Bloodborne Pathogens Awareness Training

Bloodborne Pathogens Awareness Training

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. Version 1

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 Version 1

Section 1 Bloodborne Pathogens: General Information, Regulations, Transmission, and Exposure

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 prescribes safeguards to protect these workers against exposure to bloodborne pathogens and other potentially infectious materials (OPIM) and reduce the risk from exposure Version 1

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 Blood is the single most important source of HIV, HBV, and other bloodborne pathogens in the occupational setting. This standard does not apply to animal blood unless the animal has been purposely infected with HIV or HBV. Persons handling animals or animal blood should follow general precautions as recommended by the Centers for Disease Control/National Institutes of Health Publication, Biosafety in Microbiological and Biomedical Laboratories (Publication No ). Version 1

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. Version 1

Regulations Issued in 1991, OSHA’s Bloodborne Pathogens standard, published in Title 29 of the Code of Federal Regulations , 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 Needlestick Safety and Prevention Act (Act): Because of exposure to bloodborne pathogens from accidental sharps injuries in healthcare and other occupational settings continued to be a serious problem, OSHA’s Bloodborne Pathogens Standard was modified to provide greater detail of the requirement for employers to identify, evaluate, and implement safer medical devices. The Act also mandated additional requirements for maintaining a sharps injury log and for the involvement of non-managerial health care workers in evaluating and choosing devices. Version 1

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 Version 1

OSHA Enforcement Inspection Penalties/Sanctions Compliance Assistance
Serious Violation Other-Than-Serious Violation Willful Violation Repeated Violation Failure to Correct Prior Violation Compliance Assistance OSHA compliance safety and health officers (CSHOs) inspect covered establishments. Inspections can be programmed (routine) or unprogrammed (in response to fatalities, catastrophes, and complaints). The types of violations can carry monetary penalties. The amount of the penalty will depend on the type, severity, and employer’s demonstrated efforts to comply with the Act. Compliance assistance through a consultation is available to employers who want help in establishing and maintaining safe and healthful workplaces. It is provided at no cost to the employer. The service is primarily targeted toward smaller employers with hazardous operations. Version 1

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 co-worker 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. The standard applies to all employers with employees who have occupational exposure to blood or OPIM, regardless of how many workers are employed. However, workplaces with 10 or fewer employees are exempt from OSHA recordkeeping requirements and are also exempt from recording and maintaining a Sharps Injury Log. All other applicable provisions of the Bloodborne Pathogens Standard still apply. Version 1

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 Important factors that influence the overall risk for occupational exposures to bloodborne pathogens include the number of infected individuals in the patient population and the type and number of blood contacts. Most exposures do not result in infection. The risk of infection after a specific exposure may vary with the following factors: Pathogen involved Type of exposure Amount of blood involved in the exposure Amount of virus in the patient’s blood at the time of exposure Version 1

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 Percutaneous means piercing the skin. Other potential modes of transmission include (depending on the pathogen): Unprotected sexual contact with an infected person (primarily HBV and HIV) By sharing needles and/or syringes (primarily for drug injection) with someone who is infected (HBV, HCV, HIV) Through transfusions of infected blood or blood clotting factors (less common) From an infected mother to her baby during birth (HBV, HCV, HIV) Through breastfeeding after birth (primarily HIV) Version 1

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 days) Can live on a dry surface for at least 7 days and still be capable of causing infection Essentially a bloodborne virus with other bodily fluids being infectious, most often semen and saliva. Risk of infection after exposure with a percutaneous injury is 6-30%. HBV is 100 times more infectious than HIV. Number of new infections per year declined from an average of 160,000 in the 1980s to about 73,000 in 2003. Greatest decline is among children and adolescents due to the routine hepatitis B vaccination. About 5,000 people die each year of disease caused by HBV. During 1984 to 1995, an estimated 100 to 200 health care personnel died annually as a result of occupationally-acquired HBV infection. Hepatitis B virus vaccine has been available since 1982 and is the best protection against HBV. Version 1

