BLOODBORNE PATHOGENS Training

BLOODBORNE PATHOGENS TRAINING

THE OCCUPATIONAL SAFETY AND HEALTH

ADMINISTRATION(OSHA) STANDARD

Revised January 2011

INTRODUCTION What is the bloodborne pathogens

standard? Who needs bloodborne pathogens

(BBP) training? What content needs to be included?

OSHA’s EXPECTATIONS Employers Duties

identify job risks and classify

provide appropriate training

provide exposure plan

provide appropriate equipment

Compliance

Employees Duties follow employer’s plan know job classification complete training use equipment

provided by employer Compliance

OSHA REQUIRED INFORMATION

Documents General explanation of

bloodborne pathogens Hepatitis B immunization Explanation of tasks that

may involve exposure

BLOODBORNE PATHOGENS DEFINED

Disease-causing microorganisms that may be present in human blood or other potentially infectious material (OPIM) Viruses – Hepatitis B (HBV), Hepatitis

C (HCV), HIV Bacteria - Syphilis Parasites - Malaria

MODES OF TRANSMISSION

Puncture wounds or cuts Contact (touch, splash,

or spray) with blood or OPIM on:mucous membranenon-intact skin

cuts, abrasions, burns acne, rashes paper cuts, hangnails

contaminated sharps

Objective Objective of BBP

standard is to minimize or eliminate the hazard posed by work that may expose one to blood or OPIM

Effectively treat employees involved in an exposure to BBP

RISK OF EXPOSURE

If an exposure occurs one should know: Is there a way to prevent

infection What are signs & symptoms of

infection availability of counseling availability of post-exposure

treatment & follow-up

OCCUPATIONAL EXPOSURE INCIDENTS

Occupational contact with blood or OPIM is considered an exposure incident

If an exposure occurs: wash with soap & water report incident document incident seek “immediate” medical

evaluation follow employer’s exposure

control plan

IMMEDIATE MEDICAL EVALUATION

“Immediate” means prompt medical evaluation and prophylaxis

An exact timeline cannot be stated Time limits on effectiveness of

prophylactic measures vary depending on the infection of concern

REPORTING AN INCIDENT

Date and time of incident

Job classification Location in the

worksite where incident occurred

Work practice being followed

Engineering controls in use

Procedure being performed

PPE in use

Minimal Information to Report

MEDICAL EVALUATION POST EXPOSURE

Entitled to confidential medical evaluation Personal decision about blood testing Blood may be tested only with consent Blood may be stored for 90 days, while

considering testing Interpretation of any test results occurs

with health care provider

BLOOD TESTING Blood may be tested for

antibodies to: Human Immunodeficiency Virus

(HIV) Hepatitis C Virus (HCV) Hepatitis B Virus (HBV) Other disease-causing organisms

Source blood may also be tested with consent

Results of tests of source blood will be made known to exposed person

SPECIFIC BLOODBORNE PATHOGENS

Definition Signs and symptoms Course of infection Prevention and control Post-exposure

prophylaxis and follow-up care

HBV DEFINED

HBV is Hepatitis B Virus It is a virus which affects the liver Highest rate of disease in persons 20-49 years

of age HBV carriers are people infected who never

fully recovered. 30-40% of people with acute HBV have no idea

how or when the became infected HBV very durable, can survive in dried blood

for up to 7 days

SIGNS & SYMPTOMS OF HBV

Jaundice - yellow color to the skin and whites of eyes

Fatigue Abdominal Pain Loss of appetite Nausea and vomiting Joint pain 30% of infected persons have no signs

& symptoms

COURSE OF HBV INFECTION

Incubation period ranges from a few weeks to several months

Some cases of HBV resolve without complications

Chronic liver disease may occur in 6 to 7% of those infected with HBV

HBV PREVENTION A vaccine does exist to prevent HBV

infection

Employers are required to offer HBV vaccination to employees covered under BBP standard

Follow Universal Precautions any time you are dealing with blood or body fluids

HBV POST-EXPOSURE PROPHYLAXIS & FOLLOW-UP

No cure for HBV infection

Post-exposure prophylaxis should begin within 24 hours; no later than 7 days after exposure

