Slide 1:Exposure Bloodborne Control / What Employers and Employees Need to Know Pathogens


Slide 2:My Safety Training Online Outside consulting company rbuglione@tampabay.rr.com


Slide 3:Introductions Getting around Ground rules


Slide 4:What are “Bloodborne pathogens” Viruses and bacteria in human blood that can cause disease in humans, including hepatitis B and C viruses and the human immunodeficiency virus, or HIV. Workers exposed to these pathogens risk serious illness.


Slide 5:OSHA has determined that employees face a significant health risk as a result of occupational exposure to blood and OPIM (Other Potentially Infectious Material). This exposure can be minimized or eliminated by implementing an Exposure Control Program. OSHA enacted the Occupational Exposure to Bloodborne Pathogens standard in 1991 ( 29 CFR 1910.1030).


Slide 6:Changes required by the Needlestick Safety and Prevention Act: Enacted by Congress in 2000, P.L. 106-430 revises the 1991 OSHA Bloodborne Pathogens Standard to include increased emphasis on the use of engineering controls such as safety needles; more accurate recording of needlesticks; and the involvement of workers in the selection of equipment and work practices to prevent needlesticks and other exposures to blood.


Slide 7:DID YOU KNOW? This workbook is available for .pdf download at the OR-OSHA web site, as are the training materials for all our other workshop topics. Check us out at: www.orosha.org


Slide 8:What We’ll Discuss... This short introduction to the Exposure Control Plan, as detailed in OAR 437, Div 2/Z, Bloodborne Pathogens, is designed to familiarize you with the various program requirements and how to manage them effectively at your workplace. Please feel free to ask questions at any time, and thanks for attending.


Slide 9:Describe requirements of the written Exposure Control Plan Describe information, recordkeeping, and training requirements Identify engineering and work practice controls, and personal protective equipment Be familiar with hepatitis B vaccination and post-exposure/follow-up procedures Objectives


Slide 10:Scope and Application * The Standard applies to all occupational exposure to blood or other potentially infectious materials (OPIM). Occupational Exposure to Bloodborne Pathogens


Slide 11:What is occupational exposure? Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties;


Slide 12:Parenteral Literally, entry into the body by any other route than the mouth/digestive system; typically, this takes the form of needlesticks, cuts and abrasions. This definition includes human bites that break the skin, which are most likely to occur in violent situations, e.g., prison and law enforcement personnel, psychiatric ward workers.


Slide 13:The standard covers all employees who could be reasonably expected to come into contact with human blood and OPIM in the course of their work. * Full rule located on the web at: www.orosha.org


Slide 14:Definitions “Blood” means human blood, components and products of human blood. Pathogen: An agent of disease; pathogens include bacteria such as staph, viruses such as HIV, and fungi such as yeast. The term "pathogen" was devised about 1880 and was compounded from patho- meaning disease + gen indicating a producer = a producer of disease.


Slide 15:Bloodborne Pathogens Pathogenic micro-organisms in human blood that can cause disease While HIV, HBV and HCV are specifically named, the term includes any pathogenic micro-organism that is present in human blood or OPIM and can infect and cause disease in persons who are exposed to blood containing the pathogen.


Slide 16:More Definitions... Other Potentially Infectious Materials” (OPIM) include: Human blood components and/or products Semen Vaginal secretions Cerebrospinal fluid Synovial fluid (joints) Pleural fluid (chest) Pericardial fluid (heart) Peritoneal fluid (abdomen) Amniotic fluid (childbirth) Saliva in dental procedures Any body fluid that is visibly contaminated with blood Any fluids in which differentiation of body fluid types is difficult or impossible


Slide 17:Still More Definitions… The Importance of Engineering Controls Engineering Controls All control measures that isolate or remove a hazard from the workplace, e.g., sharps disposal containers and self-sheathing needles... ...safer medical devices such as sharps with engineered sharps injury protections and needleless systems. Expanded wording from the Needle-stick Prevention Act