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 HCV is not transmitted efficiently through occupational exposures to blood. The average incidence after accidental percutaneous exposure is approximately 1.8%. Transmission rarely occurs from mucous membrane exposures to blood, and no transmission in health care personnel has been documented from intact or non-intact skin exposures to blood. Environmental contamination: Recent studies suggest HCV may survive on environmental surfaces at room temperature at least 16 hours, but no longer than 4 days. The epidemiologic data for HCV suggest that environmental contamination is not a significant risk for transmission in the health-care setting with the possible exception of the hemodialysis setting. The risk for transmission from exposure to fluids or tissues other than HCV-infected blood is expected to be low. No vaccine available to prevent infection. 70-80% of persons who have acute HCV develop chronic disease. It is the leading indication for liver transplants. HCV is a more frequent cause of chronic liver disease than hepatitis B. Currently, an estimated 3.0 million Americans (nearly 2% of the population) are chronically infected with HCV. 8,000 to 10,000 people die in the US each year because of hepatitis C related cirrhosis or HCV related liver cancer. Version 1

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 Symptoms are similar to symptoms of many other illnesses; a blood test is needed to confirm HIV infection. Average risk of HIV transmission after a percutaneous exposure to HIV-infected blood is estimated to be 0.3% and after a mucous membrane exposure, approximately 0.09%. The average risk for transmission after non-intact skin exposure is estimated to be less than the risk for mucous membrane exposures. The risk for transmission after exposure to fluids or tissues (other than HIV-infected blood) is probably considerably lower than for blood exposures. Factors that determine the health care personnel’s risk of infection with HIV include the prevalence of infection among patients, the frequency and nature of exposures, and the quantity of blood from the source person the health care personnel is exposed to. HIV-infected persons are likely to transmit the virus from the time of early infection throughout life. At the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the US were living with HIV/AIDS; 24-27% were undiagnosed and unaware of their HIV infection. Version 1

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 Needlesticks and sharps are examples of percutaneous exposure (also referred to as parenteral). Non-intact skin: chapped skin, abrasions, dermatitis, scratches, cuts, burns, or other lesions. Version 1

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 Exposure to bloodborne pathogens is not limited to workers in these occupations. Anyone handling any item that has come in contact with human blood or OPIM, such as workers handling used medical equipment or devices could be at risk for exposure to BBPs. Free workplace consultations are available in every state to small businesses that want on-site help establishing safety and health programs and identifying and correcting workplace hazards. OSHA has a network of over 70 Compliance Assistance Specialists in local offices available to provide employers and employees tailored information and training. Version 1

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%) The most common percutaneous injury is a needlestick. An estimated 600,000 to 800,000 percutaneous injuries occur each year in the US. Contaminated sharps is any contaminated object that can penetrate the skin (includes, but not limited to, needles, scalpels, broken glass, broken capillary tubes, exposed ends of dental wires, etc.) Version 1

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 All of these preventative measures will be covered in detail in Sections 2 and 3 of this course. Version 1

Section 1 Q & A Any questions on information covered in this section?
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Exposure Control Plan and Compliance Methods
Section 2 Exposure Control Plan and Compliance Methods

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 At a minimum, the plan must be reviewed annually. However, whenever changes in risks, procedures, or employee positions affect or create new occupational exposure, the existing plan must be reviewed and updated accordingly. The following are examples of employees who must be consulted when considering and implementing safer medical devices: non-managerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps. Small medical offices may want to seek input from all employees when making a decision. Large facilities may select employees to represent the range of exposure situations encountered in the workplace. The solicitation of employees who have been involved in the input and evaluation process must be documented in the ECP. Your employer can instruct you on how to obtain a written copy of their Exposure Control Plan, if desired. Version 1

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 Exposure determination: List of all job classifications in which all employees in those classifications have occupational exposure List of job classifications in which some employees have occupational exposure List of tasks and procedures or groups of closely related task and procedures in which occupational exposure occurs and that are performed by employees in job classifications Version 1

