1. Bloodborne Pathogen Training General Industry (CA Code of Regulations, Title 8, Sec. 5193)
Sheryl Major
Department of Environmental Health and Safety
San Diego State University

2. Bloodborne Pathogen Standard

3. OSHA’s Bloodborne Pathogen Standard CCR Title 8 §5193
The California Code of Regulations, Title 8 (8 CCR), Section 5193 (Bloodborne Pathogen Standard) was enacted into law to create a Bloodborne Pathogen Standard for employers to reduce exposure of employees to bloodborne pathogens found in human blood or other potentially infectious materials.

4. OSHA’s Bloodborne Pathogen Standard
The standard is written to be applied to the health care industry as well as other industries where contact with blood or other potentially infectious material is a job task.
Other Industries:
Plumbing
Custodial
Landscape Management

5. Who is Covered by this Standard?
All employees who could “reasonably anticipate” as the result of performing their job/duties contact blood and other potentially infectious materials
“Good Samaritan” acts such as assisting a co-worker with a nosebleed would NOT be considered occupational exposure

6. OSHA’s Bloodborne Pathogen Standard
The BBP Standard applies to all occupational exposure to blood or other potentially infectious materials such as:
Human blood, blood components, and products made from human blood
Human body fluids

7. OSHA’s Bloodborne Pathogen Standard
The main focus of this standard centers on pathogenic microorganisms that are present in human blood and other potentially infectious materials and can cause disease in humans :
Human Immunodeficiency Virus (HIV),
Hepatitis B, and C Viruses (HBV, HCV).

8. Common Bloodborne Pathogens
Virus
HIV
Hepatitis B
Hepatitis C
Source of Virus
Blood/ OPIM
Route of Transmission
Percutaneous, Mucocutaneous
Incubation Period
Up to 6 years
7-26 week
Chronic or Long Term Infection
Long Term
Chronic for 5% of adults
Chronic for 75-85% of cases
Prevention
None
Vaccine
Symptoms
Fever, Enlarged lymph nodes, Sore throat, Rash
Fever, Fatigue, Abdominal pain,
Loss of appetite
Nausea, Jaundice
Epidemiology of general population
50,000 cases annually
300,000 cases annually
16,000 new cases in 2009

9. Definitions

10. What Does Blood Mean? Blood means:
Human blood, blood components, and products made from human blood

11. What Does Other Potentially Infectious Materials Mean?
OPIM is a catch-all definition for any and all HUMAN tissues, cell lines, body fluids, blood, secretions, and excretions.
The following are human body fluids:
semen,
vaginal secretions,
amniotic fluid,
any body fluid that is visibly contaminated with blood,
all body fluids in situations where it is difficult or impossible to differentiate between body fluids;
Urine, feces and vomit are excluded, except when contaminated by blood.

12. Definitions Bloodborne Pathogens
“means pathogenic microorganisms that are present in human blood, cell lines, tissues and other body fluids and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV)”

13. Definitions Exposure Incident
“means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that result from the performance of an employee's duties”.

14. Definitions Contaminated
“means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface”.

15. Types of Exposures

16. Types of Exposure
Parenteral contact means piercing mucous membranes or the skin barrier through such events as contaminated needlesticks, human bites, cuts, and abrasions.

17. Types of Exposure
Mucous Membrane contact means splash to a mucous membrane (eye, nose, mouth, etc.) by some one else's blood or other potentially infectious materials (OPIM).

18. Direct contact Types of Exposure
Contact of the skin and mucus membranes with human blood and / or body fluids is the primary exposure route. Broken skin and abrasion are chief routes of pathogen entry into the body. This type of contact is considered an exposure incident.
Secondary contact can be made with contaminated surfaces resulting in direct contact exposures.

19. SDSU Exposure Control Program

20. Exposure Control Plan Employer Exposure Control Plan
The SDSU Bloodborne Pathogen Program is resident in EH&S and covers all employees working at SDSU who, as a function of their job, come into contact with human blood or other potentially infectious materials

21. Site Specific Exposure Control Plan
The Site-Specific ECP is managed by the Hospital, Health Care Facility or Clinic and should cover specific work practices and tasks to protect employees and interns for the specific materials and job task.