Unvaccinated exposed person should receive HBV vaccine

Treatment requires health care provider

OSHA requires treatment meet CDC’s most recent guidelines

HBV infection treatment may require liver transplant

HBV IMMUNIZATION

Employees with routine occupational exposure to blood/OPIM have the right to Hepatitis B vaccination at no personal expense

Employee refusal established by signing Hepatitis B vaccination declination form

Must be made available within 10 working days of initial assignment to job

HBV VACCINATION SCHEDULE

Vaccine given in 3 dose series over 6 months 1st - on initial assignment 2nd - 30 days later 3rd - 6 months after 1st dose

CDC recommends HBVantibody testing 1 to 2 months following 3rd dose

Employer cannot require employee to use health insurance to cover test cost

Pre-screening is not required HBV is declining because of vaccine use!

HCV DEFINED

HCV is Hepatitis C Virus There is no vaccine to prevent HCV It infects liver cells resulting in acute & chronic

liver disease An estimated 3.9 million Americans have

been infected with HCV Up to 10,000 people per year die from HCV

SIGNS & SYMPTOMS OF HCV

Jaundice - yellow color to skin and whites of eyes

Fatigue Dark Urine Abdominal Pain Loss of appetite Nausea

COURSE OF HCV INFECTION

Incubation period averages 6 to7 weeks Chronic liver disease may occur in 70% of

those infected with HCV Transmission occurs when blood or body

fluids from an infected person enters the body of a non -infected person

HCV is spread through sharing needles when using drugs, needle sticks or sharps exposures on the job or from an infected mother to baby during birth

HCV PREVENTION Please note: there is NO vaccine

available to prevent HCV infection HCV infection in workers is best prevented by

following Universal Precautions Do not shoot drugs HCV may be spread by sex, but this is rare Do not share personal care items

Toothbrushes Razors Nail clippers

HCV POST-EXPOSURE PROPHYLAXIS & FOLLOW-UP

No cure for HCV No post-exposure pro-

phylaxis recommended

Tests for HCV anti-bodies & liver function recommended at time of exposure

Tests should be repeated 4-6 months post exposure

Treatment of HCV requires a health care provider

OSHA requires treatment that meets most recent CDC guidelines

HCV infection treatment may include liver transplant

HIV DEFINED

HIV is Human Immunodeficiency Virus HIV can cause acquired immune

deficiency syndrome (AIDS) Risk of HIV infection from a puncture

injury or cut exposure to HIV infected blood is very low - 0.3% (1/300 )

Stated another way, 99.7% of needlestick/cut exposures do not lead to infection

SIGNS & SYMPTOMS OF HIV

Signs and symptoms include: Weight loss Night sweats or fever Gland swelling or pain Muscle and/or joint pain Flu-like symptoms

Cannot rely on signs and symptoms to confirm if one is infected

COURSE OF INFECTION WITH HIV

HIV infection progresses in stages Course of infection varies from person

to person Acute seroconversion may occur 6-12

weeks after exposure Progressive disease in untreated

persons is characterized by a steady decline in specific white blood cell counts

Increased susceptibility to infections

HIV PREVENTION

NOTE : There is NO vaccine to prevent HIV infections

HIV infection in workers is best prevented through following Universal Precautions

Post-exposure prophylaxis with anti-viral medication can reduce risk of infection

HIV POST-EXPOSURE PROPHYLAXIS & FOLLOW-UP

No cure for HIV infection

Testing schedule for HIV antibodies at time of exposure at 3 months at 6 months

HIV antibodies usually become detectable within 3 months of infection

Treatment requires health care provider

OSHA requires treatment that meets most recent CDC guidelines

Treatment may include antiviral medications and a protease inhibitor

Transmission RatesNot all BBPs have the same transmission rate, risk

is affected by frequency of the virus, environmental viability and the amount of

organism in body fluid

Average Risk from a single needle stick

HBV: 30% (unless vaccinated)

HCV: 1-3% HIV: 0.3%

Average risk from mucous membrane exposure

HBV: 10% (unless vaccinated)

HCV: 1% HIV: 0.1%

PREVENTION Engineering Controls

Work Practice Controls

Personal Protective Equipment

Universal Precautions

ENGINEERING CONTROLS

Design safety into work tools and work space organization

Engineering controls can: Decrease risk of exposure to hazards Eliminate hazards Isolate hazards

