Bloodborne Pathogens Standard Requirements

1. Bloodborne Pathogens Standard Requirements

2. TOSHA believes the information in this presentation to be accurate and delivers this presentation as a community service. As such, it is an academic presentation which cannot apply to every specific fact or situation; nor is it a substitute for any provisions of 29 CFR Part 1910 and/or Part 1926 of the Occupational Safety and Health Standards as adopted by the Tennessee Department of Labor and Workforce Development or of the Occupational Safety and Health Rules of the Tennessee Department of Labor and Workforce Development.

3. Bloodborne Pathogens • Pathogenic micro-organisms present in human blood that can lead to diseases • Human immuno-deficiency virus (HIV) • Hepatitis B (HBV) • Hepatitis C (HCV)

4. Hepatitis A http://www.hepatitisfoundation.org/HEPATITIS/Hepatitis-A.html • Hepatitis A is the most common of the two transmitted hepatitis viruses (hepatitis A virus and hepatitis E virus) in the U.S. and is one of the two vaccine-preventable hepatitis infections (hepatitis A and B). • In children the infection is usually mild and without symptoms. • In adults the severity generally increases with increasing age. Nonetheless, full recovery is expected in about 99% of all infections. HAV infection usually resolves on its own over several weeks, but occasionally relapses occur. Hepatitis A does not lead to chronic hepatitis. • Spread primarily through person-to-person contact, or via food or water contaminated by feces from an infected person. In rare cases, it can be spread through contact with infected blood. • Basic precautions like washing hands with soap and water following bowel movements and before food preparation can reduce the incidence. Hepatitis A is prevented through vaccination. The Centers for Disease Control and Prevention (CDC) recommend hepatitis A vaccination for children aged 12 to 23 months and for adults who are at high risk for infection. Following the initial dose, a booster dose is given 6-12 months later.

5. Hepatitis B http://www.hepatitisfoundation.org/HEPATITIS/Hepatitis-B.html • Hepatitis B is a vaccine-preventable bloodborne infection. It is a serious viral disease that infects the liver • In the U.S. the disease is spread predominantly through sex with an infected person, from mother to child during childbirth, (regardless if the delivery is vaginal or through Caesarean section), and through contact with infected blood or body secretions among injection drug users, health care workers, first-responders, and others at risk of exposure • For the treatment of chronic hepatitis B two oral drugs – tenofovir and entecavir – and an injected drug, pegylated interferon are available and considered first-line options

6. Hepatitis C http://www.hepatitisfoundation.org/HEPATITIS/Hepatitis-C.html • Hepatitis C causes inflammation of the liver, with an estimated 80% of those infected developing chronic hepatitis. Many people infected with hepatitis C also can develop cirrhosis (scarring of the liver), and some may also develop liver cancer. • spread primarily through contact with infected blood. Less commonly, it can spread through sexual contact • prevent the disease is to reduce the risk of exposure to the virus. Reducing exposure means avoiding behaviors like sharing drug needles or personal items such as toothbrushes, razors, and nail clippers with an infected person. • HCV is not spread through kissing or casual contact. • Symptoms may be very mild and flu-like: nausea, fatigue, loss of appetite, fever, headaches, and abdominal pain

7. The challenge of recurrent hepatitis C virus in liver transplant recipients. • Marotta PJ. • Source • Multi-Organ Transplant Program, London Health Sciences Centre, London, Canada. • Abstract • Hepatitis C virus (HCV) has become the leading indication for liver transplantation

8. Hepatitis D http://www.hepatitisfoundation.org/HEPATITIS/Hepatitis-D.html • Hepatitis D (HDV) is spread through contact with infected blood. This disease only occurs as a co-infection with hepatitis B, or in anyone who are already infected with hepatitis B. • Not everyone infected with the hepatitis D virus will develop symptoms. You may develop a sudden fever, extreme tiredness, nausea, lack of appetite, abdominal or stomach pain, and yellowing of the skin or whites of the eyes. • Vaccination against HBV will prevent HDV

9. Hepatitis E http://www.hepatitisfoundation.org/HEPATITIS/Hepatitis-E.html • Acute hepatitis E is uncommon in the United States and very rarely results in chronic hepatitis, particularly in solid organ transplant recipients, patients with cirrhosis, and those on immunosuppressive therapies. • People most likely to be exposed to the hepatitis E virus include international travelers, particularly those traveling to developing countries where hepatitis E is endemic, those who come in contact with swine, and those who ingest pork products and venison.