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 Version 1

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 Version 1

Compliance Methods Universal Precautions
Engineering and Work Practice Controls Personal Protective Equipment Housekeeping Laundry Regulated Waste Version 1

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 WHEN IN DOUBT, USE UNIVERSAL PRECAUTIONS!!! You may remember the precursor to universal precautions, “Blood and Body Fluid Precautions.” Immunization with the HBV vaccine is recommended as an important adjunct to universal precautions (covered in more detail in Section 3). Universal precautions apply to blood and to other body fluids containing visible blood. There is documented evicence of occupational transmission of HIV and HBV to health care workers by blood. Universal precautions also apply to semen and vaginal secretions. Although both of these fluids have been implicated in the sexual transmission of HIV and HBV, they have not been implicated in occupational transmission from patient to health-care worker. Exposure to semen in the usual health-care setting is limited, and the routine practice of wearing gloves for performing vaginal examinations protects health care workers from exposure to potentially infectious vaginal secretions. Universal precautions also apply to tissues and to the following fluids: cerebrospinal fluid (CSF), synovial fluid, pleural fluid, peritoneal fluid, periocardial fluid, and amniotic fluid. The risk of transmission of HIV and HBV from these fluids is unknown; epidemiologic studies in the health care community setting are currently inadequate to assess the potential risk to health care workers from occupational exposures to them. Universal precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomitus unless they contain visible blood. Version 1

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 Engineering and work practice controls must be used to eliminate or minimize employee exposure. Engineering controls may not completely eliminate a hazard, but may reduce the hazard. When occupational exposure remains after instituting these controls, personal protective equipment (PPE) must be used. Devices must be used properly according to the manufacturer’s instructions and specifications in order to provide protection. It is the employer’s responsibility to determine which engineering controls are appropriate for specific hazards based on what is appropriate to the specific medical procedures being conducted, what is feasible, and what is commercially available. Needleless systems are devices that do not use a needle for the collection of body fluids, administration of medication/fluids, and any other procedure with potential percutaneous exposure to a contaminated sharp. An example is a jet injection system for the delivery of medications. Version 1

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 Handwashing remains one of the most effective defenses in the spread of not only bloodborne pathogens, but other disease-causing pathogens. Employers must provide handwashing facilities that are readily accessible to employees; if providing a handwashing facility is not feasible, an appropriate antiseptic hand cleanser in conjunction with clean cloth/paper towels or antiseptic towelettes must be provided. Hands must be washed with soap and running water as soon as is feasible. Eyewash stations must also be available if there is a potential for eye exposure. Contaminated needles and sharps must not be bent, recapped, or removed with these exceptions * Employer can demonstrate that no feasible alternative exists or that such action is required by a specific medical or dental procedure * Bending, recapping or needle removal must be accomplished through the use of a mechanical device or one-handed technique Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibitied in work areas where there is a reasonable likelihood of occupational exposure. Food and drink should not be kept in refrigerators, freezers, shelves, cabinets or on countertops or benchtops where blood or OPIM are present. Version 1

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 PPE may not completely eliminate exposure, as needles and sharps can potentially penetrate some PPE such as gloves and gowns. Personal protective equipment will be considered “appropriate” only if it does not permit blood or other potentially infectious materials to pass through to or reach the employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used. The employer must ensure that the employee uses appropriate PPE. In rare instances, an employee may use professional judgment to determine that in a specific instance, the use of PPE would have prevented the delivery of health care or public safety services or would have posed an increased hazard to the safety of the worker or co-worker. When the employee makes this judgment, the circumstances must be investigated and documented in order to determine whether changes can be instituted to prevent such occurrences in the future. Version 1

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 Employers must ensure that appropriate PPE is readily accessible in the appropriate sizes at the worksite or is issued to employees. If a PPE is not available in an employee’s particular size, the employee should inform the employer as soon as possible so that the appropriate size PPE can be ordered, if available. If a garment is penetrated by blood or OPIM, the garment shall be removed immediately or as soon as is feasible. Version 1

