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'According to the Occupational Safety and Health Administration (OSHA) estimates, approximately 5.6 million workers in health care and other facilities are at risk of exposure to blood borne pathogens such as the human immunodeficiency (HIV) and hepatitis B (HBV) viruses and other potentially infectious materials." (OSHA 3130, Occupational Exposure to Blood borne  Pathogens: Precautions for Emergency Responders).

Regulatory Driver

OSHA's Blood borne  pathogens standard is set forth in Title 29 Code of Federal Regulations, Part 1910.1030. The standard mandates that employers prepare a written exposure control program and that the plan evaluate routine tasks and procedures in the workplace that involve exposure to blood or other potentially infectious materials; identify workers performing such tasks; and use a variety of methods to reduce the risks.


Objectives


Audience

All persons with a potential for exposure must be provided with adequate training and information including general explanations of the modes of transmission, symptoms, epidemiology, warning signals relating to possible exposure, and procedures to follow if exposure occurs. Training must also include appropriate methods for recognizing tasks that may involve exposure to blood or other potentially infectious materials and the use and limitations of practices that would reduce exposure.

Occupational exposure means a "reasonably anticipated skin, eye, mucous membrane, or potential contact with blood or other potentially infectious materials that may result from the performance of the employee's duties"


Banner says Characteristics

 

Blood borne  pathogens are microorganisms such as viruses or bacteria that are carried in blood and can cause disease in people. There are many different blood borne pathogens including malaria, syphilis, and brucellosis, but Hepatitis B (HBV) and the Human Immunodeficiency Virus (HIV) are the two diseases specifically addressed by the OSHA Blood borne  Pathogen Standard.

Occupational Exposure is any exposure in which a person can reasonably anticipate skin, eye, mucous membrane, or potential contact with blood or OPIM resulting from the performance of an employee's duties.

Occupational exposures are usually due to: syringe

  1. Punctures through the skin with a contaminated sharp object.
  2. Contact of blood or certain body fluids with broken or non-intact skin, i.e., rashes or cuts.
  3. Splashes to the eyes, nose, or mouth. The blood borne pathogens can enter through the mucous membranes.

Banner says Bloodborne Diseases

 

The next few pages will focus primarily on HBV and HIV because, it is important to know which blood borne pathogens you may be exposed to at work.


Hepatitis B (HBV)

In the United States, approximately 300,000 people are infected with HBV annually. Of these cases, a small percentage are fatal.

"Hepatitis" means "inflammation of the liver," and, as its name implies, Hepatitis B is a virus that infects the liver. While there are several different types of Hepatitis, Hepatitis B is transmitted primarily through "blood to blood" contact. Hepatitis B initially causes inflammation of the liver, but it can lead to more serious conditions such as cirrhosis and liver cancer.

There is no "cure" or specific treatment for HBV, but many people who contract the disease will develop antibodies which help them get over the infection and protect them from getting it again. It is important to note, however, there are different kinds of hepatitis, so infection with HBV will not stop someone from getting another type.

The Hepatitis B virus is very durable, and it can survive in dried blood for up to seven days. For this reason, this virus is the primary concern for employees such as housekeepers, custodians, laundry personnel and other employees who may come in contact with blood or potentially infectious materials in a non first-aid or medical care situation.

Symptoms:
The symptoms of HBV are very much like a mild "flu". Initially there is a sense of fatigue, possible stomach pain, loss of appetite, and even nausea. As the disease continues to develop, jaundice (a distinct yellowing of the skin and eyes), and darkened urine will often occur. People who are infected with HBV, however, will often show no symptoms for some time. After exposure it can take 1-9 months before symptoms become noticeable. Loss of appetite and stomach pain, for example, commonly appear within 1-3 months, but can occur as soon as 2 weeks or as long as 6-9 months after infection.


Banner says Bloodborne Diseases

 

Human Immunodeficiency Virus (HIV)

AIDS, or acquired immune deficiency syndrome, is caused by a virus called HIV (human immunodeficiency virus). Once a person has been infected with HIV, it may be many years before AIDS actually develops. HIV attacks the body's immune system, weakening it so that it cannot fight other deadly diseases. AIDS is a fatal disease, and while treatment for it is improving, there is no known cure.

Estimates on the number of people infected with HIV vary, but some estimates suggest that an average of 35,000 people are infected every year. By the year 2002, it is possible that 2%-9% of the American population will be infected, or 5 to 15 million people. Many people who are infected with HIV may be completely unaware of it.

