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Bloodborne Pathogens Module  


    

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Exposure to blood or other potentially infectious materials (OPIM) is an issue of growing concern for health care workers. Care must be taken to prevent the transmission of bloodborne pathogens such as the Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV), in the workplace. 

Click on the area for more specific information.  Hazards found in a Bloodborne Pathogens Room Unsafe Needle Devices Handwashing Biohazard Symbol Biohazardous Waste Container Handling Practices Exposure Control Plan Latex Sensitivity Universal Precautions Blood Products IV Setup - Connectors IV Tube Personal Protective Equipment Glass Capillary Tubes Disposal of Personal Protective Clothing Red Bags or Containers
 

The following topics relate to occupational safety and health hazards with blood or OPIM: 





Bloodborne Pathogens Standard

Definitions for bloodborne pathogens, other potentially infectious materials (OPIM), and occupational exposure are found in 1910.1030(b).

Hazard

Animated Arrow Possible employee exposure to blood and OPIM because of an ineffective Exposure Control Plan (ECP).

Example Controls

Provide an effective ECP and training as required by the Bloodborne Pathogens Standard [1910.1030].  Each employer must:

  • Identify employees who have occupational exposure to blood or OPIM [1910.1030(b)], and then establish and implement a written Exposure Control Plan (ECP), designed to eliminate or minimize employee exposure [1910.1030(c)(1)].
  • The ECP must be made available to all employees [1910.1030(c)(1)(iii)] and be reviewed and updated at least yearly [1910.1030(c)(1)(iv)].
  • Ensure that employees with occupational exposure to bloodborne pathogens receive appropriate training at no cost to employees, and during working hours [1910.1030(g)(2)(i)].
    • Training requirements are listed in [1910.1030(g)(2)(vii)].
  • It is recommended that employers review recordkeeping data required by the bloodborne pathogens standard to help evaluate the effectiveness of the ECP. 
Example Exposure Control Plans:

Additional Information:

     

 

Needlestick Injuries

An estimated 800,000 needlestick injuries occur each year. Nursing staff are most frequently injured. EPINET Data show needlestick injuries occur most frequently in patient rooms. 

Needlestick injuries account for up to 80 percent of accidental exposures to blood. (OSHA JSHQ, 1998). 

NOTE: Recording of Exposure Incidents: For recordkeeping purposes, an occupational bloodborne pathogens exposure incident (e.g. needlestick, laceration, or splash) should be classified as an injury since it is usually the result of an instantaneous event or exposure. CPL 2-2.44D,X.

Hazard

Exposure to blood and OPIM from needlestick injuries due to: 

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Example Controls

Engineering and Work Practice Controls must be the primary means to eliminate or minimize exposure to bloodborne pathogens. Where engineering controls will reduce employee exposure either by removing, eliminating or isolating the hazard, they must be used, and changes to the Exposure Control Plan (ECP) must include these engineering controls [1910.1030(c)(1)(iv), 1910.1030(d)(2)(i) and OSHA Directive 2.44D, XIII (D)(2)].

  • Engineering Controls are controls (e.g., sharps disposal containers, self-sheathing needles) that isolate or remove the bloodborne pathogens hazard from the workplace [1910.1030(b)].
    • NOTE: The exposure control plan must document consideration and implementation of appropriate commercially available and effective engineering controls designed to eliminate or minimize exposure [OSHA Directive 2.44D,XIII,C5].
    • Suggested non-mandatory forms are provided to assist employers in evaluating engineering controls [Appendix B, OSHA Directive CPL 2-2.44D]. The appendix includes the sample evaluation form developed by the Emergency Care Research Institute (ECRI). 
  • Work Practice Controls are controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting recapping of needles by a two-handed technique) [1910.1030(b)].
  • Needlestick prevention program: The standard requires immediate follow-up of employees after a needlestick [1910.1030(f)(3)]. It is recommended that such follow-up include identifying injury patterns and accident analysis to determine if other training, procedures, or safer needle devices should be used to prevent future accidents. 
    • Post-exposure Evaluation and Follow-up also includes:
      • A confidential medical exam [1910.1030(f)(3)].
      • Documentation of the route(s) of exposure, and the circumstances under which the exposure incident occurred [1910.1030(f)(3)(i)]. 
      • Testing of the source individual's blood [1910.1030(f)(3)(ii)(A)] and making the results of the source individual's testing usually after consent available to the exposed employee [1910.1030(f)(3)(ii)(C)].
      • Administration of post-exposure prophylaxis, when medically indicated, as recommended by the U.S. Public Health Service [1910.1030(f)(3)(iv)].


