Transcript BBP Presentation

Bloodborne Pathogens
Awareness Training
1
Introduction
This is an awareness level
course that will provide
general information on
bloodborne pathogens to
help minimize serious
health risks to people who
may be exposed to blood
and other potentially
infectious materials.
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Course Agenda
Section 1: Bloodborne Pathogens: General
Information, Regulations,
Transmission, and Exposure
Section 2: Exposure Control Plan and
Compliance Methods
Section 3: Hepatitis B Vaccination and
Post-Exposure Follow-Up
Section 4: Labeling, Training, and
Recordkeeping
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Section 1
Bloodborne Pathogens:
General Information,
Regulations, Transmission,
and Exposure
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Bloodborne Pathogens
Bloodborne pathogens pose a
potential risk to approximately 8 million
U.S. workers in health care and other
areas of the workforce
OSHA’s Bloodborne Pathogens
standard, published in Title 29 of the
Code of Federal Regulations
1910.1030 prescribes safeguards to
protect these workers against
exposure to bloodborne pathogens
and other potentially infectious
materials (OPIM) and reduce the risk
from exposure
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What is a bloodborne pathogen?
Bloodborne pathogens (BBPs) means
pathogenic microorganisms that are
present in human blood and can cause
disease in humans. These pathogens
include, but are not limited to, hepatitis B
virus (HBV), hepatitis C virus (HCV), and
human immunodeficiency virus (HIV)
Blood means human blood, human blood
components, and products made from
human blood
Other potentially infectious materials
(OPIM) such as other body fluids
contaminated with visible blood
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Definition of OPIM
Other potentially infections materials (OPIM) also include
the following human body fluids: semen, vaginal
secretions, cerebrospinal fluid, synovial fluid, pleural
fluid, pericardial fluid, peritoneal fluid, amniotic fluid,
saliva in dental procedures, any body fluid that is visibly
contaminated with blood, and all body fluids in situations
where it is difficult to differentiate between body fluids.
It also includes any unfixed tissue or organ (other than
intact skin) from a human (living or dead) and HIV- or
HBV-containing culture medium or other solutions, and
blood, organs, or other tissue from experimental animals
infected with HIV or HBV.
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Regulations
Issued in 1991, OSHA’s Bloodborne Pathogens
standard, published in Title 29 of the Code of Federal
Regulations 1910.1030, is part of the Occupation Safety
and Health Act of 1970 (OSH Act) under the US.
Department of Labor
Updated in January, 2001 (changes effective April, 2001)
as a result of the Needlestick Safety and Prevention Act
issued in November 2000
Includes additional guidelines for HIV and HBV research
laboratories and production facilities
Many states administer their own occupational safety
and health programs through plans approved under the
OSH Act
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Bloodborne Pathogen
Standard Summary
Establish an Exposure Control Plan
Use engineering controls
Enforce work practice controls
Provide personal protective equipment
Make Hepatitis B vaccinations available
Provide post-exposure follow-up
Use labels and signs to communicate
hazards
Provide information and training to
employees
Maintain employee medical and training
records
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OSHA Enforcement
Inspection
Penalties/Sanctions
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Serious Violation
Other-Than-Serious Violation
Willful Violation
Repeated Violation
Failure to Correct Prior Violation
Compliance Assistance
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Who is covered by the standard?
The standard applies to all employees who may
reasonably anticipate occupational exposure to
blood or other potentially infectious materials
(OPIM).
“Good Samaritan” acts such as assisting a coworker with a laceration or nosebleed would not
be considered occupational exposure.
If an employer designates and trains employees
to render first aid or medical assistance as a part
of their job duties, they are covered by the
protections of this standard.
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Why is protection so important?