Examples of PPE: 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 Gloves are to be worn when it can be reasonably anticipated that the employee may have hand contact with blood, OPIM, mucous membranes, and non-intact skin; when performing vascular access procedures and when handling or touching contaminated items or surfaces. Gloves can reduce hand contamination by 70-80%. Long or artificial nails can puncture some gloves rendering them ineffective as protective equipment. For employees who are allergic to gloves (or latex), employers must make other alternatives available and readily accessible such as: hypo-allergenic gloves, glove liners, powderless gloves, etc. When feasible, an employer may wish to use disposable PPE to eliminate cleaning of items. NOTE: The only exception to requirement of gloves: if an employer in a volunteer blood donation center judges that routine gloving for all phlebotomies is not necessary, then the employer shall make gloves available to all employees who wish to use them for phlebotomy, periodically reevaluate the policy, not discourage the use of gloves for phlebotomy. The employer must require that gloves be worn in the following situations: when the employee has cuts, scratches, or other breaks in his/her skin; when the employee judges that hand contamination with blood may occur, for example, when performing phlebotomy on an uncooperative individual; and when the employee is receiving training in phlebotomy. Version 1

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: Location within the facility Type of surface to be cleaned Type of soil present Tasks or procedures being performed in the area Worksite also refers to permanent fixed facilities such as hospitals, dental/medical offices, etc. and also includes temporary non-fixed workplaces such as ambulances, blood mobiles, etc. Decontamination means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or items is rendered safe for handling, use, or disposal. Version 1

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 Appropriate disinfectants include: Diluted bleach solution EPA registered tuberculocides and sterilants The lists of EPA Registered Products are available from the National Antimicrobial Information Network at (800) Protective coverings (plastic wrap, aluminum foil, etc.) used to cover equipment and surfaces must be removed and replaced as soon as feasible when obviously contaminated or at the end of the workshift (if contaminated during the shift). All bins, pails, cans, and similar receptacles intended for reuse which have a reasonable likelihood of contamination with blood or OPIM would be inspected and decontaminated on a regularly scheduled basis; also cleaned and decontaminated immediately or as soon as feasible upon visible contamination. Broken glassware which may be contaminated should not be picked up directly with the hands, but should be cleaned up using mechanical means such as a brush and dust pan, tongs, or forceps. Reusable sharps that are contaminated with blood or OPIM must not be stored or processed in a manner that requires employees to reach by hand into the containers where the sharps have been placed. Version 1

Laundry Handle contaminated laundry as little as possible using appropriate PPE Place and transport in labeled or color-coded 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 When a facility uses Universal Precautions in the handling of all soiled laundry, alternative labeling or color-coding is sufficient if it permits all employees to recognize the containers as requiring compliance with Universal Precautions. When a facility ships contaminated laundry off-site to a second facility which does not use Universal Precautions in the handling of all laundry, the facility generating the contaminated laundry must place such laundry in bags or containers which are labeled or color-coded in accordance with the regulation. Version 1

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 Can also include PPE that has been contaminated with blood or OPIM that meets these criteria. Version 1

Regulated Waste Must be placed in closeable, leak-proof containers built to contain all contents during handling, storing, transporting, or shipping and be appropriately labeled or color-coded 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 Disposal of all regulated waste should be in accordance with applicable regulations of the United States, States and Territories, and political subdivisions of States and Territories. The standard requires that all equipment that may be contaminated must be examined and decontaminated as necessary prior to servicing or shipping. If complete decontamination is not feasible, the equipment must be labeled with the required biohazard label which also specifically identifies which portions of the equipment remain contaminated. In addition, the employer must ensure that this information is conveyed to the affected employees, servicing representative, and/or the manufacturer, as appropriate, prior to handling, servicing, or shipping. Version 1

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 When moving containers of contaminated sharps from the area of use, the containers must be closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling, storage, transport, or shipping. Version 1

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Hepatitis B Vaccination and Post-Exposure Follow-up
Section 3 Hepatitis B Vaccination and Post-Exposure Follow-up

