Transcript BBP training to give to trainers

Welcome to
Bloodborne
Pathogens Training!
Please make yourself
comfortable. We will
begin promptly.
NYS Dept. of Labor, Div. Of Safety and Health
At the End of This Session,
You Will:
Know what OSHA’s
bloodborne pathogens standard
is.
Know what to do about
bloodborne pathogens in your
workplace.
Disclaimer
6
The antidote to
FEAR is
KNOWLEDGE
--Ralph Waldo Emerson
Purpose
Protect
yourself
from
bloodborne
diseases on
the job
What will we talk about?
OSHA’s Bloodborne Pathogens
Standard
How bloodborne diseases are
spread on the job
The Exposure Control Plan
How to prevent exposure
What will we talk about?
The Hepatitis B Vaccine
What to do if you are exposed
Signs and labels
What will we not talk
about?
Diseases carried in body fluids
other than blood
Off-the-job exposures
DEFINITIONS
Occupational Safety and
Health Administration
A branch of the U.S.
Department of Labor which
enforces the Occupational
Safety and Health Act of 1970.
Bloodborne Pathogens
Standard
29 CFR 1910.1030
What Is a Bloodborne
Pathogen?
An organism (“germ”) that
is
found in human blood
can cause disease in humans
Bloodborne Diseases
HIV (AIDS)
Hepatitis B
Hepatitis C
Malaria
Syphilis
Leptospirosis
CreutzfeldtJakob
Etc.
How do you catch a
bloodborne disease on the
job?
Be cut, scratched, or stuck by a
contaminated object
Get blood on skin, esp. skin with
open sores, cuts
Get blood in eyes, nose, mouth
(mucous membranes)
You Cannot Catch HIV or
Hepatitis B From
A mosquito bite
A human bite (unless the biter
has bleeding gums or mouth
sores)
Blood
Human blood
Blood components
Products made from
human blood
OPIM
Other Potentially Infectious Materials
Specific body fluids that can transmit
bloodborne pathogens, body fluids that
cannot be distinguished from each
other, unfixed human tissue or organs.
Includes saliva in dental procedures.
Regulated Waste
Liquid or semi-liquid blood
or OPIM
 Items contaminated with
blood or OPIM that can
release the substances in a
liquid or semi-liquid state if
compressed
Regulated Waste
 Items caked with
dried blood or
OPIM that can release these
materials during handling
 Contaminated sharps
 Pathological or microbiological
wastes containing blood or OPIM
Parenteral
Piercing the
skin or
mucous
membranes
Example: cuts,
scratches,
needlesticks
Occupational Exposure
“Reasonably anticipated”
skin, eye, mucous membrane
or parenteral contact with
blood or OPIM resulting from
your job duties
Exposure Incident
A specific occurrence of eye,
mouth, other mucous
membrane, non-intact skin,
or parenteral contact with
blood or OPIM
How many exposure
incidents does it
take to be infected?
Contaminated
Blood is present or
“reasonably
anticipated”
On an item or surface
How much blood
has to be on a
surface for it to be
“contaminated”?
Decontaminate
Remove, inactivate, or
destroy BBP so they cannot
transmit infectious particles
Chemical or physical means
Where on your job
can you be exposed?
On-the-job Exposure
Cut by contaminated instrument.
Body fluids splash in eye/nose/mouth.
Body fluids splash onto skin with
cuts, sores, rash,etc.
Giving first aid or CPR.
Exposure Control Plan
Your written exposure control
plan must contain the following
information:
Who is potentially exposed
Job duties or tasks with exposure
Exposure Control Plan
Personal protective equipment
(PPE) you will use.
Standard operating procedures.
Emergency procedures.
Housekeeping schedule.
Exposure Control Plan
How and when you will
comply with the
standard.
Exposure Control Plan
Which situations could use
engineering controls to
eliminate or minimize
exposure.
How you will evaluate
exposure incidents.
Exposure Control Plan
• Changes in technology
that eliminate or reduce
employee exposure.