Slide 18:Two New Definitions 1. Sharps with Engineered Sharps Injury Protections (SESIP) Non-needle sharps or needle devices containing built-in safety features, e.g.: Syringes with a sliding sheath that shields the attached needle after use Needles that retract into a syringe after use Shielded or retracting catheters IV delivery systems that use a catheter port with a needle housed in a protective covering


Slide 19:2. Needle-less Systems Devices which provide an alternative to needles for various procedures to reduce the risk of injury involving contaminated sharps, e.g.: Collection of bodily fluids Jet injection systems which deliver liquid medication beneath the skin or into a muscle


Slide 20:What is HIV? HIV (human immuno- deficiency virus) is the virus that causes AIDS. Passed from one person to another through blood-to-blood and sexual contact Infected pregnant women can pass HIV to their babies during pregnancy or delivery, as well as through breast-feeding. People with HIV have what is called HIV infection. Most of these people will develop AIDS as a result of their HIV infection. Bloodborne Infectious Diseases...HIV/AIDS


Slide 22:What is AIDS? AIDS stands for Acquired Immuno-Deficiency Syndrome. Caused by the HIV virus The HIV virus destroys a certain kind of blood cells CD4+ T cells (helper cells) which are crucial to the body’s immune system. The immune system is weakened to the point that it has difficulty fighting off certain infections. These types of infections are known as "opportunistic" infections because they seize the opportunity a weakened immune system provides to cause illness.


Slide 23:What body fluids transmit HIV? These body fluids DO SPREAD the HIV virus: blood semen vaginal fluid breast milk other body fluids containing blood These body fluids MAY SPREAD the HIV virus: Cerebrospinal fluid Synovial fluid Amniotic fluid


Slide 24:What is hepatitis B? Hepatitis B is a germ (virus) that gets into your body and attacks your liver. Your liver helps your body digest the food you eat. It also helps your body get rid of poisons. Bloodborne Infectious Diseases...Hepatitis B Virus


Slide 27:Bloodborne Infectious Diseases...Hepatitis B Virus


Slide 28:Will I die from hepatitis B? Most people (9 out of 10) recover from HBV, but some do not. Recovery usually results in lifetime immunity. Hepatitis B sometimes causes liver damage (cirrhosis) that does not go away. It can also cause liver cancer, which may lead to death. Good medical care can make your risk less for these.


Slide 29:How do you get hepatitis B? It is passed by contact with the blood or other body fluids of someone who has the virus. There are 3 main ways to get hepatitis B: Having sex without condoms with someone who has the hepatitis B virus Being born to a mother who has the virus Sharing needles and syringes


Slide 30:What is hepatitis C (HCV)? The most common chronic bloodborne infection in the United States (CDC) In about 85% of the cases the infection is permanent, and people infected become chronic carriers. The number one cause of liver transplants in the U.S. Bloodborne Infectious Diseases...Hepatitis B Virus


Slide 32:Primarily through large or repeated direct percutaneous (via blood vessels) exposures to human blood, i.e., injecting drug use blood and blood product transfusion prior to 1992 (very rare since 1992) How is Hepatitis C spread?


Slide 33:Occupational Transmission of HCV Bloodborne Infectious Diseases...Hepatitis B Virus Inefficiently transmitted by occupational exposures Case reports of transmission from blood splash to eye No reports of transmission from skin exposures to blood Post-exposure prophylaxis with HBIG is not generally effective in preventing Hepatitis C.


Slide 34:Other Transmission Issues HCV is not spread by kissing, hugging, sneezing, coughing, food or water, sharing eating utensils or drinking glasses, or casual contact. Health Care Personnel (HCP)- to-Patient Transmission of HCV Rare; prevalence 1-2% among health care workers In U.S., none related to performing invasive procedures Most appear related to HCW substance abuse


Slide 35:More than 20 other infections can be transmitted through contaminated needles… Hepatitis B virus Hepatitis C virus HIV, also known as the AIDS virus RECAP: DISEASES TRANSMITTED IN BLOOD


Slide 36:Chance of getting hepatitis B from a syringe infected with the hepatitis B virus 30% Chance of getting hepatitis C from a syringe infected with the hepatitis C virus 3%-5% Chance of getting HIV from a syringe infected with the HIV virus 0.3%


