Bloodborne Pathogens

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Bloodborne Pathogens
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Bloodborne Pathogens

• Scope and Coverage
• Original thrust was aimed at
• Hospitals
• First Responders (ambulance, fire, police)
• Dental practices
• Non medical classifications
• Funeral directors and morticians
• Police crime labs
• Barbers and cosmetologists

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Bloodborne Pathogens

• Scope and Coverage also effects
• Maintenance and Custodial workers
• Housekeeping and Laundry services
• Waste Handling and Disposal services

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Bloodborne Pathogens

• OSHA Regulation 29CFR 1910.1030
• History Effective Dates
• Purpose of the Regulation
• Employer Requirements
• Scope and Coverage
• Exposure Control Plan

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Bloodborne Pathogens

• 1991- OSHA publishes the final regulation for
  Bloodborne Pathogens in December.
• 1992- OSHA regulation effective in March
• 1992- Deadline for the completion of the written
  Exposure Control Plan (May)
• 2000- Needlestick Safety and Prevention Act

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Needlestick Safety and Prevention Act Timeline

• P. L. 106-430 signed November 6, 2000
• Revised Standard published in Federal Register
  Jan. 18, 2001
• Effective date April 18, 2001
• Enforcement of new provisions July 17, 2001
• Adoption in OSHA state-plan states October 18,
  2001

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Revisions to Standard

• Additional definitions, paragraph (b)
• New requirements in the Exposure Control Plan,
  paragraph (c)
• Solicitation of input from non-managerial
  employees, paragraph (c)
• Sharps injury log, paragraph (h)

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Bloodborne Pathogens Standard

• Major Provisions by Paragraph
• (b) Definitions
• (c) Exposure Control Plan (ECP)
• (d) Engineering and Work Practice Controls
• - Personal Protective Equipment (PPE)
• (e) HIV and HBV Research Labs
• (f) Vaccination, Post-Exposure Follow-up
• (g) Labeling and Training
• (h) Recordkeeping

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Bloodborne Pathogens

• To assure that no employee will suffer material
  health or functional impairment due to an
  exposure to hazardous agents while in the course
  of their employment.

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Bloodborne Pathogens

• Requirements of the Employer
• Employee education and training
• Protective measures and equipment
• Written Documentation
• Record keeping

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Bloodborne Pathogens

• There is one exemption to the rule!
• The Good Samaritan clause
• A De minimus classification
• No penalties for violation

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Bloodborne Pathogens

• Occupational Exposure
• Any reasonably anticipated skin, eye, mucous
  membrane, or parenteral contact with blood...
• .... or any other potentially infectious
  materials that may result from the performance of
  an employees duties.

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Exposure Determination

• The employer must
• Identify worker exposures to blood or other
  potentially infectious material
• Review all processes and procedures with exposure
  potential
• Re-evaluate when new processes or procedures are
  used

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Bloodborne Pathogens

• Determination of Exposure
• Potentially Infectious materials include
• semen
• vaginal secretions
• cerebrospinal fluid
• synovial fluid
• pleural fluid
• pericardial fluid
• peritoneal fluid
• amniotic fluid
• saliva in dental procedures

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Needlestick Prevention and Bloodborne Pathogens

• Needlestick incidents do happen!
• Be prepared!
• All needlestick incidents are preventable!

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Needlestick Prevention and Bloodborne Pathogens

• Once the worker has been stuck he has been
  exposed!
• Record the incident!!
• Treat the worker!

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Bloodborne Pathogens

• Employee Education and Training
• Epidemiology of bloodborne diseases is the study
  of the incidence, distribution and control of
  Hepatitis B and HIV/AIDS
• Hepatitis is an inflammation of the liver
• HIV/AIDS destroys the ability to fight infections

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Bloodborne Pathogens

• Employee Education and Training
• Symptoms of Hepatitis B
• Yellow Eyes Skin (Jaundice)
• Abdominal pain
• Fever and Vomiting
• Dark Urine
• Fatigue

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Bloodborne Pathogens

• Employee Education and Training
• Symptoms of AIDS
• Fever
• Swollen Glands
• Diarrhea
• Extreme Weight Loss
• Skin Lesions
• Mental Disorientation

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Needlestick Prevention and Bloodborne Pathogens

• Needles come in all shapes and sizes.
• Check manufacturers for the safest needle!