Unsafe Needle Devices: Most needlestick injuries result from unsafe needle devices, rather than carelessness by health care workers. 

Safer needle devices have built-in safety control devices, such as those that use a self-sheathing needle, to help prevent injuries before, during, and after use through safer design features.

Safer Needle Devices -  Before and After Use
  • The FDA is responsible for clearing medical devices for marketing in the U.S. It recommends safer needle devices with a fixed safety feature that:
    • Provides a barrier between the hands and the needle after use; the safety feature should allow or require the worker's hands to remain behind the needle at all times.
    • Is an integral part of the device and not an accessory.
    • Is in effect before disassembly and remains in effect after disposal to protect users and trash handlers, and for environmental safety.
    • Is as simple as possible, and requires little or no training to use effectively.

Improper Handling and Disposal of Needles/Sharps:  

Proper handling and disposal of needles can reduce needlestick injuries. For example, the Bloodborne Pathogens Standard:

  • Prohibits the recapping, bending, or removal of contaminated sharps, to avoid accidental punctures. Shearing or breaking of contaminated needles is also prohibited [1910.1030(d)(2)(vii)].
    • Unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical or dental procedure. In such cases the recapping or needle removal must be accomplished through the use of a mechanical device or one handed technique (2)(vii)(A) and (d)(2)(vii)(B).
  • Requires discarding of contaminated needles and other sharp instruments immediately or as soon as feasible after use into appropriate containers [1910.1030(d)(4)(iii)(A)(1)].

Containerization 

Containerization

Appropriate containers must be [1910.1030(d)(4)(iii)(A)(1)]:
  • Closable, puncture-resistant and leak-proof on sides and bottom.
  • Accessible, maintained upright and not allowed to overfill. 
  • Labeled or color coded according to 1910.1030(g)(1)(i)
    • Colored red or labeled with the biohazard symbol
    • The label shall be fluorescent orange or orange-red, with lettering and symbols in a contrasting color [1910.1030(g)(1)(i)(C)].
    • Red bags or containers may be substituted for labels [1910.1030(g)(1)(i)(E)].

Additional Information

 

 

Other Sharps  

"Contaminated Sharps" means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires [1910.1030(b)].

Hazard

Exposure to blood and OPIM through other sharps:

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  • Glass Capillary Tubes that break when used may result in a penetrating wound and expose workers to blood and OPIM.

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  • I.V. Connectors that use needle systems increase the risk of exposure to bloodborne pathogens through needlestick injuries.
  • Disposable razors that could be contaminated with blood should be considered "contaminated sharps" and disposed of properly in appropriate sharps containers.

Example Controls

Implement engineering and work practice controls to help prevent exposures.

  • Capillary Tubes:  
    • Broken glassware, such as capillary tubes is not to be picked up directly with the hands [1910.1030(d)(4)(ii)(D)].
    • Regulated wastes including capillary tubes need to be disposed of properly [1910.1030(d)(4)(iii)].
    • Gloves must be worn when among other things, handling or touching contaminated items or surfaces, such as capillary tubes [1910.1030(d)(3)(ix)].
    • In their joint document (Glass Capillary Tubes: Joint Safety Advisory About Potential Risks (1999, February)), OSHA, FDA and NIOSH warn health care workers about the hazards from breakage of glass capillary tubes and recommend the use of:
      • Capillary tubes that are not made of glass.
      • Glass capillary tubes wrapped in puncture-resistant film.
      • Products that use a method of sealing that does not require manually pushing one end of the tube into putty to form a plug.
  • I.V. connector systems: The use of needleless connector systems with I.V. setups is an engineering control that will minimize occupational exposure.
IV Connector System

FDA urges the use of needleless systems or recessed needle systems to reduce the risk of needlestick injuries and exposure to bloodborne pathogens.

These connectors use devices other than needles to connect one I.V. to another. This example shows the plunger-type system.

Additional Information

 

 

Universal Precautions  

An approach to infection control which treats all human blood and other potentially infectious materials as if they were infectious for HIV and HBV or other bloodborne pathogens [1910.1030(b)].

Hazard

Animated Arrow Exposure to bloodborne pathogens because employees are not using Universal Precautions.

Example Controls

Implement Universal Precautions according to the Bloodborne Pathogens Standard [1910.1030(d)(1)].
  • Treat all blood and other potentially infectious materials with appropriate precautions such as:
    • Use gloves, masks, and gowns if blood or OPIM exposure is anticipated.
    • Use engineering and work practice controls to limit exposure.
There are other concepts in infection control that are acceptable alternatives to universal precautions, such as Body Substance Isolation (BSI) and Standard Precautions (OSHA CPL 2-2.44D, Section D): 
  • These methods define all body fluids and substances as infectious and incorporate not only the fluid and materials covered by the Bloodborne Pathogens Standard, but expand coverage to include all body fluids and substances.