Slide 37:Bloodborne Infectious Diseases continued... FAQs, Hoaxes and Rumors


Slide 38:Each employer having an employee(s) with occupational exposure must establish a written Exposure Control Plan designed to eliminate or minimize employee exposure. Elements of the Exposure Control Plan (ECP) The exposure determination Implementation details The procedure for the evaluation of circumstances surrounding exposure incidents The Exposure Control Plan (ECP)


Slide 39:The Exposure Control Plan (ECP) continued... Additional requirements imposed on the ECP by the Needlestick Prevention Act… The ECP must be reviewed and updated annually and whenever jobs/tasks/procedures are changed. The review/update shall: Reflect changes in technology Document consideration and implementation of appropriate safer medical devices


Slide 40:Document solicitation of input from non-managerial employees who are... Responsible for direct patient care Representative sample of those with potential exposure Listing the employees involved and describing the process by which input was requested, or… Other documentation, including references to minutes of meetings, copies of documents used to request employee participation or records of responses received from employees


Slide 41:Each employer who has an employee with occupational exposure must prepare an exposure determination. This exposure determination must contain the following: A list of job classifications… A list of all tasks and procedures or groups of closely related tasks and procedures This exposure determination must be made without regard to the use of personal protective equipment. Determining Exposure: How to decide...


Slide 42:Exposure Determination…easier said than done!


Collateral Duty Clause* (issued January 15, 1997)Employers with employees who are not routinely exposed to blood or OPIM may fall under the collateral duty clause, in which case the hepatitis B vaccination would not need to be offered until an incident involving the presence of blood or OPIM occurs. :Collateral Duty Clause* (issued January 15, 1997)Employers with employees who are not routinely exposed to blood or OPIM may fall under the collateral duty clause, in which case the hepatitis B vaccination would not need to be offered until an incident involving the presence of blood or OPIM occurs. Determining Exposure: How to decide (continued)...


Slide 44:In order for an employer to qualify under the collateral duty clause, the following conditions must be met: Reporting procedures must be in place… Reports of incidents must include names…situation… All employees involved in any situation…must be offered the full hepatitis B vaccination… no later than 24 hours after the incident. Bloodborne pathogens training must be provided to all affected employees. The specifics of the reporting procedure…included in training.


Slide 45:Determining Exposure…How to decide (continued)... First Aid and CPR-trained Employees and the Applicability of the BBP Rule


Slide 46:Determining Exposure…How to decide (continued)... Non-profit Organizations and Volunteers* April 2, 1997 Mount Hood Nordic Ski Patrol This is in response to your letter …


Slide 47:Methods of Compliance Universal Precautions Engineering and Work Practice Controls Personal Protective Equipment Housekeeping


Slide 48:Universal Precautions An approach to infection control that treats all human blood and certain human body fluids as if they are infectious for HIV, HBV, and other bloodborne pathogens Universal precautions must be observed to prevent contact with blood or other potentially infectious materials. Because differentiation between body fluid types is difficult or impossible, all body fluids must be considered as potentially infectious materials. Universal Precautions vs. Standard Precautions*


Slide 49:Standard Precautions Based on the latest information on the transmission of infections in hospitals Revised CDC Guideline for Isolation Precautions in Hospitals recommend hospitals and patient care institutions implement Standard Precautions in place of Universal Precautions Standard Precautions correlates with Universal Precautions with minor revisions in nomenclature only. Additional categories of Airborne, Droplet, and Contact Precautions have been developed to manage specific diseases transmitted via such routes.


Slide 50:Overfilling containers is an often-reported problem. Be sure your containers are: Large enough Numerous enough Designed and positioned to see into Located conveniently What are “engineering controls”? Controls that isolate or remove the bloodborne pathogens hazard from the workplace, such as sharps disposal containers, self-sheathing needles


Slide 51:Methods of Compliance continued... 437-002-1030 Additional Oregon Rules for Bloodborne Pathogens Every employer with employees that use medical sharps in direct patient care must, at least annually, identify, evaluate, and select engineering and work practice controls, including safer medical devices.