22. Safety Precautions

23. Universal Precautions
Treat all human blood and other potentially infectious fluids as if they are infectious
Must be observed in all situations where differentiation between body fluid types is difficult or impossible - all body fluids shall be considered potentially infectious materials.

24. Engineering and Work Practice Controls
These are the primary methods used to control the transmission of bloodborne pathogens from blood or OPIM as a result of splashing, spraying, and aerosolization.
It means “controls that isolate or remove the bloodborne pathogens hazard from the workplace.”

25. Engineering Controls
These controls reduce employee exposure by removing the hazard.
Examples:
Sharps disposal containers

26. Work Practices

27. Workplace Control
These precautions/controls reduce the likelihood of exposure by altering how a task is performed.
Employee Hygiene
Housekeeping Precautions
Equipment/Materials Precautions
First-Aid Precautions

28. Employee Hygiene
Hand washing breaks the “hand-to-mouth and “hand-to-object” transfer of pathogens. It also removes deposited organisms after spills / splatter of contaminated droplets onto skin. Droplets are a major concern, and can be present on upper arms, backs of hands and even on the face, depending on the size and distribution of the droplets.

29. Housekeeping Precautions
Wash hands as soon as possible after contamination and after removing gloves
Clean and decontaminate equipment and surfaces that had contact with infectious materials.
Do not handle items such as pens or door handles while wearing contaminated gloves.

30. Equipment & Materials Precautions
Wear gloves and other PPE to handle contaminated laundry, equipment or absorbent material
Separate contaminated materials from non-contaminated materials
Contaminated materials shall be handled as little as possible with minimum agitation and placed in appropriately labeled red biohazard bags

31. First-Aid Precautions
To protect yourself during an injury or accident:
Protect yourself before offering assistance
Wear clean, leak-proof disposable gloves
If blood is spraying, protect your eyes nose and mouth with goggles and a mask
Keep blood off of you while you control bleeding.

32. First-Aid Precautions
If you get blood on you:
Wash it of as soon as possible with soap and water
Immediately flush your eyes with running water at a sink or eyewash station
Seek medical attention
Report the incident to your supervisor

33. Personal Protective Equipment

34. Protective Clothing or Equipment
When occupational exposure remains after engineering and work practice controls are put in place, personal protective equipment (PPE) must be used.

35. Examples of PPE
Gloves – replace immediately when visibly soiled, torn, cut, or punctured; not be worn outside contaminated areas
Protective clothing/Footwear – shall be worn as an effective barrier against blood and OPIM
Face shields and eye protection – shall be worn whenever splashes, spray, spatter, droplets, or aerosols may be generated causing eye, nose, mouth contamination
Mouthpieces and resuscitation devices

36. Recommended PPE: Gloves Concern with splash, spray, splatter: Masks Eye protection Face shields

37. Hepatitis B Vaccine

38. Vaccinations
Vaccinations for HBV and other pathogens for which USPHS vaccines are available.
Vaccinations remove the risk of acquiring the infectious agent by immunizing the individual.

39. Hepatitis B Vaccination
Hepatitis B Vaccination is offered free of charge to all employees who reasonably anticipate coming into contact with bloodborne pathogens, blood, or other potentially infectious materials Employees are NOT required to receive the vaccination as a requirement for employment.

40. Hepatitis B Vaccination Requirements
Must make available, free of charge, unless:
employee has had the vaccination
antibody testing reveals immunity
The vaccination must be performed by a licensed healthcare professional

41. Hepatitis B Vaccination Requirements
Employees who decline the vaccination must sign a declination form
Employees can change their mind regarding the vaccination at any time
Employees are not required to participate in antibody prescreening program to receive vaccination series
Vaccination booster doses are provided when recommended by the U.S. Public Health Service

42. Hepatitis B Vaccination
Under the SDSU ECP and Site Specific ECP “employee” could mean:
Employee
Student Employee
Volunteer

43. Decontamination & Disposal

44. Decontamination and Disposal
Isolate the area
Wear personal protective equipment
Disinfectant:
Solution of ¼ cup bleach per gallon of water
Commercially purchased disinfectant

