Bloodborne Pathogens Standard 1991

1. BloodbornePathogens Standard 1991 Infection Control, DA103

2. Key Federal Agencies Involved • OSHA regulates and passes laws to protect employees • Occupational Safety and Health Administration • CDC recommends guidelines for infection control • Centers for Disease Control • FDA regulates medical and dental device manufacturers • Food and Drug Administration • EPA regulates actions and materials that affect the environment • Environmental Protection Agency

3. The beginnings… • Early 1980’s • Infection control focused on protecting patient from hospital-acquired infections • Little or no emphasis on healthcare workers • AIDS epidemic • Led to awareness of transmission of Bloodborne Pathogens • HBV was actually higher occupational risk to healthcare workers • CDC’s Guideline for Infection Control in Hospital Personnel 1983 • First protocols designed to protect healthcare workers

4. Later… • Mid-1980’s • Various healthcare worker groups petitioned OSHA to take action by creating formal laws to • Reduce risk to employees from exposure to various infectious agents • Protect employees from occupational exposure to HBV • Environmental Protection Agency (EPA) (1989) • Rules about tracking and managing medical wastes

5. Finally! • 1991 OSHA published “Occupational Exposure to Bloodborne Pathogens Standard” • To eliminate or minimize occupational exposure to HBV, HIV, and other bloodborne pathogens • effective in March 1992 • 1998 CDC revised Guidelines for infection control in healthcare personnel to include methods to • reduce transmission of infections from patient to healthcare personnel and from personnel to patients. • Advancements in Healthcare Technology • Food and Drug Administration (FDA) regulates medical and dental devices • 2001 OSHA published Needlestick Safety and Prevention Act

6. Who is affected by OSHA’sBloodborne Pathogens Standard? • Any type of facility in which employees might be exposed to blood and other body fluids • Dental and medical offices • Hospitals, emergency medical services, nursing homes • Funeral homes • Some states also have their own specific OSHA regulations • Must be at least as strict as the Federal regulations

7. Examples of Bloodborne Pathogens • Known to be in blood: • HBV (Hepatitis B) • HCV (Hepatitis C) • Other Non-A, Non-B Hepatitis (Hepatitis E) • HIV (Human Immunodeficiency Virus) • Other potentially infectious material (OPIM) • Saliva and other body fluids which might contain blood

8. Major Provisions • Exposure Control Plan (ECP) • Engineering and Work Practice Controls • - Personal Protective Equipment (PPE) • Vaccination, Post-Exposure Follow-up • Labeling and Training • Recordkeeping

9. Exposure Control Plan • written action plan to minimize potential occupational exposures to infectious microorganisms • specific to the individual place of employment • Includes • Exposure determination • Details “infection control procedures” • Administrative steps • Implementation date • Recordkeeping (employee training and medical) • Training

10. Exposure Determination • made without regard to use of PPE • 1. List of job classifications where all employees have exposure potential. Category I • Dentist, dental hygienist, dental assistant HIGH RISK • 2. List of job classifications where some employees have exposure. Category II • Office staff who may help out in clinical area INTERMEDIATE RISK • 3. List of job classifications which have NO exposure. NO RISK (financial secretary, insurance secretary)

11. Compliance includes • Universal Precautions • work practices which require everyone to assume that all blood and body substances are potential sources of infection, independent of perceived risk. • Engineering Controls • devices that remove the exposure hazard from the workplace. • Work Practice Controls • altering the manner in which a task is performed to reduce risk of exposure to bloodborne pathogens

12. Universal Precautions • Not possible to identify individuals who are infectious • Same precautions used for all patients

13. Engineering Controls • Sharps containers • Readily accessible – kept in or near work area • Puncture resistant / leak-proof • Labeled or color coded biohazardous waste • Ability to close • Replaced as soon as full – no pushing down to make more room • What items go into a sharps container? Burs, scalpels, matrix bands, wires • Other examples of engineering controls are Eyewash Stations Ultrasonic Cleaner Needle Recapping Device