Bloodborne pathogens have the
potential to cause serious illness
and death. These pathogens
include, but are not limited to:
– Hepatitis B Virus
– Hepatitis C Virus
– Human Immunodeficiency Virus
(HIV)
Prevention is the best method of
protection against exposure to
bloodborne pathogens
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Transmission of
Bloodborne Pathogens
Transmission of bloodborne pathogens in
the occupational setting is primarily
through percutaneous (needlestick/sharps)
or mucous membrane exposure to
infected blood and body fluids
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Hepatitis B Virus Infection
A serious liver disease that can cause lifelong infection,
cirrhosis (scarring) of the liver, liver cancer, liver failure,
and death
Symptoms can include:
– Jaundice, fatigue, abdominal pain, loss of appetite, nausea,
vomiting, joint pain
– About 30-40% of people infected with HBV have no signs or
symptoms
Transmission
– By percutaneous (needlestick/sharps) or mucous membrane
exposure to blood and body fluids infected with HBV (acute or
chronic HBV)
Incubation period 45 to 180 days (avg. 60-90 days)
Can live on a dry surface for at least 7 days and still be capable of
causing infection
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Hepatitis C Virus Infection
A serious liver disease that can lead to long-term
infection, chronic liver disease, cirrhosis (scarring of the
liver), liver cancer, and death
Symptoms can include:
– Jaundice, fatigue, dark urine, abdominal pain, loss of appetite,
nausea
– About 80% of people infected with HCV have no signs or
symptoms
Transmission
– By percutaneous (needlestick/sharps) or mucous membrane
exposure to blood and body fluids infected with HCV (acute or
chronic HCV)
Incubation period is 6 to 7 weeks
Limited data on survival of HCV in the environment
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HIV Infection
HIV is the Human Immunodeficiency Virus that causes
AIDS; many people with HIV infection will develop AIDS
as a result
Symptoms may include:
– Rapid weight loss; dry cough; recurring fever or profuse night sweats;
profound and unexplained fatigue; swollen lymph glands in armpits,
groin, or neck; diarrhea lasting >1 week; white spots/blemishes on the
tongue, mouth, throat; pneumonia; red, brown, pink, or purplish blotches
on or under skin or inside the mouth, nose, or eyelids; memory loss,
depression, and other neurological disorders
Transmission
– By percutaneous (needlestick/sharps) or, infrequently, mucous
membrane exposure to blood or body fluids containing blood infected
with HIV
HIV antibody usually develops within 6 months of exposure
Does not survive well outside the body—environmental transmission is
remote
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What is Exposure?
Occupational Exposure means reasonably
anticipated skin, eye, mucous membrane, or
percutaneous contact with blood or other
potentially infectious materials (OPIM) that may
result from the performance of an employee’s
duties
Exposure Incident means a specific eye,
mouth, or other mucous membrane, non-intact
skin, or percutaneous contact with blood or
OPIM that results from the performance of an
employee’s duties
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Who is at risk for exposure?
Employers are responsible for determining the
hazard risk for exposure to bloodborne pathogens
in their company
– Assistance in determining a hazard risk in your
company is available through OSHA
Examples of who may be at risk:
– Nurses, physicians, emergency personnel
(emergency room employees, paramedics, EMTs),
and other healthcare workers, especially those
providing first-response medical care
– Laboratory and blood bank technologists and
technicians
– Dentists and other dental workers
– Law enforcement personnel and firefighters
– Houskeeping personnel and laundry workers
– Medical waste treatment employees
– Medical examiners and morticians
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How can exposure happen?
The most common means of
exposure is from
percutaneous injuries
(through the skin) with
contaminated sharps
(needles and scalpels) (82%)
Contact with mucous
membranes of the eyes,
nose, or mouth (14%)
Exposure of broken or
abraded skin (3%)
Human bites (1%)
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How can exposure be prevented?
Universal Precautions
– Treat all blood and body fluids as potentially infectious
Immunization with the Hepatitis B Virus Vaccine
Engineering Controls
– Safer medical devices for medical procedures and
sharps disposal
Work Practice Controls
– Safer techniques for medical procedures
– Personal Protective Equipment (PPE)
Appropriate barriers such as gloves, gowns, eye and face
protection
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Section 1 Q & A
Any questions on information
covered in this section?