• How you consider, select,
and use safer devices.
Exposure Control
Plan
• How you got input from nonmanagerial workers involved
in direct patient care to help
identify, evaluate and select
engineering and work practice
controls.
Exposure Control Plan
Labeling or color-coding system.
Exposure Control
Plan
Review and update
 at least annually
 whenever necessary to
reflect
new or modified tasks and
procedures
 new or revised employee positions.
Exposure Control Plan
Make available to employees
Make hard copy available
within 15 days of request.
Methods of
Compliance




Universal Precautions
Engineering Controls
Personal Protective Equipment
Housekeeping; Handling
Regulated Waste
How are these
people different?
Universal Precautions
Treating all human blood
and certain body fluids as
if they are known to be
infectious for bloodborne
diseases.
Hierarchy of Control
1. Engineering Controls
2. Work Practice Controls
3. Personal Protective
Equipment
Engineering Controls and
Work Practices
Engineering Controls
Controls (e.g., sharps disposal
containers, self-sheathing needles, safer
medical devices, such as sharps with
engineered sharps injury protections and
needleless systems) that isolate or
remove the bloodborne pathogens
hazard from the workplace.
Needleless System
A device that does not use needles
for:
 Collecting body fluids or withdrawing body
fluids after initial venous or arterial access is
established
 Administering medication or fluids
 Any other procedure involving potential
occupational exposure to bloodborne
pathogens due to percutaneous injuries from
contaminated sharps
Sharp with Engineered Sharps
Injury Protection
A non-needle sharp or a needle device
Used for
withdrawing body fluids
accessing of a vein or artery
administering medications or other fluids

With a built in safety feature or
mechanism that effectively reduces the
risk of an exposure incident
Self-retracting
needle/syringe
Other Engineering
Controls
Dust Pan and Dust Brush for
broken glass, etc.
Tongs for removing broken glass
objects
Engineering Controls and
Work Practices
You must use -- or have
considered, and documented why
you cannot use -- engineering
and work practice controls for
work operations involving
exposure to blood or OPIM
Engineering Controls
and Work Practices
must be your PRIMARY
means of reducing
exposure.
Engineering Controls
and Work Practices
You must :
• Identify opportunities for
change based upon an
evaluation of exposure
incidents;
Engineering Controls
and Work Practices
• Evaluate the various
alternatives;
• Make changes based on your
annual exposure control plan
review.
Check engineering controls often to
be sure they are still effective and
are not
 Broken
 Torn
 Cracked
 Leaking
 Overfull
Work Practice Controls
 Changes in how you do a job to
make exposure less likely.
 Example: put contaminated
instruments down on a tray
rather than hand directly to a
coworker
Work Practices
When searching
wastebasket:
Empty wastebasket onto paper
Search with your EYES, not with
your hand
Use tongs to retrieve the item
Personal Protective
Equipment (PPE)
Special clothing or equipment
worn to protect workers from
a hazard
PPE
Is a barrier between potentially
infectious material (blood, body
fluids, and materials
contaminated with blood and
body fluids) and your body.
Personal Protective
Equipment
Includes
gloves,
goggles,
apron,
masks, shoe
covers.
The employer
must provide
PPE
AT NO COST
to the
employee.
Personal Protective
Equipment
 accessible and in appropriate
sizes
 cleaned, repaired, replaced,
and disposed of as necessary
Appropriate
PPE includes
providing
hypoallergenic
gloves as
readily
available
alternative to
latex.
What’s wrong with this picture?
BIOHAZARD
What do I do if I
get blood on myself?
Exposure Site Treatment
SKIN
-wash with soap
and water
MUCOUS
MEMBRANES
- flush with water
Don’t touch
anything or
anyone if
there is blood
on your
hands.
Handwashing
Use non-abrasive soap
Use lots of running water
Wash gently, but thoroughly
Exposure Site Treatment
Antiseptics no more
effective than
soap and
water, but use
if you wish
What do I do if there is
no running water?
