1. Bloodborne Pathogens

2. Introduction
Welcome to this training presentation on Bloodborne Pathogens. Please use the forward and backward buttons at the bottom of this page to navigate through the training at your own pace. Thank you for doing your best to learn this important information.

3. Course Outline Why Take Bloodborne Pathogens Training? Definition
At-Risk Employees
Types of Bloodborne Pathogens
Bloodborne Pathogen Transmission
Engineering Controls
Exposure Control Plan
Training Requirements
Work Practice Controls
Regulated Waste
HBV Vaccination
Emergency Response
Medical Recordkeeping
Summary

4. Why Take Bloodborne Pathogens Training?
Employees in many industries are at risk:
Approximately 5.6 million employees in the health care, dentistry, hospitality and other industries can reasonably be expected to come into contact with blood or other potentially infectious materials (OPIM). They are at risk for bloodborne pathogen exposure.
Regulations and standards have been set:
The Occupational Safety and Health Administration (OSHA) has set a bloodborne pathogens standard which mandates safeguards to protect employees against the health hazards associated with the exposure to blood, needles, bodily fluids and OPIM.
An “at risk” employee is one who can reasonably be expected to come into contact with blood or OPIM. For employers with “at risk” employees, OSHA requires that measures be put in place to reduce the risk of exposures.
Anyone in this training is “at risk”; if you feel that you were assigned to take this training in error, contact your supervisor.

5. Why Take Bloodborne Pathogens Training?
Introductory training:
This training will satisfy the training requirements for initial employee training and annually thereafter.
For those employees who work with cultures of HIV, hepatitis B, hepatitis C, human blood or other potential infectious material known to be infected with the above bloodborne pathogens, this is an introductory training and will not satisfy the additional requirements for working with these specimens.
For additional training on working with human blood and OPIM, contact your supervisor.
Throughout the training, we will be discussing the potential sources of bloodborne pathogens and what you can do to prevent exposure.

6. Definition What are bloodborne pathogens?
Bloodborne pathogens are pathogenic micro-organisms that may be present in human blood and can cause disease in humans.
Pathogens found in blood and OPIM include the following: human immunodeficiency virus (HIV), which causes AIDs; hepatitis B virus (HBV); hepatitis C virus (HCV); syphilis and malaria.
There are many bloodborne pathogens and although this training only specifically addresses a few, they should all be considered.
Pathogens include bacteria and viruses.
It is important to note that bloodborne pathogens can only be transmitted through direct contact with human bodily fluid. Therefore, pathogens that are commonly spread through the air, like tuberculosis and influenza, are not bloodborne pathogens.

7. At-Risk Employees The Bloodborne Pathogens Standard:
Covers all employees who could be “reasonably anticipated” to face contact with blood and other potentially infectious materials as the result of performing their job duties.
Does not cover those who engage in “Good Samaritan” acts, such as assisting a coworker with a nosebleed, because it is not considered an occupational exposure.
However, if an employer allows trained employees to assist with first aid treatment on a “Good Samaritan” basis, it is considered best practice to implement the key elements of a bloodborne pathogen program.
This training is not a substitute for detailed first aid training.
We will go into detail about the potentially infectious material that you may come in contact with its potential hazards.

8. At-Risk Employees Who is at risk for exposure?
Physicians, nurses and emergency room personnel
Orderlies, housekeeping personnel and laundry employees
Dentists and other dental employees
Laboratory and blood bank technologists and technicians
Medical examiners
School employees
Law enforcement personnel
Firefighters
Paramedics and emergency medical technicians
Anyone providing first-response medical care
Medical waste treatment employees
Home healthcare employees
Those who are likely to contact blood or OPIM are considered at risk.
This list is not comprehensive and may include many more job titles that could come in contact with human blood or fluids.

