers immunizations (including smallpox vaccinations) has occupational exposure to blood borne pathogens

Universal Precautionspart of OSHA BBP standardused on ALL individualsused for ALL contact with:

blood, body fluids, OPIM mucous membranes non-intact skin

to protect against blood borne pathogens

Standard Precautions

part of CDC guidelines on infection controlused on ALL individualsblood, all body fluids, secretions,

excretions(except sweat) considered infectious (regardless of visible blood)

used to protect against all infectious agents

Standard Precautions

Hand hygieneuse of personal protective equipment

Hand Hygiene

Wash hands after touching blood, body fluids, secretions,

excretions, contaminated items, regardless if gloves are worn

immediately after removing gloves before leaving work area whenever hands are dirty or contaminated

Hand HygieneHand washing technique

turn on faucets to comfortable water temperature wet hands, apply soap, lather rub with friction for at least 15 seconds, making sure to

wash back of hands, fingers, fingertips, in between fingers

rinse with fingertips pointing downward dry hands with paper towel discard paper towel and turn off faucets with clean

paper towel

Hand HygieneWaterless alcohol gel

may use if hands are not visibly soiled

more effective against organisms convenient gentler to skin than soap, water,

paper towels takes less time than soap and water wash

Hand HygieneUse of waterless gel

press pump down completely

to dispense appropriate amount dispense into palm of one hand rub palms, backs of hands,

fingers, fingertips, between

fingers until dry, about 30 seconds make sure hands are dry before

resuming activities

PPE

gowns, gloves, surgical masks, face shields, goggles, shoe covers, aprons

used when there is a reasonable anticipation of exposure to blood, body fluids, mucous membranes, non-intact skin

provides protection for clothing, skin, eyes, mouth, nose

PPE

employer responsibilities• provide in appropriate sizes • make accessible• require use by employees• clean, launder, repair, replace as needed• provide training

PPE

Employee responsibilities: use appropriately dispose of

appropriately

PPE for DPH

Gloves non-latex wear for phlebotomies, fingersticks,

smallpox vaccinations remove between clients, wash hands select correct size have readily available at work station

PPE for DPH

Gowns protect skin, prevent soiling of clothing do not re-use disposable gowns wash hands after removing use when cleaning spills

of blood/body fluids

PPE for DPH

“Over shirts” use if desired at STD clinics

and HIV testing sites remove immediately if saturated

with blood/body fluids place in designated laundry

bags for professional cleaning

PPE for DPHLab coats

disposable lab coats used by vaccinators

at smallpox clinics remove and dispose

of before leaving

vaccination station,

wash hands

PPE for DPH

Surgical masks with eye protection/face shields cover eyes, nose, and mouth when anticipating

splash or spray to face eye glasses are not protective

PPE Removal

1) Remove gloves by grasping outside of gloved hand with other gloved hand and peel off. Hold removed glove

in gloved hand.

2) Slide fingers of

ungloved hand under

remaining glove.

Discard gloves.

PPE Removal

3) Remove any PPE from face next, handling by head bands, ear pieces, or ties. Discard.

4) Remove gown by pulling away from neck and shoulders, touching inside of gown only. Turn gown inside out. Discard.

PPE Removal

Wash hands!

Engineering Controls

Safety devices on sharps: needles, lancets must be used if available evaluated by staff

Shearing, breaking, bending, re-capping of contaminated sharps is prohibited

Do not remove needle from used tube holder after phlebotomy

Engineering Controls

Place used sharps in disposal containers immediately after use

Sharps containers puncture resistant leakproof labeled or red in color stabilized if portable

Engineering Controls

Sharps containers Replace sharps containers

when 2/3 full The users of the containers

are responsible for replacing when necessary

Work Practice Controls

Do not eat, drink, apply make-up, handle contact lenses, or smoke in areas with likely exposure to blood or OPIM testing areas areas where specimens located

Do not store food or beverages in refrigerators, freezers, coolers, shelves, cupboards where specimens are located

Work Practice ControlsDo not place hands into used sharps

containersUse a brush and dustpan or tongs or forceps

to pick up broken glass or other sharp items

Waste Disposal

Infectious waste sharps disposable items that are saturated with

blood or OPIM to the point where such material can be squeezed, poured, dripped, or flaked off the items

for DPH, most infectious waste will be sharps

Waste Disposal

Infectious waste place in red biohazard bags, seal to prevent

spillage during handling store in designated areas for collection by

waste haulers Central Health Clinic: biohazard collection

room Madison:???

Waste Disposal

Document waste disposal date removed amount where shipped by whom send completed forms to ICE

Laundry

handle with minimal agitation place dry laundry in bags at point of use laundry that is wet from blood or OPIM is

placed in plastic bags send to professional cleaners

• “over” shirts

• personal clothing visibly soiled with blood or OPIM

Labels Infectious waste: red bag with biohazard

label Sharps containers:

biohazard label blood specimens:

biohazard labeled storage

bags, storage containers refrigerators, coolers where blood or

OPIM is stored: biohazard label

Specimens

label with appropriate information wrap in material to prevent breakage place in plastic biohazard bag place paperwork in outside pouch of bag do not place specimens back into clean

collection kits store or ship appropriately

Cleaning/Disinfection

Clean first, then disinfect all equipment and environmental surfaces after contact with blood or OPIM

use EPA registered disinfectant with activity against HIV, HBV, HCV or 1:10 bleach

follow instructions on disinfectant label

Handling Blood Spills

Procedure for Cleaning Blood Spills wear PPE: gown, gloves, goggles wet cloth with the disinfectant wipe item/area with wet cloth spray disinfectant on item/area wipe with clean cloth, let air dry

Hepatitis B Vaccination

Any one with occupational exposure to blood or OPIM should be vaccinated

recommended unless:• employee has documentation of receipt of

series• antibody testing shows immunity• employee has medical contraindications

Hepatitis B Vaccination

available within 10 working days of work start date

if employee declines, must sign statement of declination

employee may request the series later

Hepatitis B Vaccination

Safety very safe vaccine US: as of 2000 more than 100 million adults

have received vaccine with few side effects serious reactions are rare mild symptoms may occur: soreness at

injection site, low-grade fever may be given during pregnancy

Hepatitis B Vaccination

Effectiveness at least 90% of adults are immune after

completing the three doses of vaccine since 1985, 90% reduction of number of

HCW infected with HBV, largely due to vaccine

Hepatitis B Vaccination

administered by deep intramuscular injection

3 doses given: 1st two doses 1 month apart, last dose is given 5 months after second dose

SLH will test antibody levels at 1-2 months after last dose to test for immunity

non-responders will be-revaccinated

Post Exposure Management

1) Clean the site percutaneous injuries:

wash with soap and water mucous membranes:

rinse copiously with water

2) Go to the nearest

Concentra clinic for evaluation.

If none in area, report to nearest ER

Post Exposure Management

3) Notify supervisor, who will notify the

ICE

4) Medical evaluation documentation of route of exposure document source person source and exposed will be tested results given to exposed person’s provider counseling