Hepatitis B Vaccination
Employers must make the Hepatitis B Vaccine available to all employees at risk of exposure: 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 More than 90% of those vaccinated will develop immunity to the hepatitis B virus. The hepatitis B vaccination is a noninfectious, yeast-based vaccine given in 3 intramuscular injections in the arm (using 1 -1/2 inch needle). It is prepared from recombinant yeast cultures, rather than human blood or plasma. Thus, there is no risk of contamination from other bloodborne pathogens nor is there any chance of developing HBV from the vaccine. The second injection should be given one month after the first, and the third injection six months after the initial dose. To ensure immunity, it is important for individuals to receive all three injections. It is not yet known how long the immunity lasts, so booster shots may be required at some point in the future. If the vaccine series is interrupted after the 1st dose, administer the 2nd dose ASAP; the 2nd and 3rd doses should be separated by at least 2 months; if only the 3rd dose is delayed, administer when convenient. Recipients of the vaccine can be tested 1-2 months after completion of the HBV vaccine series to check immunity, but the standard does not require the testing. The vaccine causes no harm to those who are already immune or to those who may be HBV carriers. Although employees may opt to have their blood tested for antibodies to determine need for the vaccine, employers may not make such a screening a condition of receiving the vaccination nor are employers required to provide prescreening. Health care personnel who have received the HBV vaccine and developed immunity to the virus are at virtually no risk for infection with HBV. Version 1

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 Employees have the right to refuse the hepatitis B vaccine and/or any post-exposure evaluation and follow-up. It is important to note, however, that the employee needs to be properly informed of the benefits of the vaccination and post-exposure evaluation through training. The employee also has the right to decide to take the vaccination at a later date if he or she so chooses. The employer must make the vaccination available at that time. If an employee declines the hepatitis B vaccination, the employer must ensure that the employee signs a hepatitis B vaccine declination. The declination's wording must be identical to that found in Appendix A of the standard. A photocopy of the Appendix may be used as a declination form, or the words can be typed or written onto a separate document. The following text for declination of the hepatitis B Vaccination is required: “I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me.” Version 1

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 The ultimate goal is to avoid exposure incidents. In the event of an exposure incident, you need to know what to do. You must check with your employer for names of persons to contact in the case of emergency and if an exposure occurs. Use of antiseptics is not contraindicated, however, no evidence exists that using antiseptics for wound care or expressing fluid by squeezing of the wound further reduces the risk of BBP transmission. Application of caustic agents (e.g., bleach) or the injection of antiseptics or disinfectants into the wound is NOT recommended. Refer to the CDC’s MMWR (Morbidity and Mortality Weekly Report): Updated US Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure prophylaxis. Generally, for exposure incidents, treatment should be implemented as soon as possible after the exposure (preferably within 24 hours), and no later than 7 days. The worker must receive a confidential medical evaluation from a licensed health care professional with appropriate follow-up. To the extent possible by law, the employer is to determine the source individual for HBV as well as HIV infectivity. The worker’s blood will also be screened, if he or she agrees. The health care professional is to follow the guidelines of the US Public Health Service in providing treatment. This would include hepatitis B vaccination. The health care professional must give a written opinion on whether or not vaccination is recommended and whether the employee received it. Only this information is reported to the employer. Employee medical records MUST remain CONFIDENTIAL. HIV or HBV status must NOT be reported to the employer. Version 1

Post-Exposure Follow-up
Employer must immediately make available to the employee a confidential medical examination and follow-up 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 The employer must ensure that the healthcare professional evaluating the exposed employee and/or responsible for the hepatitis B vaccination is provided with: (1) A copy of the BBP regulation ; (2) A description of the exposed employee’s duties as they relate to the exposure incident; (3) Documentation of the route(s) of exposure and how the exposure occurred; (4) Results of the source individual’s blood testing, if available; (5) All medical records relevant to the appropriate treatment of the employee including vaccination status, which are the employer’s responsibility to maintain. If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample must be preserved for at least 90 days. If within 90 days of the exposure incident, the employee elects to have the baseline sample testing, such testing is to be done as soon as feasible. Version 1