9. Types of Bloodborne Pathogens
Bloodborne pathogens include:
Malaria
Syphilis
Brucellosis
Hepatitis B (HBV) and C
Human immunodeficiency virus (HIV)
Although these are all pathogens transmitted through human blood and fluid, only hepatitis B, C and HIV are the ones directly regulated. All human blood and fluid should be treated as infectious to assure protection.
Human immunodeficiency virus (HIV)

10. Types of Bloodborne Pathogens
Hepatitis B virus (HBV):
Is a viral infection and causes inflammation of the liver.
Transmits primarily through blood to blood contact.
Can also cause jaundice, vomiting and, in rare cases, death.
Leads to serious conditions such as cirrhosis and liver cancer.
Can survive in dried blood for up to seven days.
Has no known cure or treatment.
Has an available vaccine.
“Hepa” refers to the liver and “itis” refers to inflammation.
The Hepatitis B virus vaccine will be offered to all employees reasonably expected to have exposure to the virus free of charge upon employment.
The vaccine is only effective if it is administered prior to exposure.
Hepatitis B virus

11. Types of Bloodborne Pathogens
HBV symptoms:
Mild flu-like symptoms
Fatigue
Possible stomach pain
Loss of appetite
Nausea
Jaundice
Jaundice is a yellow color to the skin and eyes that is the result of the liver not filtering the blood properly.
Many of the symptoms of the bloodborne pathogens are similar and should be diagnosed by a primary care provider.

12. Types of Bloodborne Pathogens
Hepatitis C virus (HCV):
Similar to HBV, can cause jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea and vomiting.
Can lead to chronic liver disease and death.
Has no cure or vaccine. Medications can suppress the virus, but treatments have a low success rate.
Survives outside the body for several days.
Can be carried by people, called carriers, who do not have symptoms of the disease.
Of the three bloodborne pathogens, HCV remains viable outside the body the longest.
Unlike Hepatitis B, Hepatitis C does not have a vaccine that can prevent infection if an exposure occurs.
People can be “carriers” of Hepatitis C without symptoms or disease manifestation.

13. Types of Bloodborne Pathogens
Human Immunodeficiency Virus (HIV):
Attacks the body's immune system, weakening it so that it cannot fight other deadly diseases.
Causes acquired immunodeficiency syndrome (AIDS). AIDS is a fatal disease and, while treatment for it is improving, there is no known cure.
The HIV virus is very fragile and will not survive for more than a few hours outside of the human body.
Employees providing first aid or medical care in situations involving fresh blood or other potentially infectious materials are particularly at risk.
There is no vaccine now to prevent HIV infection if an exposure does occur; a great deal of research is being conducted to develop a vaccine to prevent the virus from attacking the body.
The mortality rate is still high from HIV infection because there is not a comprehensive cure.
Many people die of related diseases as a result of a weakened immune system, such as tuberculosis, fungal infection and viral herpes.

14. Types of Bloodborne Pathogens
HIV symptoms:
Symptoms of HIV infection can vary, but often include the following:
Weakness
Fever
Sore throat
Nausea
Headaches
Diarrhea
White coating on the tongue
Weight loss
Swollen lymph glands

15. Bloodborne Pathogen Transmission
Pathogen sources:
Generally, bloodborne pathogens are transmitted through contact with infected human blood and other potentially infectious materials (OPIM), such as:
Semen.
Vaginal secretions.
Cerebrospinal fluid (brain spinal cord).
Synovial fluid (joints).
Pleural fluid (chest cavity).
Peritoneal fluid (abdomen).
Amniotic fluid (fluid around fetus).
Saliva (if blood is present).
Any unfixed tissue or organ from a human, living or dead, except intact skin.
Any blood, cultures or animal tissue infected with or containing HIV, HBV or HCV.
Many state occupational safety and health programs have more detailed lists of OPIM, including drug products and materials derived from human blood and source material.
Any time human blood is present, it is always considered potentially infectious and must be handled as such.

