OSHA Standards: Blood Borne Pathogens

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Bloodborne Pathogens

• Prevention of Spread of Infectious Diseases
• OSHA Long Term Care Worker Protection
  Program

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• Define bloodborne pathogens.
• Recognize OSHA standards related to
• bloodborne pathogens.
• Identify employer responsibilities related to
  compliance with OSHA standards.
• Recognize key strategies to control the spread of
  infectious diseases.

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• Bloodborne Pathogens
• Pathogens include but are not limited to
• Hepatitis B
• HIV human immunodeficiency virus

Pathogenic microorganisms that are present in
human blood or other potentially infectious
materials and can cause disease in humans.
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• 29 CFR 1910.1030, Occupational Exposure to
  Bloodborne Pathogens
• Published December 1991
• Effective March 1992
• Scope
• ALL occupational exposure to blood and other
  potentially infectious material (OPIM)

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Hepatitis B
HIV/AIDS
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What would you do? and what would other employees
do?
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• reasonably anticipated skin, eye, mucous
  membrane, or parenteral contact with blood or
  other potentially infectious materials that may
  result from the performance of an employees
  duties.
• Duties may include
• Direct Patient Care
• Phlebotomy/Laboratory
• Environmental Services
• Waste Management
• Other?

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• Exposure Determination
• all job classifications in which all employees in
  those job classifications have occupational
  exposure.
• job classifications in which some employees have
  occupational exposure.
• all tasks and proceduresin which occupational
  exposure occurs and that are performed by the
  above listed employees.

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Exposure Control Plan

• The schedule and method of implementation for
• Methods of compliance.
• Hepatitis B vaccination and post-exposure
  evaluation and follow-up for any exposure.
• Communication of hazards to employees.
• Recordkeeping.

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Exposure Control Plan

• The procedure for the evaluation of circumstances
  surrounding exposure incidents
• Immediate availability for exposed employees to
  confidential medical evaluation and follow-up.
• Documentation of the route(s) of exposure, and
  the circumstances under which the exposure
  incident occurred.

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• Standard (universal) Precautions
• shall be observed to prevent contact with blood
  or other potentially infectious materials.
• all body fluids shall be considered potentially
  infectious materials.

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• Purpose - to eliminate or minimize employee
  exposure
• Readily accessible hand washing facilities.
• Contaminated sharps management.
• Keeping food and drink out of the work area.
• Procedures involving blood handling.
• Transport of specimens.
• Contaminated equipment.
• CFR 1910.1030 (d)(2)

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• Teaching appropriate technique, make no
  assumptions!
• Availability of materials.
• Reinforcing and reminding.
• Monitoring.

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• Provide alcohol-based hand cleansers in multiple
  locations.
• Monitor use by volume replacement and
  observation.
• When they should be used if hands are not
  visibly dirty, if soap and water are not
  available.
• Frequent use is recommended, good amount, rubbing
  into all surfaces of hands until dry.
• Washing with soap and water careful technique,
  20-30 seconds, if hands are dirty, and after
  direct contact with potentially infectious
  material, after toileting, and when caring for a
  patient with a C. Difficile infection.

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Lets Take on the Challenge!
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• Shall be used where exposure remains after
  institution of engineering and work practice
  controls.
• Employer shall provide appropriate PPE at no cost
  to employee.
• May include gloves, gowns, laboratory coats,
  face shields or masks, eye protection,
  mouthpieces, resuscitation bags, pocket masks, or
  other ventilation devices.

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• Use
• Accessibility
• Cleaning, laundering, and disposal
• Repair and replacement
• Garment penetration
• PPE removal prior to leaving work area

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• Worksite maintained in clean and sanitary
  condition.
• Cleaning and decontamination of items.
• Safe disposal.

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• Contaminated sharps discarding and containment
• Approved sharp containers
• Easily accessible
• Upright
• Not allowed to overfill
• Container removal
• Close immediately prior to removal
• Place in secondary container if leakage is
  possible
• Reusable containers
• Should NOT be opened, emptied, or cleaned
  manually

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• Other regulated waste containment
• Closeable, constructed to contain all contents,
  labeled or color-coded, closed prior to removal.
• If outside contamination of the container occurs,
  it shall be placed in a second container.
• Disposal of all regulated waste shall be in
  accordance with applicable regulations.

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• Public Law 106-430
• Signed into law November 2000 enacted in 2001
  part of OSHA standards
• Needlestick Safety and Prevention Act
• Why? In 2000, it was estimated that over
  300,000 percutaneous injuries would occur
  involving contaminated sharps.

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• Requires that organizations use safer medical
  devices with injury protection or needleless
  systems.
• Need to reflect the changes in technology that
  can eliminate or reduce exposure to blood borne
  pathogens.
• Must document annually the consideration and
  implementation of safer devices.