Use disinfectant towelettes or
cleanser like Purell
Wash with soap and running
water as soon as possible
And now, for
some exercise…
Hepatitis B Vaccine
Hep B Vaccine
Series of 3 shots over 6 months
In shoulder muscle
Made from yeast, NOT from blood
You cannot get a bloodborne disease
from the vaccine
Safe and effective
Hepatitis B Vaccination
 Make available to all occupationally
exposed employees within 10 working
days of initial assignment, after
training.
 Document any exemptions.
Hepatitis B Vaccine
Your employer must make the
vaccine available to you


at a reasonable time and
place
at no cost to you
Hepatitis B Vaccination
According to current
recommendations of U.S. Public
Health Service (Centers for
Disease Control)
CDC Guidelines are in Appendices
E,F,G of compliance directive
Hepatitis B Vaccine
Your employer does not have to offer
the vaccine if:

You already had the complete
vaccination series (3 shots over 6 mos.)
· Antibody testing shows that you
are immune
· You should not receive the vaccine
for medical reasons
Hepatitis B Vaccine
You must sign a declination
form if you do not want the
Hepatitis B vaccine.
Post-Exposure Evaluation
and Follow-up
If you have an exposure incident
on the job, immediately report
the incident to your employer.
Post-Exposure Evaluation and
Follow-up
Your employer must make available to
you a confidential medical evaluation
and follow-up:
 as soon as possible
 at a reasonable time and place
 at no cost to you
 for all bloodborne pathogens
What Do I Bring to the
Doctor?
A copy of the bloodborne
pathogens standard.
A description of what you were
doing when the exposure
incident happened.
What Do I Bring to the
Doctor?
A description of the route of
exposure (e.g., splashed in eye, cut
by sharp object, swallowed) and how
the exposure incident happened.
The source person’s blood test, if you
can get it.
Your relevant medical records.
Post-Exposure Evaluation and
Follow-up
Record all conditions surrounding the
exposure incident.
Helps decide medical treatment
Helps decide about engineering
controls and work practices to
prevent future exposures
Post-Exposure Evaluation and
Follow-up
Includes HIV and Hep B-preventing
drugs if needed.
NYS law requires HIV-preventive drug
therapy for all exposure incidents.
HBV Vaccination and PostExposure Eval/Follow-up
OSHA preempts state
standards; however—
OSHA will not cite employers
who follow more stringent
state regulations.
Post-Exposure Evaluation
& Followup
OSHA will cite employers for
offering post-exposure HIV
prophylaxis according to old
(not current) guidelines.
Healthcare Professional’s Written
Opinion
1. For hepatitis B vaccination: whether or
not you need or have had the vaccine.
2. For post exposure evaluation and followup: you have been informed of the
evaluation results and any medical
conditions that need further
treatment .
Post-Exposure Eval & F/U
(cont’d)
Healthcare Professional’s Written
Opinion
Your employer must give you the
written opinion within 15 working
days of receiving it.
Medical records
Must be kept confidential
Keep for duration of
employment plus 30 years
May be kept by the doctor who
does post-exposure procedures
Information and
Training
ALL affected employees
(including part time and
temporary) must receive initial
AND annual training.
Training
You must get training:
 when you are first assigned to a job
that may have occupational exposure
 at least once a year after that
 Retraining any time procedures or
your job duties change
Information and Training
Training must include the
following categories of
information:
Information and
Training
Contents of the standard
Epidemiology and symptoms
Modes of transmission
Exposure control plan
Job duties and tasks with
exposure
Information and
Training
Exposure controls -- types, uses,
limitations
Personal protective equipment:
types, uses, basis for selection,
location, removal, handling,
decontamination, disposal
Information and
Training
Hepatitis B vaccine -- availability,
safety, effectiveness, benefits,
method of administration
Emergency procedures
Post-exposure procedures
Signs/labels/color-coding
Q & A
Information and Training
Must be in language the
employee understands
Training Records
Keep for 3 years
Trainee’s name, title, ID #
Trainer’s name, credentials
Topics covered
Labeling
WARNING LABELS must be displayed
on:
containers of regulated waste
refrigerators or freezers containing
blood /OPIM
containers used to store, transport,
or ship blood/OPIM
Labeling
Some transport containers
require DOT labeling.