16. Bloodborne Pathogen Transmission
Entry methods:
Unbroken skin forms an impervious barrier against bloodborne pathogens. However, infected blood can enter your system through the following:
Open sores
Small cuts or scratches
Abrasions
Acne
Damaged or broken skin, such as sunburn or blisters
Dried and cracked skin
If you have an open wound, you should not assist individuals with first aid.
If you must perform first aid, cover all open cuts and wounds using a bandage to prevent contact with blood or OPIM.
Dry and cracked skin may be from an abrasion but may also be the result of dermatitis from contact with a chemical or plant or due to seasonal variability in humidity.

17. Bloodborne Pathogen Transmission
Common exposure routes:
A splash or splatter of human blood or OPIM coming into contact with mucous membranes, such as the eyes, nose, mouth or broken skin.
Parenteral contact. This is when the pathogen enters directly into blood or muscle tissue and can occur via:
Injection from a needle.
Cuts from other contaminated sharps like scalpels, broken glass, etc.
Parenteral exposure can occur through injection or a cut resulting in contact with human blood or OPIM.

18. Engineering Controls Engineering controls:
These controls reduce exposure by removing the hazard or isolating the employee. Examples of engineering controls include:
Sharps disposal containers.
Self-sheathing or retracting needles.
Medical safety devices.
Needleless systems, as shown here.
Sharps with engineered injury protection.
This needleless system is used for administrating fluids in an IV system using a Luer taper connection.
Each of these control measures will be described in more detail.

19. Engineering Controls A sharps container must be:
Red or labeled with a biohazard sign.
Leak-proof.
Puncture-resistant.
Located as close as possible to the work surface.
Kept upright during use.
Inspected and replaced when two-thirds full.
Closed when full.
Transported in a secondary container if leakage is possible.
Disposed of as regulated waste, following local and federal requirements.
Assure that the sharps container is never overfilled or more than two-thirds full.
If the sharps container contains any liquids that could spill out, the closed container must be transported to final disposal location in a leak-proof container.
Contact your supervisor for appropriate disposal methods for your local jurisdiction.

20. Engineering Controls Medical safety devices:
Needleless systems: Devices that do not use needles, such as Luer taper systems, for the collection or withdrawal of body fluids or for the administration of medication or fluids.
Sharps that have engineered sharps injury protection: These have a built-in safety feature or mechanism that reduces the risk of an exposure incident. They include non-needle sharps and needle devices used for withdrawing body fluids, accessing a vein or artery or administering medications or other fluids.
The syringe shown has a plastic sheath that can be used to cover the needle tip after use. The sheath locks in place and cannot be moved once it has been put in place.
There are various safety needles on the market but all may not be correct for your work.
Your program must review these devices to determine the safest approach.

21. Exposure Control Plan An exposure control plan:
Is a written document that describes how the employer will comply with requirements and implement policies and procedures.
Identifies the jobs and tasks where occupational exposure to blood or other potentially infectious material occurs.
Describes how the employer will:
Use engineering and work practice controls.
Assure use of personal protective equipment.
Provide training.
Provide medical surveillance.
Provide hepatitis B vaccinations.
Use signs and labels.
Must be accessible and communicated to employees.

22. Exposure Control Plan Reviewing the plan:
The exposure control plan is reviewed at least annually and updated to reflect the relevant changes in:
Tasks
Procedures
Assignments
Technology
The annual review documents how the employer considers and implements safer medical devices.
The review must solicit input from potentially exposed employees on the identification, evaluation and selection of engineering and work practice controls.
St. Francis School District Exposure Control Plan
If you would like to review the exposure control plan, contact your supervisor.
You will be informed of an updated exposure control plan and trained on any changes once they are put in place.

23. Training Requirements
Training must be:
Provided at no cost to employees during working hours.
Provided at the time of the initial assignment to a job with occupational exposure and at least annually thereafter.
Provided additionally when existing tasks are modified or new tasks are required which affect an employee’s occupational exposure.
Recorded and maintained for three years.

