Suzanne Reister, Program Manager Paula Vanderpool, Program Assistant North Central Washington Workers’ Comp Trust Bloodborne Pathogens

Bloodborne Pathogens Department of Safety & Health (DOSH) Chapter WAC

Course Objectives What are Bloodborne Pathogens (BBPs)? What must I do to protect my workers? What is, and how do I write an Exposure Control Plan? What are the requirements of WAC ?

Bloodborne Pathogens (BBPs) Present in Blood or O ther P otentially I nfectious M aterials

Bloodborne Pathogens (BBPs) OPIM body fluids such as pleural, cerebrospinal, pericardial, peritoneal, synovial, and amniotic saliva in dental procedures (if blood is present) any body fluids visibly contaminated with blood body fluid where it is difficult to differentiate any unfixed tissue or organ (other than intact skin) from a human (living or dead) semen vaginal secretions

Transmission of BBPs Bloodborne Pathogens can enter your body through: a break in the skin (cut, burn, lesion, etc.) mucus membranes (eyes, nose, mouth) sexual contact other modes

Bloodborne Pathogen Diseases Main bloodborne pathogens and diseases of concern Hepatitis B Virus (HBV)Hepatitis B Virus (HBV) – Hepatitis B Hepatitis C Virus (HCV)Hepatitis C Virus (HCV) – Hepatitis C Human Immunodeficiency Virus (HIV)Human Immunodeficiency Virus (HIV) – AIDS

Transmission of BBPs Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral (piercing of the skin) contact with blood or OPIM that may result from the performance of an employee's duties Exposure Incident is a specific contact with blood or OPIM that is capable of transmitting a bloodborne disease

Exposure Control Plan To eliminate/minimize your risk of exposure Exposure determination Exposure controls Training Hepatitis B Vaccine Post exposure evaluation & follow-up Recordkeeping Exposure Control Plan

Exposure Determination Who is at risk on-the-job? In which job classifications are... All employees occupationally exposed? Some employees occupationally exposed? List the classifications List the tasks with exposure * Determine exposure without considering the use of PPE.

Exposure Determination Jobs Where All Employees Have Potential Exposure: –School nurse –First aid provider –Custodian –Teachers and parapros who work with aggressive students (biting, scratching) or with students who have special medical problems –Coaches

Exposure Determination Jobs Where Some Employees Have Exposure: –Preschool and Early childhood teachers and parapros –Intervention Specialists –Maintenance (plumbers) –Therapists, Psychologists, Speech and Language Pathologists –Teachers; especially elementary –Bus Drivers –Secretaries

Tasks and Procedures First aid procedures Athletic procedures commonly involving damage to skin or mucous membranes Vocational educational procedures involving equipment and tools which, unless properly operated, may cause injury to the skin or mucous membranes, i.e. wood & metal shops, arts & crafts, etc. Laundering of contaminated clothing, uniforms, towels, etc.

Tasks and Procedures Cleaning procedures involving blood or body fluid visibly contaminated with blood Toilet procedures Plumbing procedures involving maintenance and repair of bathrooms or cleaning solution disposal areas Interaction with students known to bite and scratch Use and disposal of hypodermic needles

Exposure Controls – A system of infection control: TREAT ALL HUMAN BLOOD AND OPIM AS IF KNOWN TO BE INFECTIOUS WITH A BLOODBORNE DISEASE.

Exposure Controls Equipment and Safer Medical Devices Physical guard Sharps disposal containers -Closable -Puncture-resistant -Leak-proof -Labeled or color- coded -DO NOT OVERFILL!