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 All employers required to maintain a log of occupational injuries and illnesses under 29 CFR 1904 must establish and maintain a sharps injury log. The standard requires that the employee be provided with post-exposure counseling following an exposure incident. Counseling should include USPHS recommendations for transmission and prevention of HIV. The healthcare professional’s written opinion for post-exposure follow-up is limited to: (1) Whether the hepatitis B vaccination is indicated and if the employee received it; (2) That the employee has been informed of the results of the evaluation; (3) That the employee has been told about any medical conditions resulting from the exposure which require further evaluation or treatment. All other findings or diagnoses will remain confidential and will not be included in the written report. Version 1

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Labeling, Training, and Recordkeeping
Section 4 Labeling, Training, and Recordkeeping

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 Warning labels must be affixed as close as feasible to the container by string, wire, adhesive, or other method that prevents their loss or unintentional removal Containers of blood, blood components, or blood products that are labeled with their contents and have been released for transfusion or other clinical use are exempted from the labeling requirements. Individual containers of blood or OPIM that are placed in a labeled container during storage, transport, shipment or disposal are exempted from the labeling requirement. Labels required for contaminated equipment must state which portions of the equipment remain contaminated. Regulated waste that has been decontaminated does not need to be labeled or color-coded. The labeling requirements do not preempt either the U.S. Postal Service labeling requirements (39 CFR Part III) or the Department of Transportation’s Hazardous Materials Regulations (49 CFR Parts ). DOT labeling is required on some transport containers (i.e. those containing “known infections substances”). It is not required on all containers for which 29 CFR requires the biohazard label. Where there is an overlap between the OSHA-mandated label and the DOT-required label, the DOT label will be considered acceptable on the outside of the transport container provided the OSHA-mandated label appears on any internal containers which may be present. Containers serving as collection receptacles within a facility must bear the OSHA label, since these are not covered by the DOT requirements. Version 1

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 Additional training provided when tasks are modified or new tasks are required may be limited to addressing the new exposures created. Part-time and temporary employees are covered and are also to be trained on company time. Personnel providers who send their own employees to work at other facilities, to be employers whose employees may be exposed to hazards. Since personnel providers maintain a continuing relationship with their employees, but another employer (your client) creates and controls the hazard, there is a shared responsibility for assuring that your employees are protected from workplace hazards. The client employer has the primary responsibility for such protection, but the “lessor” employer likewise has a responsibility under the OSH act. Version 1

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 Version 1

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 Version 1

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 Record maintenance/retention is according to OSHA’s rule governing access to employee exposure and medical records, Transfer of records must be incompliance with 29 CFR (h). If the employer ceases to do business and there is no successor employer to receive and retain the records for the prescribed period, the employer must notify the Director at least 3 months prior to their disposal and transmit them to the Director, if required to do so by the Director, within that 3 month period. Version 1

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 Version 1

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 The purpose of the log is to assist in the evaluation of devices used in the workplace and quickly identify problem areas in the facility. It must be reviewed at least annually during the review/update of the Exposure Control Plan. Do not attempt to retrieve any device from a sharps container if trying to determine the type and brand of device involved in the incident. If the data is to be made available to other parties (e.g. supervisors, safety committees, employees), any information that could be used to identify the employee must be withheld (or “de-identified”) to protect the employee’s privacy. Sharps injury log must be maintained for the period required by 29 CFR 1904 (for 5 years following the end of the calendar year that these records cover). Version 1

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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 Version 1

Q & A Any questions on any information covered in this course?
Test your knowledge of Bloodborne Pathogens….. Version 1

References 29 CFR 1910.1030 Bloodborne Pathogens
OSHA’s website at: CDC website at: NIOSH website at: Version 1

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 TELE: (215) FAX: (215) Pittsburgh Area Office Federal Office Building, Room Liberty Avenue Pittsburgh, Pennsylvania (412) (412) FAX Version 1

Bloodborne Pathogens Awareness Training

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