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2 OSHA’S EXPECTATIONS Employer’s Duties –identify job risks and classify –provide appropriate training –provide a plan –provide appropriate equipment Compliance Employee’s Duties –follow employer’s plan –know job classification –complete training –use equipment provided by employer Compliance

3 OSHA REQUIRED INFORMATION Documents General explanation of bloodborne pathogens Hepatitis B immunization Explanation of tasks that may involve exposure

4 BLOODBORNE PATHOGENS DEFINED Disease-causing microorganisms that may be present in human blood or OPIM (other potentially infectious material) –Viruses –Bacteria –Parasites

5 MODES OF TRANSMISSION Puncture wounds or cuts Contact (touch, splash, or spray) with blood or OPIM on: –mucous membrane –non-intact skin cuts, abrasions, burns acne, rashes papercuts, hangnails –contaminated sharps

6 RISK OF EXPOSURE Objective of BBP standard is to minimize or eliminate the hazard posed by work that may expose one to blood or OPIM

7 RISK OF EXPOSURE If a risk of exposure exists one should know: –if there is a way to prevent infection –symptoms and course of infection –availability of counseling –availability of post- exposure treatment & follow-up

8 OCCUPATIONAL EXPOSURE INCIDENTS Occupational contact with blood or OPIM is considered an exposure incident If an exposure occurs: –wash with soap & water –report incident –document incident –seek “immediate” medical evaluation –follow employer’s exposure control plan

9 IMMEDIATE MEDICAL EVALUATION “Immediate” means prompt medical evaluation and prophylaxis An exact timeline cannot be stated Time limits on effectiveness of prophylactic measures vary depending on the infection of concern

10 REPORTING AN INCIDENT Date and time of incident Job classification Location in the worksite where incident occurred Work practice being followed Procedure being performed PPE in use Minimal Information to Report

11 MEDICAL EVALUATION POST EXPOSURE Entitled to confidential medical evaluation Personal decision about blood testing Blood may be tested only with consent Blood may be stored for 90 days, while considering testing Interpretation of any test results occurs with health care provider

12 BLOOD TESTING Blood may be tested for antibodies to: –Human Immunodeficiency Virus (HIV) –Hepatitis C Virus (HCV) –Hepatitis B Virus (HBV) –Other disease-causing organisms

13 SPECIFIC BLOODBORNE PATHOGENS Definition Signs and symptoms Course of infection Prevention and control Post-exposure prophy- laxis and follow-up care

14 HIV DEFINED HIV is Human Immunodeficiency Virus HIV can cause acquired immune deficiency syndrome (AIDS) Risk of HIV infection from a puncture injury exposure to HIV infected blood is very low %

15 SIGNS & SYMPTOMS OF HIV Signs and symptoms include: –Weight loss –Night sweats or fever –Gland swelling or pain –Muscle and/or joint pain Cannot rely on signs and symptoms to confirm if one is infected

16 COURSE OF INFECTION WITH HIV Incubation period from HIV infection to AIDS can be 8 to 10 years Varies greatly among individuals

17 HIV PREVENTION There is no vaccine to prevent HIV infection Follow Universal Precautions

18 HIV POST-EXPOSURE PROPHYLAXIS & FOLLOW-UP No cure for HIV infection Testing schedule for HIV antibodies –at time of exposure –at 3 months –at 6 months HIV antibodies usually become detectable within 3 months of infection Treatment requires health care provider OSHA requires treatment that meets most recent CDC guidelines

19 HCV DEFINED HCV is Hepatitis C Virus It affects the liver It is the most common chronic bloodborne infection in US Risk of HCV infection after exposure to HCV infected blood is 1.8% 70 to 75% of those with acute HCV infection have no symptoms

20 SIGNS & SYMPTOMS OF HCV Jaundice - yellow color to skin and whites of eyes Fatigue Headache Abdominal Pain Loss of appetite Nausea and vomiting

21 COURSE OF HCV INFECTION Incubation period averages 7 weeks Chronic liver disease may occur in 70% of those infected with HCV