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Section 2
Exposure Control Plan and
Compliance Methods
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Exposure Control Plan
Each employer must establish an Exposure Control Plan
(ECP) to eliminate or minimize employee exposures
Must be written
Must be reviewed annually and updated, as necessary,
to reflect changes in:
– Technology that will help eliminate or reduce exposure
– Employee tasks, assignments, procedures which affect exposure
Annually document that employer has considered and
implemented safer medical devices (if feasible)
– Employers must solicit input from frontline workers (potentially
exposed) in identifying, evaluating, and selecting engineering
controls
Plan must be accessible to employees
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Exposure Control Plan
Exposure Determination
– Identify worker exposure to blood or
OPIM
– Review all processes and procedures
with exposure potential
– Re-evaluate when new processes or
procedures are used
Exposure determination must be
made without regard to the use of
personal protective equipment
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Engineering and
Work Practice Controls
Employer Responsibility:
Review/evaluate available engineering
controls (safer medical devices) at
least annually
– Document review/evaluation in ECP
Review new devices and technologies
at least annually
– Must solicit input from non-managerial
employees in the selection of controls
– Document review in ECP
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Engineering and
Work Practice Controls
Employer Responsibility:
Implement engineering controls/devices as
appropriate
– Document evaluation and implementation in ECP
– Controls must be used if they reduce employee
exposure either by removing, eliminating, or isolating
the hazard
Train employees on safe use and disposal
– Document in ECP
Train employees to use current and new devices
and/or procedures
– Document in ECP
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Compliance Methods
Universal Precautions
Engineering and Work
Practice Controls
Personal Protective
Equipment
Housekeeping
– Laundry
– Regulated Waste
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Universal Precautions
OSHA’s required method of control to protect employees
from exposure to all human blood and OPIM
Refers to a concept of bloodborne disease control which
requires that all human blood and certain human body
fluids are treated as if known to be infectious for HIV,
HBV, HCV and other bloodborne pathogens
Must be observed in all situations where there is a
potential for contact with blood or OPIM
Intended to prevent percutaneous, mucous membrane,
and non-intact skin exposure to bloodborne pathogens
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Engineering Controls
Primary methods used to control
transmission of bloodborne pathogens
Controls that reduce employee exposure
to bloodborne pathogens in the
workplace by isolating or removing the
hazard from the workplace
– Sharps disposal containers
– Self-sheathing needles
– Safer medical devices
Sharps with engineered sharps injury
protections
Needleless systems
OSHA does not approve or endorse any
medical device product
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Work Practice Controls
Controls that reduce the likelihood of exposure
by altering the manner in which a task is
performed
– Handwashing
After removing gloves
As soon as possible after exposure
Use of gloves does not eliminate the need for
handwashing!