Additional Information

 

 

Personal Protective Equipment (PPE)

Hazard

Exposure to blood and OPIM due to an ineffective PPE program. Common problems include improper:

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Example Controls

Personal Protective Equipment (PPE) is required by the Bloodborne Pathogens Standard and can provide some protection from infectious materials as a barrier to protect skin and mucous membranes from contact with blood and other potentially infectious materials.

  • Appropriate PPE, addressed in 1910.1030(d)(3)(i), must be provided by the employer, at no cost to the employee, in appropriate sizes and be used by personnel if blood or OPIM exposure is anticipated. The type and amount of PPE depends on the anticipated exposure. PPE includes:
    • Gloves, gowns, laboratory coats, masks, face shields, eye protection, mouthpieces, resuscitation bags, pocket masks, or other ventilation devices.
    • Gloves must be worn when hand contact with blood, mucous membranes, OPIM, or non-intact skin is anticipated, and when performing vascular access procedures, or when handling contaminated items or surfaces [1910.1030(d)(3)(ix)].
Handwashing according to the Bloodborne Pathogen Standard:
  • Employers must ensure that employees wash hands and any other skin with soap and water or flush mucous membranes with water as soon as feasible after contact with blood or other potentially infectious materials (OPIM) [1910.1030(d)(2)(vi)].
  • Employers must provide readily accessible handwashing facilities, [1910.1030(d)(2)(iii)] and ensure that employees wash their hands immediately or as soon as feasible after removal of gloves [1910.1030(d)(2)(v)].
Disposal of Protective Clothing:
  • Protective clothing must be removed before leaving the room; [1910.1030(d)(3)(vii)], and disposed of in an appropriately designated area or container for storage, washing, decontamination or disposal [1910.1030(d)(3)(viii)].

 

Latex Allergy

It is estimated that 8-12% of health care workers are latex sensitive with reactions ranging from irritant contact dermatitis and allergic contact sensitivity, to immediate, possibly life threatening, sensitivity.

Hazard

Animated Arrow Developing latex sensitivity or latex allergy from exposure to latex in products like latex gloves.  

Example Controls

Use appropriate gloves for latex-sensitive employees:

  • The employer shall ensure that appropriate personal protective equipment, in the appropriate sizes, is readily accessible at the worksite or is issued to employees. Hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided [1910.1030(d)(3)(iii)]. 
    • Among the alternatives are synthetic, low protein, and powder free gloves. Powder free gloves may reduce systemic allergic responses. 
      • Eliminate the unnecessary use of latex gloves when no risk of exposure to blood or OPIM exists.
    • Note: Hypoallergenic gloves, glove liners, or powderless gloves are not to be assumed to be non-latex or latex free.
    • The FDA now requires labeling statements for medical devices that contain natural rubber and prohibits the use of the word "hypoallergenic" to describe such products. (Federal Register, Volume 62, No. 189, effective September 30, 1998). A summary is provided in the FDA talk paper Latex Labeling Required for all Medical Devices (1997, September 30).
  • Hand washing is required by OSHA's Bloodborne Pathogens Standard after removal of gloves or other personal protective equipment. This helps to minimize powder and/or latex remaining in contact with the skin [1910.1030(d)(2)(v)].

It is recommended that thorough clean-up of any residual powder in the workplace with appropriate vacuum filters will reduce latex sensitivity and decrease employee exposure.

The Laundry and Pharmacy modules also address latex allergy issues.

Additional Information

 

 

Labeling and Signs

Hazard

Exposure to bloodborne pathogens due to improper labeling and signs of potential hazards.

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Example Controls 

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Implement labeling and signs required by the Bloodborne Pathogens Standard, such as:

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  • Biohazardous Waste Container: Regulated waste, such as I.V. tubing used to administer blood, contaminated PPE, and needles etc., must be disposed of into appropriately labeled biohazardous waste containers [1910.1030(g)(1)(i)(A)].
  • These labels shall be fluorescent orange or orange-red, with lettering and symbols in a contrasting color [1910.1030(g)(1)(i)(C)].

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  • Red bags or red containers may be substituted for labels [1910.1030(g)(1)(i)(E)].
  • Exception for Blood Products: Individual containers of blood, blood components, or products that are labeled as to their contents and have been released for transfusion or other clinical use need not be labeled as hazardous [1910.1030(g)(1)(i)(F)].
  • Note: Individual containers of blood or OPIM need not be labeled if placed in a labeled container for storage, transport, shipment or disposal  [1910.1030(g)(1)(i)(G)].