45. Decontamination If cleaning up wet blood/body fluids:
Place paper towel or absorbent material over the contaminated fluid to soak up
Spray paper towel area with disinfectant
Red bag contaminated paper towels
Spray area with disinfectant solution and wipe dry
If cleaning up dried blood/body fluids:
Spray with disinfectant solution
Wipe with paper towel

46. Decontamination and Disposal
Properly dispose of contaminated PPE, towels, rags in a red biohazard bag inside a rigid, puncture resistant, leak-proof secondary container with a biohazard label on the outside of the container and lid, during use, storage and transport. Affix generator address label to red biohazard bag

47. Biohazard Warning Label
Warning labels required on:
Containers of regulated biohazard red bags and red sharps container
Refrigerators, freezers, and other equipment containing blood and other potentially infectious materials
Other containers used to store, transport, or ship blood or other potentially infectious materials
Biohazard labeled red bags or containers may be substituted for sticker labels

48. Disposal Sharps Waste Must be contained in “sharps container”.
Tightly close or tape closed the lid of a full sharps container ready for disposal.
Store sharps container ready for disposal for not more than 7 days.
Label sharps container with the word “Sharps Waste” or the biohazard symbol and the word “Biohazard”.
Must also be labeled with the generator’s name, address and phone number that is legible and easily visible on the outside of the container.

49. Exposure

50. Exposure Incident A specific incident with contact with blood or OPIM
If there are no infiltration of mucous membranes or open skin surfaces, it is not considered an exposure incident
Report all incidents involving blood or bodily fluids. Complete and submit to EH&S and Supervisor the Incident/Accident Report Form

51. What to do if an exposure occurs?
Employee must:
Wash exposed area with soap and water
Flush splashes to nose, mouth, or skin with water
Irrigate eyes with water or saline
Report the exposure incident to supervisor

52. What to do if an exposure occurs?
Medical evaluation and treatment should begin as soon as possible after exposure, preferably within 24 hours, and no later than 7 days. BBP Exposure including needlestick is referred to Sharp Rees-Stealy Occupational Medicine or Urgent Care (619)

53. What to do if an exposure occurs?
Complete and submit to EH&S and Supervisor:
Incident/Accident Report Form,
Supervisor Injury Report and,
if applicable, Sharps Injury Log.

54. Sharps Injury Log
The Sharps Injury Log is completed after a Sharps injury occurred:
Description of sharps injury
Opinion of safer engineered sharps
Log is a confidential document
Forms

55. Post Exposure Follow-Up
Complete a medical evaluation:
The identity and consent from the source individual is legally obtained if required.
Results of the source individual's testing shall be made available to the exposed employee.
provide for post-exposure prophylaxis.
provide for counseling and evaluation of reported illnesses.
The Post Exposure Follow Up is provided at no cost to the employee.

56. Records

57. Medical Recordkeeping
EH&S
Employee’s name
Employee’s hepatitis B vaccination status
Medical records must be maintained for duration of employment plus 30 years according to OSHA’s rule governing access to employee exposure and medical records

58. Medical Recordkeeping
SDSU
Results of examinations, medical testing, and post-exposure evaluation and follow-up procedures
Health care professional’s written opinion
Information provided to the health care professional
Employee medical records must be kept confidential and not disclosed or reported without the employee’s written consent (unless required by law)

59. Training Requirements
Provide at time of initial assignment to a job with occupational exposure and at least annually thereafter
Additional training needed when existing tasks are modified or new tasks are required which affect the worker’s occupational exposure
Maintain training records for 3 years

60. Summary
OSHA’s Bloodborne Pathogens standard prescribes safeguards to protect workers against the health hazards from exposure to blood and other potentially infectious materials, and to reduce their risk from this exposure
Implementation of this standard not only will prevent hepatitis B cases, but also will significantly reduce the risk of workers contracting AIDS, Hepatitis C, or other bloodborne diseases

61. Questions?
For questions regarding the Bloodborne Pathogen Standard at SDSU, enrollment into program, Hepatitis B vaccination, or other questions related to bloodborne pathogens in the work place contact the following:
Sheryl Major Biosafety Officer (619)
Millie Tran Associate Director (619) Environmental Health & Safety (619)