– Needle and Sharps Safety
Do not recap needles with 2-handed technique
Do not bend or break sharps
Use appropriate containers for disposal or re-use
– Perform procedures involving blood or OPIM to
minimize splashing, spraying, spattering and
generation of droplets
– No food or smoking in work areas
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Personal Protective Equipment
Specialized clothing or equipment worn by an
employee for protection against potentially
infectious materials
General work clothes (e.g., uniforms, pants,
shirts or blouses) not intended to function as
protection against a hazard are not considered
to be personal protective equipment (PPE)
Employers must provide “appropriate” PPE at no
cost to employees
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Personal Protective Equipment
PPE must be properly used, cleaned,
decontaminated, laundered, repaired, and
disposed of at no cost to employees
– The manufacturer’s instructions for use, cleaning, and
decontamination must be followed in order for PPE to
remain effective
Must be removed when leaving the area or upon
contamination with potentially infectious
materials
– DO NOT take PPE home to launder, clean, or
disinfect
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Personal Protective Equipment
Examples of PPE:
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Gloves
Gowns, Aprons, Laboratory Coats
Surgical caps, hoods, shoe covers
Face shields or masks and eye
protection
– Mouthpieces, resuscitation bags,
pocket masks, or other ventilation
devices
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Housekeeping
Ensure that the worksite is maintained in a
clean and sanitary condition
Determine and implement an appropriate
written schedule for cleaning and method of
decontamination based upon:
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Location within the facility
Type of surface to be cleaned
Type of soil present
Tasks or procedures being performed in the area
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Housekeeping
Work surfaces must be decontaminated
with an appropriate disinfectant:
– After contact with blood or OPIM
– Completion of procedures
– Immediately or as soon as feasible with
obvious contamination or after any spill of
blood or OPIM
– At the end of the work shift
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Laundry
Handle contaminated laundry as little as
possible using appropriate PPE
Place and transport in labeled or colorcoded bags or containers at the location
where used
– Wet laundry with potential for leakage must be
placed and transported in bags or containers
that prevent leakage of fluids to the exterior
No sorting or rinsing at location where
used
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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 that are caked with dried
blood or OPIM and are capable of
releasing these materials during
handling
Contaminated sharps
Pathological and microbiological
wastes containing blood or OPIM
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Regulated Waste
Must be placed in closeable, leakproof containers built to contain all
contents during handling, storing,
transporting, or shipping and be
appropriately labeled or colorcoded
Close prior to removal
If outside contamination of the
regulated waste container occurs, it
should be placed in a second
container that meets the above
requirements
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Regulated Waste
Additional requirements for discarding and
containing contaminated sharps:
– Discard immediately or as soon as feasible
– Containers must be puncture resistant and
leak-proof on sides and bottom
– During use, sharps containers should be
Easily accessible to personnel in the immediate
area where sharps are used/found
Maintained upright throughout use
Replaced routinely and not be allowed to overfill
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Section 2 Q & A
Any questions on
information covered in this
section?
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Section 3
Hepatitis B Vaccination and
Post-Exposure Follow-up
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Hepatitis B Vaccination
Employers must make the Hepatitis B
Vaccine available to all employees at
risk of exposure:
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Within 10 working days of initial assignment
Free of charge
At a reasonable time and place
Vaccination must be performed by or under
the supervision of a licensed healthcare
professional
The following are exceptions:
– Employee has had the vaccination
– Antibody testing reveals immunity
– Vaccine is contraindicated for medical
reasons
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Hepatitis B Vaccination
Employees who decline vaccination must sign a
declination form
Employers must provide the vaccination to
Employees who decline and then at a later date
decide to accept the vaccination
Employers cannot require employees to
participate in an antibody prescreening program
in order to receive the vaccination
Employers must provide a booster dose(s) of the
vaccine if it is recommended by the US Public
Health Service at a future date
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What happens if an
exposure occurs?
Wash exposed area with soap and
water
Flush splashes to the nose, mouth or
skin with water
Irrigate eyes with water, saline, or
sterile irrigants
Report the exposure
Seek the assistance of a health care
professional to determine what
follow-up actions or treatment may
be needed
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Post-Exposure Follow-up
Employer must immediately make available to the
employee a confidential medical examination and followup
Document date and time of exposure
Document routes of exposure and how the exposure
occurred
Identification of the source individual (if feasible and
allowable by applicable laws)
– Obtain consent from source individual for blood to be tested as
soon as feasible (unless there is a known HBV or HIV infection)
– Results to be made available to the exposed employee
Obtain exposed employee’s consent for blood to be
collected and tested as soon as feasible
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Post-Exposure Follow-up
Record injuries from contaminated sharps in a
sharps injury log
Provide risk counseling and offer post-exposure
protective treatment for disease, when
recommended by a healthcare professional in
accordance with current US Public Health
Service guidelines
Provide written opinion of findings to employer
and copy to employee within 15 days of the
evaluation
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Section 3 Q & A
Any questions on
information covered in
this section?