10. Other Bloodborne Pathogens • Syphilis • Malaria • Brucellosis • Babesiosis • Leptospirosis • Arborviral Infections • Relapsing Fever • Creutzfeld-Jacobs Disease--Mad-cow • Viral Hemorrahgic Fever--Ebola

11. Blood Semen Vaginal secretions Cerebrospinal fluid Pleural fluid Pericardial fluid Peritoneal fluid Amniotic fluid Saliva in dental proc. Any visibly contaminated body fluid Any body fluid where differentiation is difficult Any unfixed tissue or organ Aqueous and vitreous humors in the eyes Potentially Infectious Materials –All Can Transmit Hepatitis B, C, and HIV

12. Other Body Fluids • These body fluids do NOT have enough virus in them to transmit disease UNLESS they are contaminated with blood • Urine • Feces • Tears • Sweat • Vomitus • Spit

13. Modes of Transmission • Stick or Cut • Splash to mucous membranes of the eyes, nose, mouth • Non-intact skin exposure

14. Universal Precautions • Must be observed • All blood and body fluids are treated as if known to be infected with HIV, HBV, HCV, etc. • Do not come into contact with another person's blood or body fluids

15. Exposure Control Plan • Employer's plan describing how compliance with the standard is achieved • Describes what employees are covered • Describes tasks that are covered • Describes post-exposure follow-up procedures • Must be reviewed and updated annually • Must be accessible to employees • Every employee should know the procedure to follow to obtain a copy

16. Exposure Control Plan • Safer Medical Devices • The Exposure Control Plan must be updated every 12 months to reflect evaluation, consideration, and selection of appropriate devices • Document in the plan the devises evaluated and those currently used • Front line employees must be involved in the selection of devices

19. Handwashing • The single most important aspect of infection control • Wash hands when contaminated with blood or body fluids and after removing personal protective equipment • Use antiseptic hand cleaner clean paper/cloth towels or antiseptic towelettes when "in the field" • Wash hands with soap and water asap

20. Needles/Sharp Objects • Use sharps with sharps injury prevention or needleless systems for all procedures involving sharps • Place in puncture resistant, labeled, leak-proof containers for transport, storage, and/or disposal • Keep the container closed • Do not bend, break, recap, or remove needles • Do not pick up contaminated broken glass directly with the hands • Do not reach by hand into containers where contaminated sharps are placed • Do not overall sharps containers

21. Eating/Drinking • Do not eat or drink in areas where there is exposure to blood or body fluids • Do not store food in refrigerators, freezers, cabinets, on shelves or countertops where blood or other body fluids are present

22. Personal Protective Equipment (PPE) • Wear PPE to prevent blood or body fluids from getting on your clothes, skin, underclothes, etc. • Must be provided at no cost to the employee • Employer must enforce the use • Must be removed prior to leaving the work area and placed in designated area

23. Parental exposure stick or cut Mucous membrane splash Non-intact skin spill or splash gloves gowns glasses/ goggles masks pocket masks shoe covers PPE

24. Decontamination • Clean and decontaminate all equipment and environmental and working surfaces after contact with blood and/or body fluids • Decontaminate with appropriate disinfectant • EPA registered tuberculocidal disinfectant • EPA registered disinfectant with label stating it is effective against HIV and HBV • Household bleach, diluted 1:10-1:100, made fresh daily

25. Contaminated Laundry • Remove contaminated clothing when it becomes contaminated • Place immediately in bag or container that is labeled • Prevent leakage

26. Regulated Waste • Sharps containers • Needles • Blades • Broken glass • Red bags • Liquid or semi-liquid blood or OPIM • Items caked with dried blood or OPIM • Items that could release blood or OPIM • Pathological waste • Microbiological waste