Exposure Controls Safe Work Practices  Wash hands after each glove use and immediately or ASAP after exposure.  Remove PPE before leaving work area.  Flush body parts with water after contact with blood or OPIM

Exposure Controls Safe Work Practices Clean-up of spills and broken glassware/sharps contaminated with blood or OPIM Wear protective eyewear and mask if splashing is anticipated Remove glass and other sharps materials using a brush and dust pan, forceps, etc. Do not use your hands Properly discard all materials into a sharps or puncture-resistant biohazardous waste container Use paper/absorbent towels to soak up the spilled materials

Exposure Controls Safe Work Practices Clean-up of spills and broken glassware/sharps (cont.) Clean the area with 10% bleach or EPA-registered disinfectant Saturate the spill area with disinfectant. Leave for 10 minutes (or as specified by product manufacturer) or allow to air dry Properly dispose of paper towels and cleaning materials into proper waste containers

Exposure Controls Personal Protective Equipment (PPE) Gloves -Latex -Nitrile -Vinyl -Utility Nitrile and vinyl gloves

Exposure Controls Personal Protective Equipment (PPE) Protective clothing -Lab coat -Gown -Apron -Shoe cover or boot

Exposure Controls Personal Protective Equipment (PPE) Eye-Face Protection and Masks -Safety glasses with side shields -Splash goggles -Face shield -Mask

Exposure Controls Personal Protective Equipment (PPE) Resuscitation Devices

Exposure Controls Housekeeping Maintain a clean and sanitary workplace Written cleaning and decontamination schedule and procedures Approved disinfectant – bleach, EPA-approved Contaminated waste disposal methods Laundry DISINFECTANT

Exposure Controls Laundry  Contaminated articles: (list items that are laundered)  Handle as little as possible  Wear PPE when handling and/or sorting: ­Gloves ­Gown

Exposure Controls Communication of Hazards Biohazard Labels and Signs Must have biohazard symbol Labels attached securely to any containers or items containing blood/OPIM Red bags/containers may substitute for labels Predominantly fluorescent orange or orange/red background Lettering and symbol in contrasting color to background

Exposure Controls 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 caked with dried blood or OPIM that are capable of releasing these materials during handling Contaminated sharps

Exposure Controls Regulated Waste - Containers Easily accessible Labeled or color-coded Leak-proof, closeable Puncture-resistant for sharps Replaced routinely (do no overfill!)

Hepatitis B Vaccine No cost to potentially exposed employee Made available after BBP training and within 10 days of assignment 3 shots: 0, 1, & 6 months If decline, must sign Declination Form –vaccine available at later date if desired

Training Provided to occupationally exposed employees: –At time of initial assignment –At least annually thereafter –Cover specific required elements –Interactive –Qualified trainers

Training Content An accessible copy of the WAC rule Explanation of epidemiology and symptoms of bloodborne diseases Transmission of bloodborne diseases Explanation of the exposure control plan Information about PPE Information about the Hepatitis B vaccine

Training Content The use and limitations of methods that will prevent or reduce exposure (work practices, PPE equipment, etc.) What to do when an exposure incident occurs and post-exposure evaluation Explanation of signs, labeling, color-coding An opportunity for questions and answers with trainer at time of the training

Post-exposure evaluation School District’s Responsibility: Provide immediate medical evaluation and follow-up to exposed employee Test blood of source person if HBV/HCV/HIV status unknown-consent required Provide results to exposed employee Test blood of exposed employee Provide information to Health Care Professional (HCP)

Post-exposure evaluation School District’s Responsibility: (cont.) Provide exposed employee with copy of the evaluating HCP written opinion within 15 days of completion of evaluation Provide employee with information about laws on confidentiality for the source individual Provide post-exposure treatment as needed, including counseling Investigate the exposure incident

Recordkeeping Medical Records For employees with exposure Confidential Hepatitis B vaccination status Post-exposure evaluations HCP’s written opinions Information provided to HCP as required Maintain for length of employment + 30 years

Recordkeeping Training Records Dates Content summary Trainer name & qualifications Attendee’s names & job titles Maintain for 3 years

Plan Evaluation Review and/or update annually Whenever necessary to reflect changes that affect occupational exposure, including improved safety devices

Your Plan Specifics Exposure determination Identify who is responsible for: –review, update, implementation of your plan –providing PPE, equipment –providing required training –investigating exposure incidents –maintaining required records –providing information about the vaccine

Summary Determine who has occupational exposure Establish a written exposure control plan Use exposure control methods Provide personal protective equipment Provide employee training Make Hepatitis B vaccine available Post-exposure evaluation and follow-up Maintain medical and training records