Bloodborne Pathogens

1. Bloodborne Pathogens Suzanne Reister, Program Manager Paula Vanderpool, Program Assistant North Central Washington Workers’ Comp Trust 509-667-7100

2. Bloodborne Pathogens Department of Safety & Health (DOSH) Chapter 296-823 WAC

3. Course Objectives • What are Bloodborne Pathogens (BBPs)? • What must I do to protect my workers? • What is, and how do I write an Exposure Control Plan? • What are the requirements of WAC 296-823?

4. Bloodborne Pathogens (BBPs) Present in Blood Other Potentially Infectious Materials or

5. Bloodborne Pathogens (BBPs) OPIM • body fluids such as pleural, cerebrospinal, pericardial, peritoneal, synovial, and amniotic • saliva in dental procedures (if blood is present) • any body fluids visibly contaminated with blood • body fluid where it is difficult to differentiate • any unfixed tissue or organ (other than intact skin) from a human (living or dead) • semen • vaginal secretions

6. Transmission of BBPs Bloodborne Pathogens can enter your body through: • a break in the skin (cut, burn, lesion, etc.) • mucus membranes (eyes, nose, mouth) • sexual contact • other modes

7. Bloodborne Pathogen Diseases

8. Transmission of BBPs Occupational Exposure • means reasonably anticipated skin, eye, mucous membrane, or parenteral (piercing of the skin) contact with blood or OPIM that may result from the performance of an employee's duties Exposure Incident • is a specific contact with blood or OPIM that is capable of transmitting a bloodborne disease

9. Exposure Control Plan Exposure Control Plan To eliminate/minimize your risk of exposure • Exposure determination • Exposure controls • Training • Hepatitis B Vaccine • Post exposure evaluation & follow-up • Recordkeeping

10. Exposure Determination Who is at risk on-the-job? In which job classifications are ... • All employees occupationally exposed? • Some employees occupationally exposed? • List the classifications • List the tasks with exposure *Determine exposure without considering the use of PPE.

11. Exposure Determination • Jobs Where All Employees Have Potential Exposure: • School nurse • First aid provider • Custodian • Teachers and parapros who work with aggressive students (biting, scratching) or with students who have special medical problems • Coaches

12. Exposure Determination • Jobs Where Some Employees Have Exposure: • Preschool and Early childhood teachers and parapros • Intervention Specialists • Maintenance (plumbers) • Therapists, Psychologists, Speech and Language Pathologists • Teachers; especially elementary • Bus Drivers • Secretaries

13. Tasks and Procedures • First aid procedures • Athletic procedures commonly involving damage to skin or mucous membranes • Vocational educational procedures involving equipment and tools which, unless properly operated, may cause injury to the skin or mucous membranes, i.e. wood & metal shops, arts & crafts, etc. • Laundering of contaminated clothing, uniforms, towels, etc.

14. Tasks and Procedures • Cleaning procedures involving blood or body fluid visibly contaminated with blood • Toilet procedures • Plumbing procedures involving maintenance and repair of bathrooms or cleaning solution disposal areas • Interaction with students known to bite and scratch • Use and disposal of hypodermic needles

15. Exposure Controls UNIVERSAL PRECAUTIONS – A system of infection control: TREAT ALL HUMAN BLOODANDOPIM AS IF KNOWN TO BE INFECTIOUS WITH A BLOODBORNE DISEASE.

16. Exposure Controls Equipment and Safer Medical Devices • Physical guard Sharps disposal containers • Closable • Puncture-resistant • Leak-proof • Labeled or color-coded • DO NOT OVERFILL!

17. Exposure Controls Safe Work Practices • Wash hands after each glove use and immediately or ASAP after exposure. • Remove PPE before leaving work area. • Flush body parts with water after contact with blood or OPIM

18. Exposure Controls Safe Work Practices Clean-up of spills and broken glassware/sharps contaminated with blood or OPIM • Wear protective eyewear and mask if splashing is anticipated • Remove glass and other sharps materials using a brush and dust pan, forceps, etc. Do not use your hands • Properly discard all materials into a sharps or puncture-resistant biohazardous waste container • Use paper/absorbent towels to soak up the spilled materials