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Section 4
Labeling, Training, and
Recordkeeping
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Biohazard Warning Labels
Warning labels must be
predominantly fluorescent orange or
orange-red with lettering and
symbols in a contrasting color
Warning labels are required for:
– Containers of regulated waste
– Refrigerators and freezers containing
blood or OPIM
– Other containers used to store,
transport or ship blood or OPIM
Red bags or red containers may be
substituted for labels
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Training
Employers must ensure that all employees with
occupational exposure participate in a training
program
– Provided at no cost and during working hours
– Provided at the time of initial assignment to tasks with
occupational exposure (and at least annually)
– Provide additional training when existing tasks are modified
or new tasks are required which affect the employee’s
potential exposure
Maintain training records for 3 years
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Training Elements
Copy of the standard with explanation of the contents
Epidemiology and symptoms of bloodborne disease;
modes of transmission of bloodborne pathogens
Exposure Control Plan specific to the site
Recognition of hazards
Use of engineering controls, work practices and PPE
Exposure Incidents and Post-exposure follow-up
Labels/signs/color coding
Opportunity for live question and answer session
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Recordkeeping
Medical Records
Medical Recordkeeping for Employee
Exposure must include:
– Employee’s name and social security number
– Employee’s hepatitis B vaccination status
– Results of all examinations, medical testing,
and follow-up procedures
– Copy of information provided to the
healthcare professional
– Employer’s copy of the healthcare
professional’s written opinion
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Recordkeeping
Medical Records
Employee medical records:
– Must be kept CONFIDENTIAL
– Not disclosed or reported to any
person within or outside the
workplace without the employee’s
written consent (unless required by
law and/or this regulation)
– Maintained for the duration of
employee’s employment plus 30
years
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Recordkeeping
Training Records
Training Record maintenance is
required for 3 years from the training
date. The following information must
be included:
– Dates of the training
– Contents or summary of the training
– Names and qualifications of persons
conducting the training
– Names and job titles of all persons
attending the training
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Recordkeeping
Sharps Injury Log
Employers must establish and maintain a sharps
injury log to record injuries from contaminated
sharps
The log must be maintained in a way to ensure
employee privacy
The log must at a minimum contain:
– Type and brand of device involved in the incident
– Location where the incident occurred
– Explanation of how the incident occurred
Requirement applies to any employer who is
required to maintain a log of occupational injuries
and illnesses under 29 CFR 1904
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Section 4 Q & A
Any questions on
information covered in this
section?
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Summary
OSHA’s Bloodborne Pathogens Standard is intended to
provide safeguards to protect workers against the health
hazards from exposure to blood and other potentially
infectious materials (OPIM) and to reduce the risk from
exposure
– Create a safer work environment through the use of engineering
and work practice controls
– Reduce the risk of exposure by the proper use of personal
protective equipment and through proper housekeeping and
waste handling and disposal
– Provide guidance on handling an exposure incident
Implementation of this standard is expected to prevent
hepatitis B cases and significantly reduce the risk of
occupationally-acquired HIV, hepatitis C, and other
bloodborne pathogens
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Q&A
Any questions on any
information covered in this
course?
Test your knowledge of
Bloodborne Pathogens…..
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References
29 CFR 1910.1030 Bloodborne Pathogens
OSHA’s website at: http://www.osha.gov
CDC website at: http://www.cdc.gov
NIOSH website at:
http://www.cdc.gov/niosh/topics/bbp/
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Where to Get More Information
Regional OSHA office for Pennsylvania
(Region III, DE, DC, MD, PA, VA, WV):
Regional Office
U.S. Department of Labor/OSHA
The Curtis Center-Suite 740 West
170 S. Independence Mall West
Philadelphia, PA 19106-3309
TELE: (215) 861-4900
FAX: (215) 861-4904
Pittsburgh Area Office
Federal Office Building, Room 1428
1000 Liberty Avenue
Pittsburgh, Pennsylvania 15222-4101
(412) 395-4903
(412) 395-6380 FAX
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