HIV is a very fragile virus, and will not survive very long outside of the human body. It is primarily of concern to employees providing first aid or medical care in situations involving fresh blood or other potentially infectious materials. It is estimated that the chances of contracting HIV in a workplace environment are only 0.4%. However, because it is such a devastating disease, all precautions must be taken to avoid exposure.

If you believe you have been exposed to HBV or HIV, especially if you have experienced any of the signs or symptoms of these diseases, you should consult your physician or doctor as soon as possible.


Symptoms:

Symptoms of HIV infection can vary, but often include weakness, fever, sore throat, nausea, headaches, diarrhea, a white coating on the tongue, weight loss, and swollen lymph glands.

AIDS infection essentially occurs in three broad stages. The first stage happens when a person is actually infected with HIV. After the initial infection, a person may show few or no signs of illness for many years. Eventually, in the second stage, an individual may begin to suffer swollen lymph glands or other lesser diseases which begin to take advantage of the body's weakened immune system. The second stage is believed to eventually lead to AIDS, the third and final stage, in all cases. In this stage, the body becomes completely unable to fight off life-threatening diseases and infections.

Banner says Bloodborne Diseases

HBV and HIV Comparisons

 

HBV and HIV Comparisons

HBV

HIV

Virus Concentration

One teaspoon can contain  1 billion HBV particles

One teaspoon contains  about 15 HIV particles

Survival Rate Outside the Body

Can remain alive up to 10 days, even in dried blood

Will not survive for more than a few minutes when exposed to room temperature; will usually die within seconds

Victims Due to Occupational Exposure

10,000 / year

 Less than 100 workers *

Vaccine

Yes

No

Fatality Rate

very low

high

Cure

None

None

* 1982-1992 Statistics

HBV is more readily transmissible than HIV.
HBV, unlike HIV, can be transmitted through direct contact with contaminated environmental sources.

 

Banner says Bloodborne Diseases

OTHER DISEASES CAUSED BY BLOOD BORNE PATHOGENS

While the most significant diseases caused by blood borne pathogens are Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV), HBV is the major concern in occupational exposures.

Other diseases that are the result of blood borne pathogens: sick stickman

Banner says Hepatitis B Vaccinations

HEPATITIS B VACCINE

OSHA and CDC consider HBV vaccine the best protection against the most common blood borne disease - Hepatitis B.

Employees who have routine exposure to blood borne pathogens (such as doctors, nurses, first aid responders, etc) shall be offered the Hepatitis B vaccine series at no cost to themselves unless:

In these cases they need not be offered the series.

Although the vaccine must be offered to you by your employer, you do not have to accept that offer. You may opt to decline the vaccination series, in which case you will be asked to sign a declination form. Even if you decline the initial offer, you may choose to receive the series at anytime during your employment thereafter, for example, if you are exposed on the job at a later date.

As stated in the Emergency Procedures section, if you are exposed to blood or potentially infectious materials on the job, you may request a Hepatitis B vaccination at that time. If the vaccine is administered immediately after exposure it is extremely effective at preventing the disease.

The Hepatitis B vaccination is given in a series of three shots. The second shot is given one month after the first, and the third shot follows five months after the second. This series gradually builds up the body's immunity to the Hepatitis B virus.

The vaccine itself is made from yeast cultures; there is no danger of contracting the disease from getting the shots, and, once vaccinated, a person does not need to receive the series again. There are booster shots available, however, and in some instances these may be recommended (for example, if there is an outbreak of Hepatitis B at a particular location).

A post-exposure vaccination, Hepatitis B Immune Globulin (HBIG), is available to those who have not been vaccinated and have an exposure to blood known to be infected with HBV. Usually a single injection, HBIG has proven to be 75% effective in preventing HBV for several months.

 

Banner says Modes of Transmission

 

Blood borne  pathogens such as HBV and HIV can be transmitted through contact with infected human blood and other potentially infectious body fluids (OPIM) such as:

It is important to know the ways exposure and transmission are most likely to occur in your particular situation, be it providing first aid to an employee involved in an accident, handling blood samples in the laboratory, or cleaning up blood from a hallway.

Any other fluid, material, object, or surface that is visibly contaminated with these fluids or blood is considered to be potentially infectious.

IF THERE IS ANY DOUBT whether or not fluid contains blood or any of the above fluids, TREAT AS INFECTIOUS.

Fluids NOT considered a Blood borne Disease risk (unless visibly contaminated with blood) are: Saliva, Nasal Secretions, Sweat, Urine, Feces, Tears, Vomitus, and Sputum (the mucous secretions produced by the lower respiratory tract).
NOTE: These fluids CAN transmit many other infections and diseases.

