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Bloodborne Pathogens and Infection
Control OSHA
Objectives:
Upon completion of this course the student will have an
understanding of the proper handling of hazrdous bio-waste they may
encounter in their duties as a healthcare worker, the infectious
diseases associated with these bloodborne pathogens, the steps needed to
prevent these infections and the OSHA regulations and rules regarding
them.
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.
The
following topics relate to occupational safety and health hazards with
blood or OPIM:
| · Bloodborne Pathogens Standard |
· Personal Protective Equipment |
| · Needlestick Injuries |
· Latex Allergy |
| · Other Sharps |
· Labeling and Signs |
| · Universal Precautions |
· HBV, HIV, and HCV |
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Bloodborne
Pathogens Standard
Definitions for
bloodborne pathogens, other potentially infectious materials (OPIM),
and occupational exposure are found in 1910.1030(b).
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Hazard
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 record keeping
data required by the bloodborne pathogens standard to
help evaluate the effectiveness of the ECP.
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Example
Exposure Control Plans: |
- A Model
Exposure Control Plan is provided to assist employers
in developing their own plans [OSHA Directive CPL 2-2.44D
Appendix D (1999, November 5)]. The following
sections and downloadable forms are provided below.
- Exposure Control
Plan
- Policy
- Program
Administration
- Employee
Exposure Determination
- Methods
of Implementation and Control
- Hepatitis
B Vaccine
- Post-exposure
Evaluation and Follow-up
- Administration
of Post-Exposure Evaluation and Follow-Up
- Procedures
for Evaluating the Circumstances Surrounding an
Exposure Incident
- Employee
Training
- Record keeping
- Sample
Forms:
- Written
Opinion for Hepatitis B Vaccination
- Written
Opinion for Post-Exposure Evaluation
- Bloodborne
Pathogen Exposure Evaluation Form
- Hepatitis
B Declination Form
Additional
Information:
- Bloodborne
Pathogens Technical Links Page.
- Model
Exposure Control Plan for Home Care: A Guide for
Hospice/Home Agencies on the Bloodborne Pathogens Standards.
OSHA Office of Occupational Nursing, (1994), 5.2K PDF, 74
pages.
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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.
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Hazard
Exposure to
blood and OPIM from needlestick injuries due to:
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- Improper
handling and disposal of needles.
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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].
- 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:
Unsafe
Needle Devices: Most needlestick injuries result from unsafe
needle devices, rather than carelessness by health care
workers.
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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.
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- 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
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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)].
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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)].
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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.
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- Disposable
razors that could be contaminated with blood
should be considered "contaminated sharps"
and disposed of properly in appropriate sharps
containers.
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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.

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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.
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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)].
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Hazard
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Exposure
to bloodborne pathogens because employees are not using
Universal Precautions. |
Example Controls
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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.
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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.
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Personal
Protective Equipment (PPE)
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Hazard
Exposure to
blood and OPIM due to an ineffective PPE program. Common
problems include improper:
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)].
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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.
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Hazard
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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.
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Labeling
and Signs
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Hazard
Exposure to
bloodborne pathogens due to improper labeling and signs of
potential hazards.
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- Individual
units of blood, for transfusion
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- Biohazard
label on regulated waste containers
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- Disposal
of contaminated I.V. tubing into a biohazardous
waste container
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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)].
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- Biohazard
Label: Containers that contain regulated
waste, (contaminated PPE, needles,
etc.), must bear the biohazard
symbol, in accordance with 1910.1030(g)(1)(i)(A).
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- 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)].
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- 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)].
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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.
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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).
- At no cost to
employee, at a reasonable time and place [1910.1030(f)(2)(i)].
- After the
employee has received the required training [1910.1030(f)(1)].
- Within 10 working
days of initial assignment.
- Those declining
the hepatitis b vaccine must sign a declination
statement . A sample
declination form is available.
- OSHA provides the
following non-mandatory sample form: Written
Opinion for Hepatitis B Vaccination.
- 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)].
- OSHA provides a non-mandatory sample
form
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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.
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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)].
- A health care
professional's written opinion is required after an
exposure incident [1910.1030(f)(5)(ii)].
- The non-mandatory sample form is available:
Written
Opinion for Post-Exposure Evaluation.
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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).
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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)].
- The following
non-mandatory sample form is available: Written
Opinion for Post-Exposure Evaluation.
- 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).
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