19. Exposure Controls Safe Work Practices Clean-up of spills and broken glassware/sharps (cont.) • Clean the area with 10% bleach orEPA-registered disinfectant • Saturate the spill area with disinfectant. Leave for 10 minutes (or as specified by product manufacturer) or allow to air dry • Properly dispose of paper towels and cleaning materials into proper waste containers

20. Nitrile and vinyl gloves Exposure Controls Personal Protective Equipment (PPE) • Gloves • Latex • Nitrile • Vinyl • Utility

21. Exposure Controls Personal Protective Equipment (PPE) • Protective clothing • Lab coat • Gown • Apron • Shoe cover or boot

22. Exposure Controls Personal Protective Equipment (PPE) • Eye-Face Protection and Masks • Safety glasses with side shields • Splash goggles • Face shield • Mask

23. Exposure Controls Personal Protective Equipment (PPE) • Resuscitation Devices

24. DISINFECTANT Exposure Controls Housekeeping Maintain a clean and sanitary workplace • Written cleaning and decontamination schedule and procedures • Approved disinfectant – bleach, EPA-approved • Contaminated waste disposal methods • Laundry

25. Exposure Controls Laundry • Contaminated articles: (list items that are laundered) • Handle as little as possible • Wear PPE when handling and/or sorting: • Gloves • Gown

26. Predominantly fluorescent orange or orange/red background Lettering and symbol in contrasting color to background Exposure Controls Communication of Hazards Biohazard Labels and Signs • Must have biohazard symbol • Labels attached securely to any containers or items containing blood/OPIM • Red bags/containers may substitute for labels

27. Exposure Controls 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

28. Exposure Controls Regulated Waste - Containers • Easily accessible • Labeled or color-coded • Leak-proof, closeable • Puncture-resistant for sharps • Replaced routinely (do no overfill!)

29. Hepatitis B Vaccine • No cost to potentially exposed employee • Made available after BBP training and within 10 days of assignment • 3 shots: 0, 1, & 6 months • If decline, must sign Declination Form • vaccine available at later date if desired

30. Training • Provided to occupationally exposed employees: • At time of initial assignment • At least annually thereafter • Cover specific required elements • Interactive • Qualified trainers

31. Training Content • An accessible copy of the WAC rule • Explanation of epidemiology and symptoms of bloodborne diseases • Transmission of bloodborne diseases • Explanation of the exposure control plan • Information about PPE • Information about the Hepatitis B vaccine

32. Training Content • The use and limitations of methods that will prevent or reduce exposure (work practices, PPE equipment, etc.) • What to do when an exposure incident occurs and post-exposure evaluation • Explanation of signs, labeling, color-coding • An opportunity for questions and answers with trainer at time of the training

33. Post-exposure evaluation School District’s Responsibility: • Provide immediate medical evaluation and follow-up to exposed employee • Test blood of source person if HBV/HCV/HIV status unknown-consent required • Provide results to exposed employee • Test blood of exposed employee • Provide information to Health Care Professional (HCP)

34. Post-exposure evaluation School District’s Responsibility: (cont.) • Provide exposed employee with copy of the evaluating HCP written opinion within 15 days of completion of evaluation • Provide employee with information about laws on confidentiality for the source individual • Provide post-exposure treatment as needed, including counseling • Investigate the exposure incident

35. Recordkeeping Medical Records • For employees with exposure • Confidential • Hepatitis B vaccination status • Post-exposure evaluations • HCP’s written opinions • Information provided to HCP as required • Maintain for length of employment + 30 years

36. Recordkeeping Training Records • Dates • Content summary • Trainer name & qualifications • Attendee’s names & job titles • Maintain for 3 years

37. Plan Evaluation • Review and/or update annually • Whenever necessary to reflect changes that affect occupational exposure, including improved safety devices

38. Your Plan Specifics • Exposure determination • Identify who is responsible for: • review, update, implementation of your plan • providing PPE, equipment • providing required training • investigating exposure incidents • maintaining required records • providing information about the vaccine

39. Summary • Determine who has occupational exposure • Establish a written exposure control plan • Use exposure control methods • Provide personal protective equipment • Provide employee training • Make Hepatitis B vaccine available • Post-exposure evaluation and follow-up • Maintain medical and training records