14. Work Practice Controls • Hand washing • One handed scoop (needle recapping) • No eating, drinking or smoking in clinical area • Minimize spatter: • Using suction • Dental Dams • Proper waste disposal methods • Bloody gauze, tissue specimens, extracted teeth • Specimens in a leak proof container (biopsy tissue) • Decontaminate equipment before shipping or servicing; if not possible, label item as a biohazard • Use of PPE

15. Compliance also involves: • House keeping: • Written schedule for cleaning and disinfections • Contaminated surfaces and equipment must be cleaned at once • Use protective barriers whenever possible • Regulated containers of disposable infectious hazardous waste • Must be closeable and leak proof • Must be labeled and color coded (red, biohazard) • Must be placed in a secondary container (must also be labeled) • Dispose according to state regulations • Medical or hazardous waste hauler, must be a hired, contracted company

16. Additional Compliance Methods: • Laundry: • Employee does NOT take laundry home • This is the employers responsibility • Handling should be kept to a minimum • Transport in labeled or color coded bags • Can be washed on site (using PPE) or by a professional service

17. Vaccinations and Post-exposure Follow-up • Hepatitis B vaccination: • Recommended for all healthcare workers • 3 injections: 1st, 2nd one month after, 3rd five months after first injection Note: some people do not respond to first series and must have a second series of injections; if those don’t “take”, they probably have a natural immunity • Employer must offer vaccination series within 10 days of employment; must pay for the series • Employee can refuse to have the series, but may be asked to sign a declination waiver • Employee can change mind and have vaccination series at a later time • If CDC determines that a booster injection is recommended (in the future) the employer must also make that available to the employee

18. Why HBV? • Virus transmitted in blood • Healthcare workers are at high risk to exposure • In 2005, about 51,000 people became infected with HBV • People who are infected with HBV can spread it to others, even if they don’t appear sick. About 5-10% become “carriers” • Acute (short-term) illness. • Flu-like symptoms OR no symptoms • Seem to recover but actually develop … • Chronic (long-term) infection. • liver damage (cirrhosis) •liver cancer •death • Each year about 3,000 to 5,000 people die from cirrhosis or liver cancer caused by HBV.

19. Post-Exposure Follow-up • After you complete this lecture, please read the article entitled: Steps to Follow After a Stick Incident and answer the questions for credit

20. Sharps Injuries • All sharps injuries must be recorded in a Sharps Injuries Log • Used to help employer and staff determine situations where sharps injuries might occur AND to make engineering and work practice control changes to prevent injuries • Sharps injuries can be greatly reduced with a no-recapping policy for needles • Needle re-capping is allowed in dental offices but we must use proper precautions, such as recapping devices

21. Labeling and Training • Labels: • Biohazard: symbol and words must be visible • Fluorescent orange or orange red in color • Red bags or containers substitute for labels • Labels must be placed on: • Regulated waste (gauze, teeth, tissue, etc) • Refrigerators or freezers with OPIM or blood inside • Transport or storage containers • Contaminated equipment

22. Information and Training: • Includes all employees with possible occupational exposure (full time, part time, temps, and students) • New employees must train within 10 days of start date • Entire staff annually (at least) • Additional training when tasks modified or new ones added • Questions and answer period should be included • Review all of the Bloodborne Pathogens Standard • Document training, and keep it for 3 years • Date, trainer, who attended and subjects covered

23. Record-keeping • Medical Records: • Kept on each occupational exposed : • Vaccination status and dates • Any post-exposure documentation • Must be kept separate and confidential • Maintain for 30 years after employment ends • Training Records • Documentation of dates, trainer, who attended, subject matter • Maintain for 3 years

24. Employee Responsibility: • Cooperate and follow office policies • Training • Universal Precautions • Use PPE • Use safe work practices and engineering controls • Report unsafe situations to employer • Keep work area neat and clean • Know your job classifications and risks • Get immunized against HBV, if you are able to