24. Work Practice Controls
Using universal precautions involves:
Treating all human blood or OPIM as contaminated with bloodborne pathogens.
Treating all materials that have been contaminated with human blood or OPIM as potentially infectious with bloodborne pathogens.
Minimizing handling and manipulation of materials contaminated with human blood or OPIM.
Employees should assume that all human blood is infectious.
“Universal Precautions” is treating all blood and OPIM as if they were infectious and protect yourself accordingly with proper PPE.
Following universal precautions is an integral part of preventing exposure to bloodborne pathogens.

25. Work Practice Controls
Implementing work practice controls:
These are steps to take in order to complete job tasks safely by reducing the likelihood of exposure through choices. Recommended controls include:
Covering any cuts or abrasions, especially those near your hands.
Not touching the face or mouth when a potentially infectious material is present.
Not eating, drinking, smoking or applying cosmetics, including lip balm when a potentially infectious material is present.
Following universal precautions: employees should assume that all human blood is infectious.
An antimicrobial hand soap is preferable for hand-washing after a potential exposure.
Work practices, along with using engineering controls and personal protective equipment, will reduce the risk of exposure to bloodborne pathogens

26. Work Practice Controls
Sharps safety:
Do not bend or break needles.
Do not recap needles.
Place needles in a sharps container as soon as possible.
Use forceps or another device to pick-up sharps, such as broken glass or a loose needle.
Syringes should never be resheathed or recapped.
Never pick-up needles or broken glass with hands, even if wearing gloves.
Devices, like the self-sheathing needles described earlier, will prevent the possibility of injuries from needlesticks.
If a sharps injury does occur, report it to your supervisor and record the incident on the Sharps Injury Log

27. Work Practice Controls
Biohazard warning labels must be placed on:
Containers of regulated waste.
Containers used to store, transport or ship blood or other potentially infectious materials.
Refrigerators, freezers and other storage locations that contain blood and other potentially infectious materials.
Laundry containers being sent for cleaning.
Sharps containers.
Labels may be purchased in various sizes to be used throughout the workplace to label work areas and containers.
Red bags or containers may be substituted for labels.

28. Work Practice Controls
Housekeeping:
A written schedule must be developed for cleaning and decontamination at the work site based on:
The location within the facility.
The type of surface to be cleaned.
The type of soil present.
The tasks or procedures being performed.
An assessment should be conducted to determine the appropriate cleaning and decontamination material.
Housekeeping measures, chemicals and responsibilities must be included in the exposure control plan.

29. Work Practice Controls
Housekeeping (continued):
Work surfaces must be decontaminated with an appropriate disinfectant:
After the completion of procedures.
When surfaces are contaminated.
At the end of the work shift.
Follow instructions on the product label for dilution, contact time on the surface and required personal protective equipment (PPE).
A diluted bleach solution, 1% household bleach, is considered to be an effective disinfecting agent.
Many decontamination chemicals have associated health and physical hazards; all chemicals hazards, including the chemical labels and safety data sheet, should be reviewed prior to working with the chemical.
The chemical is only effective if it is left on the surface for the appropriate contact time.

30. Work Practice Controls
Spill clean up:
If a spill occurs, cordon off the area.
Put on the required personal protective equipment (PPE).
Place absorbent materials, such as paper towels, on the spill.
Pour disinfectant on and around the spill area, allowing the disinfectant to flow into the spill.
Allow the disinfectant to sit for the required contact time.
At the end of the contact time, collect the absorbent material.
Wipe up excess disinfectant with absorbent material.
Place absorbent material and disposable PPE in a red bag or bag with a biohazard symbol to be disposed of as regulated waste.
Review the Exposure Control Plan for details about what to do in your specific organization.
Employees must be trained on spill clean-up procedures, including appropriate PPE and contact time for the disinfectant used in your organization.

31. Work Practice Controls
Personal protective equipment (PPE):
PPE is specialized clothing or equipment that is worn by an employee for protection against infectious materials.
Always wear personal protective equipment (PPE) in potential exposure situations.
Replace PPE that is torn, punctured or soiled.
Reusable PPE must be properly cleaned, laundered, disinfected, repaired and disposed of at no cost to employees.
Wash hands immediately after removing PPE.
A thorough risk assessment of PPE must be conducted to determine the correct PPE for each task involving human blood and OPIM.
Always wash hands and any other potentially exposed part of the body with anti-microbial soap and warm water after removing PPE.