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Methods of Compliance

• Universal Precautions
• Engineering Controls
• Work Practice Controls
• Personal protective equipment
• Housekeeping

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Bloodborne Pathogens

• Employee Education and Training
• Modes of Transmission of Bloodborne Pathogens
• Parenteral
• Intravenous Injection
• Accidental Needlestick
• Sexual
• Unprotected Sex
• Mucous Membrane
• Respiratory tract
• Alimentary tract (Nutrition/Digestive)

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Bloodborne Pathogens

• Control Measures
• Engineering Controls
• Serve to reduce employee exposure in the
  workplace by either isolating the worker from the
  exposure or removing the hazard
• Examples
• Surgical gloves
• Self retracting needles
• Sharps Containers

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Bloodborne Pathogens

• Control Measures
• Work Practice Controls
• Reduce the likelihood of exposure through the
  alteration of the manner in which the task is
  performed.
• Examples
• Using Gloves
• Handwashing
• Method of removing contaminated gloves
• Recapping needle procedures

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Bloodborne Pathogens

• Control Measures
• Personal Protective Equipment (PPE)
• Minimizes the risk of infectious materials
  entering into the workers body through
• skin lesions or
• entry through the eyes, nose, or mouth
• Examples
• Gloves
• Gowns
• Face Shields

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Bloodborne Pathogens

• Control Measures
• Universal Precautions
• An approach to infection control
• All human blood and human body fluids are treated
  as if they are infected!

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Bloodborne Pathogens

• HBV Vaccinations
• HBV Vaccinations are the most important part of
  HBV infection control
• Gloves and other PPE do not prevent puncture
  wounds or unanticipated exposures.
• Set of three inoculations
• Good for ten years

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Bloodborne Pathogens

• Post Exposure Evaluation Follow Up
• Exposure Incident means a specific eye, mouth,
  other mucous membrane, non-intact skin, or
  parenteral contact with blood or other infectious
  materials that result from the performance of an
  employees duties.

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Bloodborne Pathogens

• Post Exposure Evaluation Follow Up
• Following a report of an exposure incident, the
  employer provide a confidential medical
  evaluation which will include
• Documentation of route of exposure
• HIV/HBV status of the source individual
• Serological testing of the blood ASAP
• Post exposure vaccine (HBIG) if indicated
• Medical evaluation of the reported illness
• Counseling of the exposed individual

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Bloodborne Pathogens

• Regulated Waste Disposal
• Contaminated items that
• Would release blood or other potentially
  infectious materials
• IF they are
• Pourable
• Drippable
• Compressible

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Bloodborne Pathogens

• Housekeeping and Laundry
• Keep the worksite clean and sanitary
• Use a hospital grade VIRUCIDE
• OR a 110 bleach to water solution

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Bloodborne Pathogens

• Tags, Labels Bags
• Tags and Labels
• Fluorescent orange or red-orange
• Lettering in a contrasting color
• Biohazard symbol in a contrasting color.
• Bags must have this label on them (or they must
  be red in color) and leak proof.

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Bloodborne Pathogens

• Record keeping
• The employer shall establish and maintain an
  accurate record for each employee with an
  occupational exposure incident.
• Records shall include
• Name Social Security Number of employee
• Copy of employees HBV vaccination records
• Copy of all medical testing and findings
• Copy of physicians written opinion

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Bloodborne Pathogens

• Record keeping
• The employer shall maintain records for
• The duration of the employment
• PLUS 30 years
• Records must be kept CONFIDENTIAL!

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Bloodborne Pathogens

• Exposure Control Plan Must Address
• Exposure Determination
• Employee Education and Training
• Control Measures
• HBV Vaccinations
• Post Exposure Evaluation and Follow Up
• Regulated Waste Disposal
• Tags, Labels, and Bags
• Housekeeping and Laundry
• Record keeping

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Needlestick Prevention and Bloodborne Pathogens

• Contaminated needles and sharps
• Account for 20 infectious agents
• OSHAs primary concern
• HIV
• HBV
• HCV

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Needlestick Prevention and Bloodborne Pathogens

• CDC
• Hospital workers- 348,000 sticks a year!
• Non-Hospital Healthcare- 590,000 sticks a year
• OVER 1600 needle sticks daily!

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Needlestick Prevention and Bloodborne Pathogens

• OSHA Bloodborne Pathogen Standard
• Published in 1991
• Did not address safer devices
• Did not address safer best practices

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Needlestick Prevention and Bloodborne Pathogens

• Needlestick Safety and Prevention Act
• November 6, 2000
• Directed OSHA to revise their standard
• Federal Register can be found at www.osha.gov

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Needlestick Prevention and Bloodborne Pathogens

• Four changes to OSHAs regulation
• Refined definitions
• Exposure Control Plan modificiation
• Mandatory employee input
• Updated recordkeeping

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Exposure Control Plan1910.1030(c)New Provisions

• The ECP must be updated to include
• Changes in technology that reduce/eliminate
  exposure
• Annual documentation of consideration and
  implementation of safer medical devices
• Solicitation of input from non-managerial
  employees

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Engineering ControlsNew Definition

• means controls (e.g., sharps disposal
  containers, self-sheathing needles, safer medical
  devices, such as sharps with engineered sharps
  injury protections and needleless systems) that
  isolate or remove the bloodborne pathogens hazard
  from the workplace.
• Engineering Controls - includes additional
  definitions and examples
• Sharps with Engineered Sharps Injury Protections
  - SESIP
• Needleless Systems