22 HCV PREVENTION No vaccine exists to prevent HCV infection Follow Universal Precautions

23 HCV POST-EXPOSURE PROPHYLAXIS & FOLLOW-UP No cure for HCV No post-exposure pro- phylaxis recommended Tests for HCV anti- bodies & liver function recommended at time of exposure Tests should be repeated 4-6 months post exposure Treatment of HCV requires a health care provider OSHA requires treat- ment that meets most recent CDC guidelines

24 HBV DEFINED HBV is Hepatitis B Virus It affects the liver Prevalence of HBV infection among healthcare workers is 10 times greater than HCV infection

25 SIGNS & SYMPTOMS OF HBV Jaundice - yellow color to the skin and whites of eyes Fatigue Headache Abdominal Pain Loss of appetite Nausea and vomiting

26 COURSE OF HBV INFECTION Incubation period averages 12 weeks Most cases of HBV resolve without complications Chronic liver disease may occur in 6 to 7% of those infected with HBV

27 HBV PREVENTION A vaccine does exist to prevent HBV infection Employers are required to offer HBV vaccination HBV vaccination to employees covered under BBP standard. Debra Currier at Shiprock Administration Office Ext: Follow Universal Precautions

28 HBV POST-EXPOSURE PROPHYLAXIS & FOLLOW-UP No cure for HBV infection Post-exposure prophylaxis should begin within 24 hours; no later than 7 days after exposure Exposed person should receive HBV vaccine Treatment requires health care provider OSHA requires treatment meet CDC’s most recent guidelines

29 HBV IMMUNIZATION Employees with routine occupational exposure to blood/OPIM have right to HBV vaccination at no personal expense Employee refusal established by signing HBV vaccination declination form

30 HBV VACCINATION SCHEDULE Vaccine given in 3 doses over 6 months –1st on initial assignment –2nd one month later –3rd five months after 2nd dose Employer cannot require employee to use health insurance to cover test cost Pre-screening is not required HBV is declining because of vaccine use!

31 PREVENTION Work Practice Controls Personal Protective Equipment Universal Precautions

32 SHARPS CONTAINERS MUST BE: closable and puncture resistant leak proof labeled or color-coded functional sufficient in number easily accessible and main- tained in upright position replaced per agency policy DO NOT overfilled

33 HANDWASHING Readily available facilities Washing after removing PPE Using antiseptic hand cleanser when a sink isn’t readily available

34 HANDWASHING First roll out paper towel or have towel readily available so as not to touch other surfaces to reach it

35 HANDWASHING Turn on tap water and adjust temperature Use plenty of soap

36 HANDWASHING Wash hands using friction on all surfaces for at least 30 seconds

37 HANDWASHING Dry hands thoroughly DO NOT turn off the water yet

38 HANDWASHING Turn off tap with a dry part of the towel DO NOT touch surfaces with clean hands

39 CLEANING Clean work surfaces according to employer’s exposure control plan Use PPE and EPA-approved solution DO NOT take contaminated materials home to launder!

40 PERSONAL PROTECTIVE EQUIPMENT (PPE ) Specialized clothing/equipment used for protection when risk of exposure exists Must prevent blood or OPIM from contaminating clothing or skin Must be available at no cost to employee Must be in appropriate sizes Must be in good working condition Must be properly maintained Employee must be trained in proper use

41 TYPES OF PERSONAL PROTECTIVE EQUIPMENT Gloves Masks Eye shields Gowns/aprons

42 LATEX GLOVES Medical products containing latex must be labeled Allergies to latex are increasing Substitutes for latex-containing materials must be made available

43 UNIVERSAL PRECAUTIONS Infection control approach that treats all human blood and certain body fluids as if they are known to contain bloodborne pathogens

44 CCSD Policy: GBGC-E Exposure Control Plan Contact Payroll for Workman’s Comp Charlotte Simpson Ext Contact Debra Currier for Hep B vaccine information. Ext

45 EXPOSURE Determination High Risk – Coaches, physical ed instructors, custodians, certain special ed program personnel, playground duty personnel, health services personnel, and security personnel. Moderate Risk – Regular instructional program personnel, other special ed program personnel, school level office personnel, maintenance personnel, food services personnel, and special assignment personnel (e.g., counselors, librarians). Includes record keeping provisions and is reviewed annually



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