HBV and HIV are most commonly transmitted through:

lady holding clipboard and syringe

Accidental puncture from contaminated needles and other

 sharps can result in transmission of blood borne pathogens.

In most work or situations, transmission is most likely to occur because of accidental puncture from contaminated needles, broken glass, or other sharps; contact between broken or damaged skin and infected body fluids; or contact between mucous membranes and infected body fluids. For example, if someone infected with HBV cut their finger on a piece of glass, and then you cut yourself on the now infected piece of glass, it is possible that you could contract the disease. Anytime there is blood-to-blood contact with infected blood or body fluids, there is a slight potential for transmission.

Unbroken skin forms an impervious barrier against blood borne pathogens. Infected blood, however, can enter your system through:

Blood borne  pathogens may also be transmitted through the mucous membranes of the

For example, a splash of contaminated blood to your eye, nose, or mouth could result in transmission.

Banner says Personal Protective Equipment, Work Practices, and Engineering Controls

 

It is extremely important to use personal protective equipment and work practice controls to protect yourself from Blood borne  pathogens.

"Universal Precautions" is the name used to describe a prevention strategy in which all blood and potentially infectious materials are treated as if they are, in fact, infectious, regardless of the perceived status of the source individual. In other words, whether or not you think the blood/body fluid is infected with Blood borne  pathogens, you treat it as if it were. This approach is used in all situations where exposure to blood or potentially infectious materials is possible. This also means that certain engineering and work practice controls shall always be utilized in situations where exposure may occur.

Practicing Universal Precautions requires use of engineering controls, personal protective equipment, and good work practices.

Personal Protective Equipment

Probably the first thing to do in any situation where you may be exposed to Blood borne  pathogens is to ensure you are wearing the appropriate personal protective equipment (PPE). For example, you may have noticed that emergency medical personnel, doctors, nurses, dentists, dental assistants and other health care professionals always wear latex or protective gloves. This is a simple precaution they take in order to prevent blood or potentially infectious body fluids from coming into contact with their skin. To protect yourself, it is essential to have a barrier between you and the potentially infectious material.

Rules to follow:

If you work in an area with routine exposure to blood or potentially infectious materials, the necessary PPE should be readily accessible. Contaminated gloves, clothing, PPE, or other materials should be placed in appropriately labeled bags or containers until it is disposed of, decontaminated, or laundered. It is important to find out where these bags or containers are located in your area before beginning your work.

Gloves
Gloves should be made of latex, nitril, rubber or other water impervious materials. If glove material is thin or flimsy, double gloving can provide an additional layer of protection. Also, if you know you have cuts or sores on your hands, you should cover them with a bandage or similar protection as an additional precaution before donning your gloves. You should always inspect your gloves for tears or punctures before putting them on. If a glove is damaged, don't use it! When taking contaminated gloves off, do so carefully. Make sure you don't touch the outside of the gloves with any bare skin, and be sure to dispose them in a proper container so that no one else will come in contact with them.

Always
check your gloves
for damage
before using them

Goggles
person wearing gogglesAnytime there is a risk of splashing or vaporization of contaminated fluids, goggles and/or other eye protection should be used to protect your eyes. Again, Blood borne  pathogens can be transmitted through the thin membranes of the eyes so it is important to protect them. Splashing could occur while cleaning up a spill, during laboratory procedures or while providing first aid or medical assistance.

Face Shields
person wearing face shield
Face shields may be worn in addition to goggles to provide additional face protection. A face shield will protect against splashes to the nose and mouth.

Aprons
an apron
Aprons may be worn to protect your clothing and to keep blood or other contaminated fluids from soaking through to your skin.
 

Normal clothing that becomes contaminated with blood should be removed as soon as possible because fluids can seep through the cloth to come into contact with skin. Contaminated laundry should be handled as little as possible, and it should be placed in an appropriately labeled bag or container until it is decontaminated, disposed of or laundered.

Remember to use universal precautions and treat all blood or potentially infectious body fluids as if they were contaminated. Avoid contact whenever possible, and whenever it's not, wear personal protective equipment. If you find yourself in a situation where you must come into contact with blood or other bodily fluids and you have no standard personal protective equipment handy, you can improvise. Use a towel, plastic bag, or some other barrier to help avoid direct contact.