Where overlap,
 DOT label OK for outside
shipping container.
OSHA label required on inside
container.
It's a dirty job, but
somebody's got to do
it...
Housekeeping
Cleaning and
decontaminating equipment
and surfaces
Housekeeping:
Appropriate
Disinfectants
Fresh (made daily) solutions of
household bleach diluted to the
appropriate strength for the job
(for example, 1:10 to 1:100)
Housekeeping:
Appropriate
Disinfectants
EPA registered tuberculocides,
sterilants and products
specifically registered against
HBV and HIV
Housekeeping:
Appropriate
Disinfectants
see:
http:/ace.orst.edu/info/nain/lists.htm
(National Antimicrobial Information
Network, products listing)
Housekeeping:
Handling, containing and disposing of
regulated waste and contaminated
sharps
Regulated waste must be properly
contained and disposed of.
Sharps Containers
Must be:
Closable
Puncture resistant
Leakproof
Labeled
Sharps Containers
Inadequate training on
safe work practices and use
of sharps containers may
cause unnecessary exposure
Recordkeeping
Training and medical records for
each affected employee
29 CFR 1910.1020 requirements apply
(keep exposure records for duration of
employment plus 30 yrs.)
Medical records must be kept
confidential
Sharps Injury Log
You must establish and
maintain a log of
percutaneous injuries from
contaminated sharps if you
are required to maintain an
OSHA-300 log.
Sharps Injury Log
Must contain at least the following
information:
The type and brand of device
involved in the incident
The department or work area where
the exposure incident occurred
An explanation of how the incident
occurred
Sharps Injury Log
Records must protect the
confidentiality of the injured
employee.
 Keep the log for at least five
years after the year in which the
incident occurred
The Bloodborne
Diseases
What are they all
about?
Risk of HIV
Transmission
percutaneous exposure
.3%
mucous membrane exposure
.09%
skin exposure—even less
Factors Affecting
HIV Transmission Risk
Larger quantity of blood
- Device visibly contaminated with
patient’s blood
- Needle placed directly in patient
- Deep injury to worker
Source patient with terminal illness
Hepatitis B
THE major infectious hazard for
health-care workers
Much easier to get than HIV
Chronic HBV
Infection:
Consequences



Chronic active hepatitis
Cirrhosis
Liver cancer
Hepatitis C Virus (HCV)
Most common chronic
bloodborne infection in the
U.S.
Nearly 4 million Americans
infected with HCV
Most have no symptoms
Hepatitis C
Transmission
Large/repeated direct percutaneous
exposures to blood
- blood transfusions until 1992
- Intravenous drug use (60%
U.S. HCV transmission)
HCV Infection Prevalence
Characteristic
hemophilia Rx with
pre 1987 products
injecting drugs
gen. population
health care workers
HCV infection
prevalence %
87
79
1.8
1
Occupational HCV
Infection Risk
Sharps exposures from
HCV+
1.8%
Blood splashes to eye
reported
HCV - Clinical Features
incubation period
average 6-7 wks
range 2-26 wks
no discernable symptoms
60-70%
jaundice
20-30%
nonspecific (loss of appetite,
malaise, abdominal pain)
10-20%
Chronic HCV Infection
15-25% recover
75-85% develop chronic infection . Of those,
60-70% develop active liver disease
10-20% develop cirrhosis 20-30 yrs
1-5% develop liver cancer
It’s
SHOWTIME!
(Wash your hands before
passing the popcorn)
?
?
?
? QUESTIONS?
?
?
?
Sharpen your
pencils… It’s time for
a QUIZ!