 

 

Bloodborne Illnesses - Hepatitis B Virus

Hepatitis is an inflammation of the liver that can lead to liver damage and/or death. The CDC estimates 800 health care workers became infected with HBV in 1995. This figure represents a 95% decline in new infections from the 1983 figures. The decline is largely due to the immunization of workers with the Hepatitis B vaccine, and compliance with other provisions of OSHA's Bloodborne Pathogens Standard.

Hazard

Exposure to potentially fatal bloodborne illnesses such as Hepatitis B Virus (HBV). 

  • Hepatitis is much more transmissible than HIV. 
  • Risk of infection from a single needlestick is 6%-30% (CDC 1997).
  • 50% of the people with HBV infection are unaware that they have the virus. 
  • The CDC states that HBV can survive for at least one week in dried blood on environmental surfaces or contaminated needles and instruments.

Example Controls

  • Prevent the exposure in the first place by implementing an effective Exposure Control Plan as required by the Bloodborne Pathogens Standard [1910.1030(c)(1)]. 
  • Employers must offer to all employees who have occupational exposure to blood or OPIM, under the supervision of a licensed physician the hepatitis b vaccination [1910.1030(f)(2)]:
    • Except as provided in 1910.1030(f)(2)(i)
  • Health care workers who have ongoing contact with patients or blood and are at ongoing risk for injuries with sharp instruments or needlesticks must be offered testing for antibody to hepatitis B surface antigen one to two months after the completion of the three-does vaccination series.
    • Employees who do not respond to the primary vaccination series must be offered a second three dose vaccine series and retesting. Non-responders must be offered medical evaluation [1910.1030(f)(1)(ii)(D)].
  • Following a report of an exposure incident the employer shall make immediately available to the exposed employee a confidential medical evaluation and follow-up [1910.1030(f)(3)].
  • If a worker is exposed to HBV, timely post-exposure follow-up with hepatitis b immune globulin and initiation of hepatitis b vaccine which must be offered [1910.1030(f)(1)(ii)(D)], are more than 90% effective in preventing HBV infection. 
  • A health care professional's written opinion is required after an exposure incident [1910.1030(f)(5)]. 

Additional Information

 

Bloodborne Illnesses - Human Immunodeficiency Virus (HIV)

HIV infection has been reported following occupational exposures to HIV-infected blood through needlesticks or cuts; splashes in the eyes, nose, or mouth; and skin contact. Most often, however, infection occurs from needlestick injury or cuts.

Hazard

Exposure to potentially fatal bloodborne illnesses such as HIV.  

  • Risk of HIV infection after needlestick is 1 in 3000 or 0.3%.
  • The CDC documented 55 cases and 136 possible cases of occupational HIV transmission to U.S. health care workers between 1985 and 1999.
Example Controls
  • Prevent the exposure in the first place by implementing an effective Exposure Control Plan as required by the Bloodborne Pathogens Standard [1910.1030(c)(1)]. 
  • Under certain circumstances post-exposure prophylaxis for HIV must be provided to health care workers who have an exposure incident, as defined in 1910.1030(b).
    • Limited data suggests that such prophylaxis may considerably reduce the chance of becoming infected with HIV. However, the drugs used for prophylaxis have many adverse side effects. 
    • No vaccine currently exists to prevent HIV infection, and no treatment exists to cure it.
  • Employees who have an incident must be offered a confidential medical evaluation and follow-up [1910.1030(f)(3)].  
Additional Information

 

 

 Bloodborne Illnesses - Hepatitis C Virus (HCV)  

HCV infection is the most common chronic bloodborne infection in the  United States, affecting approximately 4 million people. Hepatitis C infection is caused most commonly by needlestick injuries. HCV infection often occurs with no symptoms, but chronic infection develops in 75% to 85% of patients, with 70% developing active liver disease (CDC 1998).

Hazard

Exposure to potentially fatal bloodborne illnesses such as Hepatitis C Virus (HCV), which is:  

  • A major cause of chronic liver disease.
  • The leading reason for liver transplants in the United States in 1997 (CDC).
Example Controls
  • Prevent the exposure in the first place by implementing an effective Exposure Control Plan as required by the Bloodborne Pathogens Standard [1910.1030(c)(1)]. 
  • Employees who have an exposure incident shall be offered a confidential medical evaluation and follow-up [1910.1030(f)(3)]. 
  • A health care professional's written opinion is required after an exposure incident [1910.1030(f)(5)]. 
  • No vaccine is available for hepatitis C. Immunoglobulin or antiviral therapy is not recommended and no effective post-exposure prophylaxis is known at this time (CDC 1998).
Additional Information

 

 


 

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