Examples of Engineering Controls…needle-less systems :Examples of Engineering Controls…needle-less systems


Slide 53:More Examples of Engineering Controls… needle-less systems


Slide 54:“Add-on” safety features


Slide 55: Methods of Compliance continued... What are common “work practice controls? These are practices that reduce the likelihood of exposure by changing the way a task is performed. Examples: Prohibiting recapping of needles using a two-handed technique Handwashing (see next page) Flushing mucous membranes after contact with body areas with blood or OPIM Appropriate procedures for laundry handling


Slide 56:Employers must provide handwashing facilities which are readily accessible to employees. If handwashing facilities are not possible, antiseptic hand cleanser and towels or towelettes must be available.


Slide 57:CDC Hand Hygiene Guideline Fact Sheet*(issued October 25, 2002)


Slide 58: Methods of Compliance continued... 3) Personal Protective Equipment Employer must provide, at no cost to the employee, appropriate personal protective equipment… PPE will be considered “appropriate” only if it does not permit blood or other OPIM to pass through or reach the employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used.


Slide 59:4) Housekeeping Ensure that the worksite is maintained in a clean and sanitary condition The employer must determine and implement an appropriate written schedule … Appropriate disinfectants include: Diluted household bleach solution EPA-registered tuberculocides


Regulated Waste : Regulated Waste What is Regulated Waste? Liquid or semi-liquid blood or OPIM Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed Items caked with dried blood or OPIM that are capable of releasing these materials during handling Contaminated sharps Pathological and microbiological wastes containing blood or OPIM


Slide 61:Regulated Waste continued... Sharps containers must be: Closeable Puncture resistant Leak proof Labeled or color-coded


Slide 62:During use, containers must be: Easily accessible Maintained upright Replaced routinely (no overfill) When moved, containers must be: Closed immediately If leaking, put in secondary container If reusable, opened, emptied, cleaned in a manner that will not expose employees


Slide 63:Needles must be disposed of in a sharps container. Improperly disposed needles can injure housekeepers, custodians and other people.


Slide 64:Contaminated laundry must be handled as little as possible with a minimum of agitation. It must be: Bagged/containerized where used Not sorted/rinsed where used Placed/transported in labeled or color-coded bags or containers Placed/transported in leak-proof bags or containers if leaks likely Employees must wear proper PPE. Laundry


Slide 65:Hepatitis B Vaccination... General Hepatitis B vaccine and vaccination series made available to all…within 10 working days … Employee may decline to be vaccinated… Employee may change mind at any time… Employees trained to report exposures immediately… Post-exposure evaluation and follow-up…made available.


Slide 66:Services to be free to the employee at a reasonable time and place performed or supervised by a physician or other health care professional tests to be conducted by an accredited laboratory


Slide 67:May personnel service/temporary employment agencies require as a condition of employment that prospective employees obtain the HepB vaccination on their own? Yes. Since there is no employer-employee relationship established in instances of pre-employment, OSHA standards do not apply.


Slide 68:Hepatitis B Vaccination continued... Vaccination Details regarding Health Care Personnel (HCP) Definition of Health Care Personnel Persons (e.g., employees, students, contractors, attending clinicians, public-safety workers, or volunteers) whose activities involve contact with patients or with blood or other body fluids from patients in a health-care, laboratory, or public safety setting The potential exists for blood and body fluid exposure to other workers, and the same principles of exposure management could be applied to other settings.


Slide 69:Definition of Exposure for HCP’s A percutaneous injury (e.g., a needlestick or cut with a sharp object) or contact of mucous membrane or non-intact skin (e.g., exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or other body fluids that are potentially infectious.