27. Hepatitis B Vaccination • the HBV vaccination must be offered after the employee has received training and within 10 working days of job assignment • At no cost • Provided by PLHCP • According to US Public Health Service most current recommendations • “Immunization of Health Care Workers: Recommendations of ACIP and HICPAC,” MMWR, Vol. 46, No. RR-18

28. HBV Vaccination • Employees who do not take the shots must sign a declination statement • Highly recommended • Few contraindications • Three-shot series—titer 1-2 months after last shot • No booster currently recommended • Each person must have a health care professional's written opinion • A copy must be provided to the employee within 15 days of completion of the evaluation • An employee can decline now, take the shots later

29. Written Opinion • Each person must have a health care professional's written opinion for hepatitis B vaccination • A copy must be provided to the employee within 15 days of completion of the evaluation

30. VACCINES TO PREVENT • Hepatitis A and B can be prevented through immunization. Awareness of the importance of immunizing against these diseases is growing, and new initiatives are capitalizing on this interest. • No vaccine to prevent hepatitis C is available. http://www.cdc.gov/idu/hepatitis/vaccines.pdf

31. Post-Exposure Follow-up • After exposure incident • Stick or cut • Splash • Non-intact skin exposure • At no cost • Begin ASAP after exposure incident • Report exposure incident to your supervisor or designated personnel immediately

32. Post-Exposure Follow-up • Investigation of the incident • ID source individual, obtain consent, and test their blood to determine HBV, HCV, and HIV infectivity ASAP • Results of source individual's test given to exposed person • Obtain and test exposed person's blood for HBV, HCV, and HIV serological status

33. Post-Exposure Follow-up • Post-exposure prophylaxis as indicated by CDC • “Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis” June 29, 2001, Vol 50, No. RR-11 • “Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis,” September 30, 2005, Vol 54, RR-09 • Counseling and Evaluation of reported illnesses

34. Written Opinion • The employee must be provided a copy of the Health Care Professional's Written Opinion for Post-Exposure Follow-up within 15 days of completion of the evaluation

36. Containers with contaminated items Can substitute red Labels

37. Training • For all employees listed in the Exposure Determination • At no cost to employees • During working hours • At the time of initial assignment • Annually--within 1 year of last training date • Must be opportunity for interactive questions and answers • Train employees on adopted safer needle devices before implementation

38. Training • Five Easy Questions • What is universal precautions? • What do you do when there is a blood spill? • Personal protection • Clean-up and disposal procedures • Disinfection (hazard communication applies) • What do you do with contaminated sharps and laundry? • Have you been offered the HBV vaccination free of charge? • Where is the Exposure Control Plan?

39. Additional Training • Copy of the BBP standard, 29 CFR 1910.1030, must be accessible to you • Explanation of methods of recognizing tasks that may involve exposure to blood and/or body fluids • Information on types, use, location, removal, handling, decontamination, and disposal of ppe • Basis of selection of ppe • Actions to take and persons to contact in a bloodborne emergency that you do not know how to handle • Procedure to follow if exposure incident occurs • Opportunity for interactive Q & A

40. Records • Medical records • Name and social security number • HBV vaccination status • Results of exposure incident follow-up • Health care professional's written opinions • Info provided to health care professional • Confidential

41. Records • Training • Dates • Contents • Names and qualifications of trainers • Names and titles of persons attending

42. Records • Sharps Injury Log • Per the Tennessee Sharps Injury Prevention law • Keep a log of all sharps injuries with • Type and brand of device involved in the incident • Department or work area where the incident occurred • Explanation of how the incident occurred

43. Resources • www.osha.gov www.tennessee.gov/labor-wfd/tosha • www.cdc.gov • www.cdc.gov/niosh • Memphis Office 901-543-7259 • Jackson Office 701-423-5641 • Nashville Office 615-741-2793 1-800-249-8510 • Knoxville Office 865-594-6180 • Kingsport Office 423-224-2042 • Chattanooga 423-634-6424 • Consultative Services 1-800-325-9901