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• Must maintain a Sharps Injury Log.
• List for each incident the type and brand of
  device involved, department/work area, and how
  the incident happened.
• Must solicit input from non-managerial staff in
  the identification, evaluation, and selection of
  effective engineering and work practice controls
  and shall document this input process in the
  Exposure Control Plan.

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• Shall be handled as little as possible
• Bagged or containerized at the location where it
  was used.
• Containers labeled or color-coded.
• Leak proof bags or containers.
• Employer shall ensure that employees who have
  contact with contaminated laundry wear protective
  gloves and other appropriate PPE.
• Shipping to an off-site facility.

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• The employer shall make available the Hep B
  vaccine appropriate medicationto all employees
  who have occupational exposure.
• Post-exposure evaluation follow-up care to all
  employees who have had an exposure incident
• No cost to the employee
• At a reasonable time
• Licensed physician or healthcare professional
• According to recommendations of the US Public
  Health Service
• All lab tests are conducted by an accredited lab
  at no cost to employee

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• Yes
• Must have them complete the Declination Statement
  and keep that document.
• 1910.1030 Appendix A (mandatory)
• Individuals can change their mind at any time and
  receive the vaccinations.

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• Documentation of the route(s) of exposure.
• Identification and documentation of the source
  individual.
• Collection and testing of blood for HBV and HIV.
• Post-exposure prophylaxis and care.
• Counseling.
• Evaluation of reported illnesses.

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• Labels and Signs
• Information and Education
• At the time of initial assignment
• At least annually
• When changes occur
• Content and vocabulary appropriate
• to educational level,
• literacy, and language of employees

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• Provided to all employees who may be at risk for
  exposure.
• At no cost.
• Minimum requirements
• CFR 1910.1030 (g)(2)(vii) lists all training
  program requirements.

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• Medical Records
• Shall be maintained for duration of employment
  plus 30 years.
• Training Records
• Shall be maintained for 3 years from the date of
  training.

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• Lack of training
• Busy, hectic, rushing
• Decreased awareness of hazards
• wont happen to me.

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• What strategies can we use that are really
  effective?
• What types of infectious diseases?
• Who is accountable?

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• Engineering controls involve making changes to
  the work environment to reduce work-related
  hazards.
• Work practice controls are procedures for safe
  and proper work that are used to reduce the
  duration, frequency or intensity of exposure to a
  hazard.
• Administrative controls include controlling
  employees' exposure by scheduling their work
  tasks in ways that minimize their exposure
  levels.
• Personal Protective Equipment (PPE) includes all
  clothing and other work accessories designed to
  create a barrier against workplace hazards.

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• Keys to success with all of these strategies
• Consistency
• Individual accountability

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• Current challenge with this improper and
  infrequent hand-washing or use of alcohol-based
  cleansers.
• Strategies to encourage
• Demonstrate proper technique
• Make the materials/supplies/facilities
  easy to access, close to all work areas.
• Monitor compliance
• Role modeling

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• Encouraging this with all employees and
  customers, family members/visitors.
• Consistent messages!
• Providing adequate facilities and materials.
• Monitor use and consistency of practices.
• We all need to practice this every day.

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Specialized clothing or equipment, worn by an
employee for protection against infectious or
other hazardous materials/objects. Remember
PPE is the last resort to addressing worker
hazard. (Hierarchy of Controls)
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• PPE for eyes, face, hand, extremities, protective
  clothing, respiratory devices, protective shields
  and barriers
• Shall be provided, used, and maintained in
  a sanitary and reliable condition,
• Wherever it is necessary by reason
• of hazards or processes or environment.

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• Must provide PPE at no cost to employee.
• Must assess all work environments for potential
  hazards.
• Must provide training to any employee who uses
  any PPE.
• Must pay for replacement of any required PPE,
  unless the employee has lost or intentionally
  damaged the item.

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• Chemical
• Radiological
• Thermal
• Mechanical
• Noise
• Blood and OPIM (other potential infectious
  material)
• Encountered by an employee in a manner capable of
  causing injury or impairment in any function/body
  part through absorption, inhalation, or physical
  contact.

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• Employer shall assess the workplace to determine
  if hazards are present that require the use of
  PPE.
• Communicate presence of hazards to employees.
• Select the appropriate PPE must fit each
  employee.

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• Engage supervisors and employees in the process.
• Assess in all work locations support service
  areas, patient care areas, specialty areas,
  facility management areas, external areas, etc.
• Need to have a written certification that
  identifies what was evaluated, who did it, the
  date.
• Reassess when appropriate - if services change,
  locations change.