Banner says Personal Protective Equipment, Work Practices, and Engineering Controls

Work Practice Controls are UNIVERSAL PRECAUTIONS

Work Practice Controls reduce the likelihood of exposure through alteration of the manner in which tasks are performed. Effectiveness depends on employee motivation. If prescribed work practice controls are not followed, risk of exposure could be greatly increased. Workers must be aware of potential exposure situations and take necessary steps to avoid contamination.

Example good work practice: When possible, employees perform their own minor first aid care. Co-workers can assist by supplying the necessary cleansing items and band-aids to the injured person, but the injured person dresses the wound.

Example bad work practice: Spraying down an area contaminated with body fluids with a hose. This action could cause other items in the area to become contaminated.

Examples of other work practice controls: Frequent hand washing; Procedures for handling "Sharps", "Regulated Waste" disposal procedures; Prohibiting eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses in areas where there is reasonable likelihood of occupational exposure.

Engineering Controls act on the source of the hazard and eliminate or reduce employee exposure without reliance on the employee to take self-protective action. These controls serve to reduce exposure in the workplace by either removing the hazard or isolating the worker from exposure.

Examples of engineering controls: Puncture-resistant sharps containers; Mechanical pipetting device; Absorbent powders; Self-sheathing needles; Biosafety cabinets/hoods.

Banner says Personal Protective Equipment, Work Practices, and Engineering Controls

Hygiene Practices

person washing hands with soap

Hand washing is one of the most important (and easiest) practices used to prevent transmission of Blood borne  pathogens. Hands or other exposed skin should be thoroughly washed as soon as possible following an exposure incident. Use soft, antibacterial soap, if possible. Avoid harsh, abrasive soaps, as these may open fragile scabs or other sores.

Hands should also be washed immediately (or as soon as feasible) after removal of gloves or other personal protective equipment. If hand washing facilities are not feasible, the employee must be provided either a "waterless" antiseptic cleanser or antiseptic towelettes. If these alternatives are used then the hands are to be washed with soap and running water as soon as feasible.

Because hand washing is so important, you should familiarize yourself with the location of the hand washing facilities nearest to you. Sinks, public restrooms, janitor closets, and so forth may be used for hand washing if they are normally supplied with soap.

If you are working in an area where there is reasonable likelihood of exposure, you should never:

  • Eat
  • Drink
  • Smoke
  • Apply cosmetics or lip balm
  • Handle contact lenses

No food or drink should be kept in refrigerators, freezers, shelves, cabinets, or on counter tops where blood or potentially infectious materials are present.

No Smoking, Eating, or Drinking sign

 

 

Banner says Personal Protective Equipment, Work Practices, and Engineering Controls

Decontamination and Sterilization

All surfaces, tools, equipment and other objects that come in contact with blood or potentially infectious materials must be decontaminated and sterilized as soon as possible. Equipment and tools must be cleaned and decontaminated before servicing or being put back to use.

Decontamination should be accomplished by using

If you are cleaning up a spill of blood, you can carefully cover the spill with paper towels or rags, then gently pour your 10% solution of bleach over the towels or rags, and leave it for at least 10 minutes. This will help ensure that the Blood borne  pathogens are killed before you actually begin cleaning or wiping the material up. By covering the spill with paper towels or rags, you decrease the chances of causing a splash when you pour the bleach on it.

If you are decontaminating equipment or other objects (be it scalpels, microscope slides, broken glass, saw blades, tweezers, mechanical equipment upon which someone has been cut, first aid boxes, or whatever) you should leave your disinfectant in place for at least 10 minutes before continuing the cleaning process.

Of course, any materials you use to clean up a spill of blood or potentially infectious materials must be decontaminated immediately, as well. This would include mops, sponges, re-usable gloves, buckets, pails, etc.

Sharps

Far too frequently, housekeepers, custodians and others are punctured or cut by improperly disposed needles and broken glass. This, of course, exposes them to whatever infectious material may have been on the glass or needle. For this reason, it is especially important to handle and dispose of all sharps carefully in order to protect yourself as well as others.

sharps disposal container

Needles

Broken Glassware

By using Universal Precautions and following these simple engineering and work practice controls, you can protect yourself and prevent transmission of Blood borne  pathogens.

banner says Housekeeping and Laundry Practices

All equipment, environmental surfaces and work surfaces shall be decontaminated as soon as possible after contact with blood or other potentially infectious materials. Disinfectants need to be either tuberculocidal or have an HIV rating (a bleach solution with a 1:10 to 1:100 dilution may also be used for decontamination).

Take steps necessary to prevent contamination spread to other areas or workers. Precautions include changing gloves/washing hands as needed, change gowns or lab coats when contaminated, do not walk from one area to another while wearing contaminated shoes or clothes.