32. Work Practice Controls
Examples of PPE:
Gloves
Gowns or laboratory coats
Face shields
Eye protection
Boots
Mouth barriers
Employees must receive training on the use, maintenance, care and limitations of the PPE that they are expected to use.

33. Work Practice Controls
Proper procedures when using PPE:
Remove PPE prior to leaving the work area.
Follow universal precautions when removing PPE, being careful to not contaminate other areas.
Wash hands immediately after removing PPE.
Remember that treating all PPE with universal precautions means you treat all PPE as if it is contaminated with human blood and infectious.
When removing gloves and lab coats, take care and never touch the outside of the glove or coat with your hands.

34. Work Practice Controls
Hand washing:
Hand washing is one of the most important (and easiest) practices used to prevent the transmission of bloodborne pathogens.
Wash hands or other exposed skin thoroughly as soon as possible following an exposure incident.
Wash hands after removing gloves.
Use antimicrobial soap.
Do not use harsh or abrasive soap.
Anti-microbial soap works best because it will kill any viral pathogens that may be on your skin.
Use warm, not scalding hot, water to wash hands for the most effective removal of pathogens from your hands.

35. Work Practice Controls
Laundry:
Remove clothing that is contaminated with blood as soon as possible.
Use universal precautions when handling contaminated laundry by handling laundry as little as possible and protecting yourself with the proper PPE.
Place clothing in approved and labeled bags or containers with the biohazard symbol.
If the laundry will soak through the container, place in a secondary container and label with the biohazard symbol.
Water soluble bags provide the greatest protection.
They dissolve in laundry to minimize handling of contaminated items.
Sorting or rinsing before transportation is not allowed.
Never take laundry home to be done in your own domestic washing machine.
Sorting or rinsing is not allowed as it may cause the virus to come in contact with your skin or become airborne as a particle.

36. Regulated Waste Regulated waste items include:
Blood or other potentially infectious materials (OPIM) in a liquid or semi-liquid form.
Contaminated items that could release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed.
Items with dried blood or other potentially infectious materials.
Contaminated items may include microscope slides, test tubes, used PPE, clean-up materials or contaminated clothing.
Check with local authorities as regulations differ for each state and region.

37. Regulated Waste Disposing of regulated waste:
Place items in closeable, leak-proof containers. These are:
Built to contain all contents during handling, storing, transporting or shipping.
Appropriately labeled or color-coded.
Closed prior to transport, storage or handling.
Placed inside a secondary container for shipping, transport or storage, if contamination occurs.
No needles or other sharps should be protruding from the container.
Never fill a container more than two-thirds full.

38. HBV Vaccination Hepatitis B vaccinations:
Employees who are routinely exposed to bloodborne pathogens, such as doctors, nurses or first aid responders, must be offered the hepatitis B vaccine series.
The vaccine series consist of three shots which build immunity to HBV. The three shot series is administered over a period of time.
The vaccine series will protect you from contracting Hepatitis B for life.

39. HBV Vaccination Hepatitis B vaccination requirements:
The hepatitis B vaccine must be:
Offered free of charge.
Provided at a reasonable time and in an accessible location.
Included for all employees at risk of exposure.
Administered within 10 working days of initial assignment.
Performed by a licensed professional.
Employees do not have to be vaccinated if:
They have already been vaccinated.
An antibody testing reveals their immunity.
They opt out after being offered the immunization.
It is preferable that the vaccine be administered prior to assignment of work.
Contact your supervisor if you have any questions about the vaccine or related medical records.

40. HBV Vaccination Hepatitis B vaccination requirements (continued):
Opting out employees:
Employees who decline the vaccination must sign a declination form.
The vaccine must be made available if an employee initially declines and later decides to accept the vaccination.
Employees are not required to participate in antibody prescreening programs to receive the vaccination series.
Vaccination booster doses must be provided if recommended by the U.S. Public Health Service.
The vaccination form, for either indicating vaccine history or declination, will be available at the end of the training.
You may receive the vaccine at any time after initial employment if you change your mind.