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• Locations/situations in where this is needed?
• Must ensure that each affected employee uses eye
  protection that provides front and side
  protection from flying objects/materials.
• If they wear prescription lenses, the eye
  protection can incorporate the prescription in
  the design, or be worn over the prescription
  lenses must not disturb the prescription lenses
  or the protective lenses.

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• Does everyone who should wear this, do so, every
  time?
• Are they fit properly?
• Are they checked to be sure they are in good
  condition?
• What could we do differently?

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• First Priority Engineering Controls.
• Includes enclosure or confinement, general or
  local ventilation, or substitution of less toxic
  materials.
• When engineering controls are not adequate or
  feasible
• Face masks or Respirators should be used!
• CFR 1910.134

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• Provided by the employer.
• Must be applicable and suitable for the purpose
  and potential hazards involved.
• Must establish and maintain a respiratory
  protection program.

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• Identify when and where respiratory PPE needs to
  be used by employees and what type.
• Provide Medical evaluations prior to fit-testing
  and use.
• Follow standards on fit-testing procedure.
• Documentation requirements!
• N95 or higher NIOSH certified
• respirators.

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• Employer must select and provide appropriate hand
  protection for employees that are exposed to
  hazards
• skin absorption of harmful substances
• severe cuts, lacerations, or abrasions
• punctures
• chemical or thermal burns
• harmful temperature extremes

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• When and where patient care, environmental
  services, engineering, other areas.
• Glove material vinyl, latex, nitrile, other.
• Sterile and nonsterile.
• Single use or reusable.
• Critical to train employees on appropriate use,
  putting on, and taking off of gloves.

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• Gown first
• Mask or respirator
• Goggles or face shield
• Gloves
• Combination of PPE will affect sequence be
  practical !

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• Select a fit tested respirator
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with elastic
• Adjust to fit
• Perform a fit check
• Inhale respirator should collapse
• Exhale check for leakage around face

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• Gloves
• Face Shield or goggles
• Gown
• Mask or respirator
• And always wash hands thoroughly after removal of
  PPE!

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Employee Education

• Must train before they use the PPE.
• Need to know at least the following
• when PPE is necessary
• what PPE is necessary
• How to properly put on, take off, adjust,
• and wear PPE
• the limitations of the PPE
• proper care, maintenance, useful life,
• and disposal of PPE
• Resources available OSHA and CDC/NIOSH

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Employee Education

• Before using any PPE.
• Document training.
• Do not make assumptions about prior
• knowledge of the use of PPE!

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• When do you want employees to use hand
  protection?
• What are some of the most important engineering
  controls we need to provide?
• Gloves/all PPE must be easily accessible, in good
  condition, good fit for every employee.
• Monitoring practices.
• Current state of our art?

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• Monitoring
• Reminders examples?
• Easy access
• Good role models/teachers

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• Careful housekeeping procedures.
• Clear procedures for cleaning of items used by
  patients.
• Control of waste materials.
• Annual flu vaccinations for staff and patients.
• (now that is a challenge!)

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• Encourage all employees to get the annual flu
  vaccine.
• Encourage employees who are at risk for
  complications due to the flu such as those over
  50 or with a chronic health condition such as
  asthma to get the pneumonia vaccine.

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• Seasonal Influenza
• 1. VACCINATION!!
• This is the primary prevention strategy.
• Developed each year with the best knowledge
• of circulating viral strains included.
• Available in intranasal form (live
  attenuated)
• and injectable form (inactive attenuated).
• 2. Adherence to good daily hygiene practices.

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• Seasonal Flu vaccine is widely available most
  years.
• Many healthcare organizations offer it free or at
  minimal cost to employees.
• Available at community clinics, pharmacies,
  doctors offices, etc.
• Current statistics approximately 30 of US
  citizens get the flu vaccine. And healthcare
  workers?

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• History I have never had the flu!
• Beliefs in stories of the past.
• One experience (misinterpreted) may decide the
  future for an individual!
• I dont like needles.
• Availability timing, access, simplicity of the
  process.

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Flu.gov, April 20, 2010
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• Sharing the facts.
• Making the vaccine easily available.
• Enlisting the aid of other employees, employee
  health staff to talk with employees.
• Assuring that patients and visitors receive the
  factual information about the vaccine.

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• Hazard awareness in healthcare.
• Must control contact with blood and OPIM.
• Provide hand, eye, face, full body protection
  easily accessible and good fit.
• Teach employees how to use, when to use, how to
  put on and take off, how to dispose.
• Prevent the spread of infections whenever
  possible!

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• To improve employee safety.
• To enhance our care of patients, keeping them and
  their families safe.

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• Definition and scope.
• OSHA standards relating to Bloodborne Pathogens
  and Personal Protective Equipment.
• Employer responsibilities.
• Employee accountability.