Slide 70:Hepatitis B Vaccination continued... More Vaccination Details regarding Health Care Personnel: Testing for Vaccination Effectiveness…Special Requirements for HCP Some Clinical Features of Acute Hepatitis B Infection Laboratory Diagnosis of Hepatitis B Infection Chronic Infection with HBV


Slide 71:Post-Exposure Evaluation and Follow-up When an exposure incident is reported, the employer immediately makes available a medical evaluation with appropriate medical treatment as indicated. The evaluation should address at least the following items: Document the route of exposure … Identify and document the source individual… Obtain consent and test… If the source is known to be infectious… Give copy of regs to health care professional… Provide the exposed employee with the test results… Test exposed employee’s blood as soon as possible… If the exposed employee consents…


Slide 72:Post-Exposure Evaluation and Follow-up continued… The employer makes sure: Access to clinicians…is available The health care professional has a copy of the OSHA BBP standard… The health care professional receives a detailed description of the exposure incident All relevant medical information…is furnished… Employer obtains and provides the employee with a copy of a written opinion…within 15 days…


Slide 73:Post-Exposure Evaluation and Follow-up continued… The Health Care Professional makes sure: All the circumstances…are evaluated… Medical decisions are based…CDC Guidelines… HCP sends the employer a written report within 15 days… . Everything else is privileged information between employee and HCP and shall not be included on the written report.


Slide 74:Hepatitis B Vaccination...and Post-Exposure Evaluation continued… DEPARTMENT OF HUMAN SERVICES OREGON HEALTH DIVISION DIVISION 12 PROCEDURAL RULES* 333-012-0269 Procedures for Mandatory HIV Testing Following Occupational Exposure to Body Fluids


Slide 75:Communicating Hazards…Two methods 1. Labels and Signs 2. Information and Training


Slide 76:1. Signs and Labels


Slide 77:2. Information and Training At no cost and during working hours At time of initial assignment to risk of exposure At least annually thereafter; sooner if changes in tasks or procedures occur Material appropriate to educational level of employee Covering key concepts in this workbook; see Appendix L, page 76 for details Must also cover site-specifics of employee’s workplace/tasks and procedures


Slide 78:An opportunity for interactive questions and answers with the trainer is a must! The trainer is expected to be knowledgeable in the subject matter as it relates to the specific workplace but not necessarily a health professional.


Slide 79:Recordkeeping: Four Categories... 1. Medical Records 2. Sharps Injury Log 3. Training Records 4. OSHA 300 Log


Slide 80:1. Medical Records Kept confidential HBV vaccination status Any medical records sent to/received from health-care professional related to HBV exposure or immunization status No HIV or other data may be collected Maintained for duration of employment plus 30 years


Slide 81:2. Sharps Injury Log* “The employer shall establish and maintain (a log) for the recording of percutaneous injuries from contaminated sharps. It shall contain at a minimum:” Type and brand of device involved in the incident Department or work area where the exposure incident occurred An explanation of how the incident occurred Maintained independent of the OSHA 300 log Maintained for 5 years


Slide 82:3. Training Records Dates of training Summary of content covered Trainer name/qualifications Maintained for 3 years from the date training occurred


Slide 83:4. OSHA 300 Log Recordable injuries include all percutaneous events, e.g., Nonrecordable events include...


Slide 84:If you have a "privacy concern case”, do not enter the employee's name on the OSHA 300 Log. Instead, enter "privacy case" in place of employee's name. You must keep a separate, confidential list of case numbers and employee names for privacy concern cases in order to update the cases and furnish information to the compliance officer if asked to do so. An employer CAN use the 300 log as their sharps injury log, with the caveat that it must either be a separate page used solely for needlesticks or in a way which provides easily extractable data, such as a computer spreadsheet program.


Slide 85:Frequently Asked Questions for Health Care Personnel What is the risk of infection after an occupational exposure? How many health-care personnel have been infected with bloodborne pathogens? What about exposures to blood from an individual whose infection status is unknown?


Slide 86:What specific drugs are recommended for post exposure treatment? How soon after exposure to a bloodborne pathogen should treatment start? Has the FDA approved these drugs to prevent blood-borne pathogen infection following an occupational exposure?


Slide 87:OTHER SOURCES OF INFORMATION HBV and HCV HIV CDC Hospital Infections Program CDC National Institute of Occupational Safety and Health’s website


Slide 88:Before you run… let’s review


Slide 89:Didn’t we have fun!!! hepB-4 virus