Bloodborne Pathogens Standard Requirements

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.

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)

Other Bloodborne Pathogens

Syphilis Malaria Brucellosis Babesiosis Leptospirosis Arborviral Infections Relapsing Fever Creutzfeld-Jacobs Disease--Mad-cow Viral Hemorrahgic Fever--Ebola

Potentially Infectious Materials –All Can Transmit Hepatitis B, C, and HIV

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

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

Modes of Transmission

Stick or Cut Splash to mucous membranes of the eyes,

nose, mouth Non-intact skin exposure

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

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

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

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

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

Needles/Sharp Objects

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

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

PPE

Parental exposure– stick or cut

Mucous membrane– splash

Non-intact skin– spill or splash

gloves gowns glasses/ goggles masks pocket masks shoe covers

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

Contaminated Laundry

Remove contaminated clothing when it becomes contaminated

Place immediately in bag or container that is labeled

Prevent leakage

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

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

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

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

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

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

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

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

Labels

Containers with contaminated items

Can substitute red

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

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?

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

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

Records

Training– Dates

– Contents

– Names and qualifications of trainers

– Names and titles of persons attending

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

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