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Solicitation of Non-Managerial EmployeesNew
Provision

• Identification, evaluation, and selection of
  engineering controls
• Must select employees that are
• Responsible for direct patient care
• Representative sample of those with potential
  exposure

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Engineering and Work Practice Controls

• The employer must
• Evaluate available engineering controls (safer
  medical devices)
• Train employees on safe use and disposal
• Implement appropriate engineering controls/devices

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Engineering and Work Practice Controls

• The employer must
• Document evaluation and implementation in ECP
• Review, update ECP at least annually
• Review new devices and technologies annually
• Implement new device use, as appropriate and
  available

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Engineering and Work Practice Controls

• The employer must
• Train employees to use new devices and/or
  procedures
• Document in ECP

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Needlestick Prevention and Bloodborne Pathogens

• Definitions
• Engineering Controls
• Needleless Systems
• Sharps with Engineered Sharps Injury Protection

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Needlestick Prevention and Bloodborne Pathogens

• Definition
• Engineering Control
• Revised to include
• Safer medical devices
• All control methods to isolate or remove hazards
• Includes blunt suture needles, plastic wrapped
  capillary tubes
• Includes sharps containers and biosafety cabinets

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Engineering and Work Practice Controls
1910.1030(d)

• Employers must select and implement appropriate
  engineering controls to reduce or eliminate
  employee exposure.

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• Where engineering controls will reduce employee
  exposure either by removing, eliminating, or
  isolating the hazard, they must be used.
• CPL 2-2.44D

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Engineering and Work Practice Controls

• Selection of engineering and work practice
  controls is dependent on the employers exposure
  determination.

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Needlestick Prevention and Bloodborne Pathogens

• Definition
• Sharps with Engineered Sharps Injury Protection
• A needle device or a non-needle device with a
  built in safety feature
• Non-needle sharp or a needle with a built-in
  safety feature or mechanism that effectively
  reduces the risk of an exposure incident.

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Needlestick Prevention and Bloodborne Pathogens

• Definition
• Needleless Systems
• New methods that do not use needles to collect
  bodily fluids, blood or deliver medication

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Hypodermic syringes with Self-Sheathing safety
feature
Self-sheathed protected position
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Hypodermic syringes with Retractable Technology
safety feature
Retracted protected position
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Phlebotomy needle with Self-Blunting safety
feature
Blunted protected position
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Add-on safety feature
Attached to syringe needle
Attached to blood tube holder
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Retracting lancets with safety features
Before During After
Before During After
In use After use
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Disposable scalpels with safety features
Retracted position
Protracted position
Protracted position
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Needlestick Prevention and Bloodborne Pathogens

• Changes to the Exposure Control Plan
• Annual review must reflect changes in technology
• Review of commercially available devices must be
  addressed

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Needlestick Prevention and Bloodborne Pathogens

• Non-managerial employees must have input to
  Exposure Control Plan Review
• May include
• Lab technicians
• Housekeeping Staff
• Maintenance Workers
• Direct patient care providers

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Needlestick Prevention and Bloodborne Pathogens

• Employee Input
• A representative sample
• A range of exposure situations
• Document it!

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Needlestick Prevention and Bloodborne Pathogens

• Recordkeeping
• Needlestick Log!!
• Confidential
• Use to determine high risk areas
• Evaluate devices

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Sharps Injury Log

• At a minimum, the log must contain, for each
  incident
• Type and brand of device involved
• Department or area of incident
• Description of incident
• Only mandatory for those keeping records under 29
  CFR 1904

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Needlestick Prevention and Bloodborne Pathogens

• Recordkeeping-
• Needlestick Log must contain
• Type of device
• Brand of device
• Department or work area
• Explanation of how the incident occurred

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Needlestick Prevention and Bloodborne Pathogens

• OSHA 200 system
• Separate needlestick log required
• May or may not be recordable!
• OSHA 200 to be replaced by OSHA 300

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Needlestick Prevention and Bloodborne Pathogens

• OSHA 300 system
• Sharps injuries recorded on OSHA 300.
• Must include brand and type of device
• Must be able to segregate sharps injuries
• Use a separate OSHA 300 form for the needlestick
  log
• OSHA 301 form for each incident!
• Computers must be able to sort by needlesticks!

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Bubonic and Pneumonic Plague!
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Hanta Virus

• 46 year old elementary school teacher
• Colorados fifth Hanta Virus victim in a year
• She lasted five days
• Lived on a ranch with husband and 3 children
• 200 cases nationwide

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Wash Your Hands

• After using toilet
• Women 74
• Men 61
• New York City- 60
• Chicago- 78
• New Orleans- 69
• Atlanta Braves Game-
• Women 89
• Men 46
• Pass the popcorn!!