BLOODBORNE PATHOGENS

1. BLOODBORNE PATHOGENS THE OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION STANDARD

2. INTRODUCTION What is the bloodborne pathogens standard? Who needs bloodborne pathogens (BBP) training? What content needs to be included? In 1991, OSHA issued regulations on occupational exposure to bloodborne pathogens. These requirements are to ensure employee safety when there is occupational exposure to disease causing microorganisms in blood or other potentially infectious materials. BBP training is required for any employee with the potential for occupational exposure to blood or other potentially infectious materials, whether you are part time, full time, temporary, or a volunteer! Annual training is required to keep up with changes in the standard. This includes any employee who might clean and dress wounds, provide emergency first aid, provide care to students where exposure to blood or other potentially infectious material (OPIM) is possible, custodial workers who clean up spills of blood or OPIM, law enforcement or correctional officers, and maintenance workers that cover healthcare facilities or clinics.. Training needs to cover: OSHA�s expectations; Bloodborne pathogens and their transmission; Occupational exposure; Immunization; Engineering controls; Work practice controls; Personal protective equipment (PPE); Universal Precautions; APS Exposure Control Plan.In 1991, OSHA issued regulations on occupational exposure to bloodborne pathogens. These requirements are to ensure employee safety when there is occupational exposure to disease causing microorganisms in blood or other potentially infectious materials. BBP training is required for any employee with the potential for occupational exposure to blood or other potentially infectious materials, whether you are part time, full time, temporary, or a volunteer! Annual training is required to keep up with changes in the standard. This includes any employee who might clean and dress wounds, provide emergency first aid, provide care to students where exposure to blood or other potentially infectious material (OPIM) is possible, custodial workers who clean up spills of blood or OPIM, law enforcement or correctional officers, and maintenance workers that cover healthcare facilities or clinics.. Training needs to cover: OSHA�s expectations; Bloodborne pathogens and their transmission; Occupational exposure; Immunization; Engineering controls; Work practice controls; Personal protective equipment (PPE); Universal Precautions; APS Exposure Control Plan.

3. OSHA�S EXPECTATIONS Employers Duties identify job risks and classify provide appropriate training provide a plan provide appropriate equipment Compliance Employees Duties follow employer�s plan know job classification complete training use equipment provided by employer Compliance Meeting OSHA�s expectations is accomplished by: Training Providing OSHA required information Providing site specific required information Documentation Ongoing observed practice Systematic review of practice Training must be provided by qualified personnel. Site specific training must be provided. The timing of the training is important and documentation is required. Training must be appropriate to the education and reading level of the participants. A qualified person must be available to answer questions during training. TIP: Training records assist the employer and OSHA in determining whether the training program adequately addresses the risk in each job.Meeting OSHA�s expectations is accomplished by: Training Providing OSHA required information Providing site specific required information Documentation Ongoing observed practice Systematic review of practice Training must be provided by qualified personnel. Site specific training must be provided. The timing of the training is important and documentation is required. Training must be appropriate to the education and reading level of the participants. A qualified person must be available to answer questions during training. TIP: Training records assist the employer and OSHA in determining whether the training program adequately addresses the risk in each job.

4. OSHA REQUIRED INFORMATION Documents General explanation of bloodborne pathogens Hepatitis B immunization Explanation of tasks that may involve exposure

5. BLOODBORNE PATHOGENS DEFINED Disease-causing microorganisms that may be present in human blood or OPIM (other potentially infectious material) Viruses Bacteria Parasites

6. MODES OF TRANSMISSION Puncture wounds or cuts Contact (touch, splash, or spray) with blood or OPIM on: mucous membrane non-intact skin cuts, abrasions, burns acne, rashes papercuts, hangnails contaminated sharps TIP: Puncture wounds most often occur when: Disposing of needles Administering injections Drawing blood Recapping needles Handling trash or dirty linensTIP: Puncture wounds most often occur when: Disposing of needles Administering injections Drawing blood Recapping needles Handling trash or dirty linens

7. RISK OF EXPOSURE Objective of BBP standard is to minimize or eliminate the hazard posed by work that may expose one to blood or OPIM

8. RISK OF EXPOSURE If a risk of exposure exists one should know: if there is a way to prevent infection symptoms and course of infection availability of counseling availability of post-exposure treatment & follow-up

9. 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

10. 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

11. 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

12. 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

13. 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

14. SPECIFIC BLOODBORNE PATHOGENS Definition Signs and symptoms Course of infection Prevention and control Post-exposure prophy-laxis and follow-up care

15. HIV DEFINED HIV is Human Immunodeficiency Virus HIV can cause acquired immune deficiency syndrome (AIDS) Risk of HIV infection from a puncture injury exposure to HIV infected blood is very low -- 0.3%

16. SIGNS & SYMPTOMS OF HIV Signs and symptoms include: Weight loss Night sweats or fever Gland swelling or pain Muscle and/or joint pain Cannot rely on signs and symptoms to confirm if one is infected

17. COURSE OF INFECTION WITH HIV Incubation period from HIV infection to AIDS can be 8 to 10 years Varies greatly among individuals