LAUNDRY that is contaminated with potentially infectious materials shall be treated as if it is contaminated and shall be placed in a proper container and handled as little as possible.

Banner says Signs, Labels, and Color Coding

 

Warning labels need to be affixed to containers of regulated waste, refrigerators and freezers containing blood or other potentially infectious material; and other containers used to store, transport, or ship blood or other potentially infectious materials.  Bags used to dispose of regulated waste must be red or orange red, and they, too, must have the biohazard symbol readily visible upon them. Regulated waste should be double-bagged to guard against the possibility of leakage if the first bag is punctured.

 universal biohazard label

Regulated waste refers to

All regulated waste must be disposed in properly labeled containers or red biohazard bags. These must be disposed at an approved facility. Most departments or facilities that generate regulated waste will have some sort of contract with an outside disposal company that will come pick up their waste and take it to an approved incineration/disposal facility.

Green label required to go on biohazardous waste[

Custodians and housekeepers will not remove bags containing any form of blood (human or animal), vials containing blood, bloody towels, rags, biohazardous waste, etc. unless the bag has one of these labels on it. They have been given very strict instructions not to handle any non-regulated waste unless it has been properly marked and labeled (including signature).

Custodians will not handle regulated waste.

Banner says Emergency Procedures

 

In an emergency situation involving blood or potentially infectious materials, you should always use Universal Precautions and try to minimize your exposure by wearing gloves, splash goggles, pocket mouth-to-mouth resuscitation masks, and other barrier devices.

If you are exposed, however, you should:

  1. Wash the exposed area thoroughly with soap and running water. Use non-abrasive, antibacterial soap if possible.
  2. Report the exposure to your supervisor as soon as possible.
  3. Fill out an exposure report form, if you desire. This form will be kept in your personnel file for 40 years so that you can document workplace exposure to hazardous substances.
  4. You may also go to the Medical Treatment Facility to request blood testing or the Hepatitis B vaccination if you have not already received it.

The Medical Treatment Facility has a specific set of procedures they will follow for all post-exposure cases. These are:

Apart from the circumstances surrounding the exposure itself, all other findings or diagnosis by the health care professional(s) will remain entirely confidential.

Banner says First Aid Providers


 

If your primary job assignment is rendering first aid such as a paramedic, EMT, lifeguard, police, athletic trainer, exposure to human blood or other potentially infectious materials (OPIM) is reasonably anticipated in performing your duties. You must be identified in the Exposure Control Plan and be offered pre-exposure hepatitis B vaccine.


 

However, if your primary job assignment is not rendering first aid and any first aid is rendered only as collateral duty, responding solely to injuries resulting from workplace incidents, hepatitis B vaccine is not offered prior to exposure incidents. Examples of individuals falling into this category are teacher, teacher's aide, daycare worker or other employees that assist injured, bleeding colleagues in the workplace.

 

 

Blood borne  Pathogen Training

1.

Sputum (the mucous secretions produced by the lower respiratory tract) is considered a potentially infectious fluid capable of transmitting Blood borne  pathogens.

A.True
B.
False
C.

D.

2.

Trash bags should be held away from the body to avoid any sharps that may be present.

A.True
B.
False
C.

D.

3.

Universal Precautions will always protect workers from exposures to all human pathogens.

A.True
B.
False
C.

D.

4.

Which of the following materials could contain Blood borne  pathogens?

A.bloody saliva
B.
semen
C.
vaginal secretions
D.
all of the above

5.

Which of the following Blood borne  viruses is thought to be transmitted through direct contact with a contaminated environmental source?

A.all viruses
B.
HIV
C.
HBV and HIV
D.
HBV

6.

You should never eat, drink, or smoke in a laboratory or other area where there may be potential exposure to Blood borne  pathogens.

A.True
B.
False
C.

D.

7.

If you have blood or potentially infectious materials splashed into your eye, you should flush your eye with clean, running water for:

A.2 minutes
B.
5 minutes
C.
10 minutes
D.
15 minutes

8.

Which Blood borne  disease can be prevented through vaccination?

A.HBV and HIV
B.
HIV
C.
HBV
D.
None

9.

If you are exposed to potentially infectious materials on the job, you may request a vaccine for which Blood borne  disease?

A.HIV
B.
Syphilis
C.
Hepatitis B
D.
Brucellosis

10.

HIV is more readily transmissible than HBV.

A.True
B.
False
C.

D.

 

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