41. Emergency Response What to do if an exposure occurs:
Wash the exposed area thoroughly with soap and running water.
Use non-abrasive, antimicrobial soap.
Flush the nose, mouth or skin with splashes of water.
Irrigate eyes with water or saline.
Report the exposure.
Seek medical attention.
An eye wash must be available and routinely tested to assure that it has correct water pressure and is free of debris.
If an exposure does occur, your supervisor will direct where to seek medical attention.

42. Emergency Response First aid procedures:
Always use universal precautions.
It is important to put an impermeable barrier between you and potentially infectious material. Minimize your exposure by wearing the following:
Gloves
Splash goggles
Pocket mouth-to-mouth resuscitation masks
Other barrier devices
In the event of an accident, first aid should only be performed by those who have been trained.

43. Emergency Response First aid procedures (continued):
When performing first aid, always use a mouth barrier to protect yourself from coming into contact with bodily fluids.
Mouth barriers should have one-way valves to keep fluids from coming up.
Commercially available products can be small enough to fit on a key chain and include latex gloves.

44. Exposure to Blood/Bodily Fluids Form
Emergency Response
Post-exposure follow-up:
Routes of exposure and how the exposure occurred must be documented.
Exposure to Blood/Bodily Fluids Form
Consent from the source individual and the exposed employee will be obtained and blood will be tested as soon as possible after the exposure incident.
Risk counseling and post-exposure protective treatment for diseases will be provided when medically indicated. This is in accordance with current U.S. Public Health Service Guidelines.
A written opinion of the findings will be provided to the employer with a copy to the employee within 15 days of the evaluation.
Hepatitis B prophylaxis administration will also be available.
You must inform your primary care provider of the potential exposure to bloodborne pathogens when seeking medical attention.
Your primary care provider will work with you to assure all information is recorded and a final report is given to your employer.

45. Medical Recordkeeping
For every incident, the following must be recorded:
The name and social security number of the employee.
The employee’s hepatitis B vaccination status.
The results of examinations, medical testing and post-exposure evaluation.
Follow-up procedures.
Information provided to the health care professional.
The health care professional’s written opinion.

46. Medical Recordkeeping
Maintain records:
Employee medical records must be kept confidential and not disclosed or reported without the employee’s written consent (unless required by law).
Medical records must be maintained for the employee’s duration of employment plus 30 years, according to OSHA’s rule governing access to employee exposure and medical records.
Medical records must comply with all federal and state laws, including The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules.

47. Medical Recordkeeping
Sharps injury log:
Employers must maintain a sharps injury log for the recording of injuries from contaminated sharps.
The log must be maintained in a way that assures employee privacy and must contain, at a minimum:
The type and brand of device involved in the incident.
The location of the incident.
A description of the incident.

48. Summary
All employees who could reasonably expect to come in contact with human blood or OPIM must follow universal precautions and be trained on bloodborne pathogens.
Implementation of a bloodborne pathogen program will not only prevent hepatitis B cases, but also will significantly reduce the risk of employees contracting HIV, hepatitis C or other bloodborne diseases.
A written exposure control plan and a training program must be in place to assure that employees are aware of hazards and work practices for bloodborne pathogens.
By taking this training, you now have a basic knowledge of the main bloodborne pathogens and how to prevent exposure to them.
Following universal precautions, whereby you treat all human blood and OPIM as infectious, will help prevent exposure.

49. Summary Best practices: Always know what hazards you are working with.
Use proper PPE in situations with bloodborne pathogens.
Report all suspected exposures.
Don't handle sharps or broken glass with your hands.
Never fill a sharps containers more than two-thirds full.
Read labels on the handling of decontaminants prior to use.
Properly dispose of pathogen waste, PPE and sharps containers as regulated waste.
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