18. HIV PREVENTION There is no vaccine to prevent HIV infection Follow Universal Precautions

19. 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

20. HCV DEFINED HCV is Hepatitis C Virus It affects the liver It is most common chronic bloodborne infection in US Needlestick injury is only occupational risk factor associated with HCV Risk of HCV infection after exposure to HCV infected blood is 1.8% 70 to 75% of those with acute HCV infection have no symptoms

21. SIGNS & SYMPTOMS OF HCV Jaundice - yellow color to skin and whites of eyes Fatique Headache Abdominal Pain Loss of appetite Nausea and vomiting

22. COURSE OF HCV INFECTION Incubation period averages 7 weeks Chronic liver disease may occur in 70% of those infected with HCV

23. HCV PREVENTION No vaccine exists to prevent HCV infection Follow Universal Precautions

24. 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 treat-ment that meets most recent CDC guidelines HCV infection treatment may include liver transplant

25. HBV DEFINED HBV is Hepatitis B Virus It affects the liver Prevalence of HBV infection among healthcare workers is 10 times greater than HCV infection

26. SIGNS & SYMPTOMS OF HBV Jaundice - yellow color to the skin and whites of eyes Fatique Headache Abdominal Pain Loss of appetite Nausea and vomiting

27. COURSE OF HBV INFECTION Incubation period averages 12 weeks Most cases of HBV resolve without complications Chronic liver disease may occur in 6 to 7% of those infected with HBV

28. HBV PREVENTION A vaccine does exist to prevent HBV infection Employers are required to offer HBV vaccination HBV vaccination to employees covered under BBP standard Follow Universal Precautions

29. HBV POST-EXPOSURE PROPHYLAXIS & FOLLOW-UP No cure for HBV infection Post-exposure prophy-laxis should begin within 24 hours; no later than 7 days after exposure 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

30. HBV IMMUNIZATION Employees with routine occupational exposure to blood/OPIM have right to HepB vaccination at no personal expense Employee refusal established by signing HepB vaccination declination form Vaccine is Recombivax HB or Energix-B Must be made available within 10 working days of initial assignment to job You may change your mind at a later time and receive the vaccine as long as you are in a job covered by the standardYou may change your mind at a later time and receive the vaccine as long as you are in a job covered by the standard

31. HBV VACCINATION SCHEDULE Vaccine given in 3 doses over 6 months 1st on initial assignment 2nd one month later 3rd five months after 2nd dose CDC recommends HepB antibody 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!

32. PREVENTION Engineering Controls Work Practice Controls Personal Protective Equipment Universal Precautions

33. ENGINEERING CONTROLS Design safety into work tools and work space organization Engineering controls can: Decrease risk of exposure to hazards Eliminate hazards Isolate hazards

34. EXAMPLES OFENGINEERING CONTROLS Hand and eye washing facilities Sharps container use Biohazard labeling Self-sheathing needles Needleless IV systems

35. 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

36. SHARPS CONTAINERS MUST BE: closable and puncture resistent leak proof labeled or color-coded functional sufficient in number easily accessible and main- tained in upright position replaced per agency policy NOT be overfilled

37. SHARPS INJURY PROTECTION Reusable sharps require proper handling (mechanical means) and decontamination Retractable needles Needleless systems

38. 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

39. PROHIBITED WORK PRACTICESDO 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 eat, drink, smoke, apply cosmetics, or handle contact lenses in areas of potential occupational exposure store beverages or food in refrigerators, freezers, or cabinets where blood or OPIM are present

40. HANDWASHING Readily available facilities Washing after removing PPE Using antiseptic hand cleanser when a sink isn�t readily available

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

42. HANDWASHING Turn on tap water and adjust temperature Use plenty of soap

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

44. HANDWASHING Dry hands thoroughly DO NOT turn off the water yet

45. HANDWASHING Turn off tap with a dry part of the towel DO NOT touch surfaces with clean hands

46. 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!

47. 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

48. TYPES OF PERSONAL PROTECTIVE EQUIPMENT Gloves Masks Eye shields Gowns/aprons Resuscitation devices

49. LATEX GLOVES Medical products containing latex must be labeled Allergies to latex are increasing Substitutes for latex-containing materials must be made available

50. UNIVERSAL PRECAUTIONS Infection control approach that treats all human blood and certain body fluids as if they are known to contain bloodborne pathogens

51. MATERIALS THAT REQUIRE PRECAUTIONS Blood Semen Vaginal secretions Cerebrospinal, synovial or pleural fluid Body fluids containing visible blood Any unidentifiable body fluid Saliva from dental procedures

52. MATERIALS THAT DO NOT REQUIRE PRECAUTIONS Universal Precautions do not apply to these fluids UNLESS blood is visible: feces nasal secretions sputum ear secretions sweat urine vomitus

53. BODY SUBSTANCE ISOLATION (BSI) An acceptable alternative to Universal Precautions Treats ALL body fluids and substances as infectious

54. 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

55. QUESTIONS?