EXAMPLES OFENGINEERING CONTROLS

Hand and eye washing facilities

Sharps container use

Biohazard labeling

Self-sheathing needles

Needleless IV systems

LABELING REGULATED WASTE

Label liquid or semi-liquid blood or OPIM Label item(s) contaminated with blood or

OPIM Label sharps contaminated with blood or

OPIM Label containers holding contaminated

equipment for storage, handling and transport

SHARPS CONTAINERS MUST BE:

closable and puncture resistant

leak proof labeled or color coded functional sufficient in number easily accessible and maintained in upright

position replaced per agency policy NOT be overfilled

SHARPS INJURY PROTECTION

Reusable sharps require proper handling (mechanical means) and decontamination

Retractable needles

Needleless systems

WORK PRACTICE CONTROLS

Behaviors using engineering controls safely and effectively

Work Practice Controls include: using sharps containers using an eyewash station WASHING HANDS after using PPE cleaning work surfaces proper laundering

PROHIBITED WORK PRACTICES

DO NOT break, shear, bend or

recap needles reach into used

sharps containers pick up contaminated

items, such as broken glass with bare hands

use a vacuum cleaner to clean up contaminated items

open or empty sharps containers

pipette or mouth suction blood or OPIM

store beverages or food in refrigerators, freezers, or cabinets where blood or OPIM are present

eat, drink, smoke, apply cosmetics, or handle contact lenses in areas of potential occupational exposure

HANDWASHING Readily available facilities

Washing after removing PPE

Using antiseptic hand cleanser when a sink isn’t readily available

HANDWASHING

First roll out paper towel or have towel readily available so as not to touch other surfaces to reach it

HANDWASHING

Turn on tap water and adjust temperature

Use plenty of soap

HANDWASHING

Wash hands using friction on all surfaces for at least 30 seconds

Sing happy birthday to yourself twice = 30 seconds

HANDWASHING

Dry hands thoroughly

DO NOT turn off the water yet

HANDWASHING

Turn off tap with a dry part of the towel

DO NOT touch surfaces with clean hands

CLEANING

Clean work surfaces according to employer’s exposure control plan

Use PPE and EPA-approved solution 10% bleach and water must be replaced

weekly Place contaminated laundry in color-coded

laundry bag, use PPE, and handle as little as possible

DO NOT take contaminated materials home to launder

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Specialized clothing/equipment used for protection when risk of exposure exists

Must prevent blood or OPIM from contaminating clothing or skin

Must be available at no cost to employee Must be in appropriate sizes Must be in good working condition Must be properly maintained Employee must be trained in proper use

TYPES OF PERSONAL PROTECTIVE EQUIPMENT

Gloves Masks Eye shields Gowns/aprons Resuscitation devices

LATEX GLOVES Medical products containing latex

must be labeled

Allergies to latex are increasing

Substitutes for latex-containing materials must be made available

UNIVERSAL PRECAUTIONS

Universal Precautions is a method of infection control in which All blood and body fluids is treated as if infectious for HIV, HBV, HCV or other bloodborne pathogens

High Risk MATERIALSUniversal Precautions always applies to: Blood Semen Vaginal secretions Cerebrospinal, synovial or pleural fluid Body fluids containing visible blood Any unidentifiable body fluid Saliva from dental procedures

Lower-risk MATERIALSBloodborne pathogen transmission is unlikely from contact with lower-risk body fluids, such as

Feces Nasal secretions Sputum Tears Urine VomitHowever, Universal Precaution still

applies

EXPOSURE CONTROL PLAN

Site specific plan provided by employers to protect employees with occupational exposure risk

Lists job classifications with exposure risk Identifies engineering controls, work practice

controls, PPE and Universal Precautions Identifies who will be trained and trainer Includes record keeping provisions and is

reviewed annually

Resources CDC website for Infection Control in

Healthcare Settings: http://www.cdc.gov/ncidod/dhqp/

Occupational Safety and Health Administration rules 29 CFR 1910.1030

A “Bloodborne Pathogens” training resource page: http://www4.uwm.edu/usa/safety/biological_safety/bbp/index.cfm