Bloodborne Pathogen training

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Bonnie DiSalvo, MSASHMUSDA/ARS/NAA
OSHAs Bloodborne Pathogens Standard
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BLOODBORNE PATHOGENS
Pathogenic organisms that are present in human
blood and can cause disease in humans. These
include, but are not limited to Hepatitis B
Virus (HBV), HCV and Human Immunodeficiency
Virus (HIV)
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• Occupational Exposed Worker
• Reasonably anticipated skin, eye, mucous
  membrane, or parenteral contact with blood or
  other potentially infectious material that may
  result from the performance of employee duties.

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OTHER POTENTIALLY INFECTIOUS MATERIAL (OPIM for
short)

• Saliva in dental procedures
• Any body fluid visibly contaminated with blood
• All body fluids in situations where it is
  difficult or impossible to differentiate between
  body fluids

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Standard Requirements

• Written Exposure Control Plan
• Universal Precautions
• Engineering and work practice controls

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Standard Requirements (cont)

• Basic housekeeping
• Medical prevention plan
• Training
• Labeling requirements and record keeping
• PPE

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EXPOSURE CONTROL PLAN1910.1030(c)
To eliminate or minimize employee exposure, the
employer shall develop a written Exposure Control
Plan that contains

• Employee exposure determination
• The schedule and method of implementing
  paragraphs (d) to (h) of the standard
• The procedures for evaluating circumstances
  surrounding an exposure incident

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EXPOSURE CONTROL PLAN

• Reviewed and updated annually
• Reflect changes in technology that would reduce
  or eliminate exposure
• Document consideration of devices

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EXPOSURE CONTROL PLAN

• Solicit input from non-managerial employees
• Identification
• Evaluation
• Selection
• Effective engineering and work practice controls
• Document (c)(1)(v)

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The Written ECP Should Include

• Use of universal precautions
• Engineering and work practice controls
• PPE
• Medical evaluations and vaccinations
• Training
• These elements are required by the standard, but
  not necessarily in the ECP

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November 2000 Law Requires

• Sharps Injury Log
• Documented non-managerial employee input on safer
  medical devices
• Documented evaluation and implementation of
  safer medical devices at least annually

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UNIVERSAL PRECAUTIONS
An approach to infection control. According to
the concept of Universal Precautions, all human
blood and body fluids are treated as if known to
be infectious for HIV, HBV, HCV and other
bloodborne pathogens.
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• Universal/Standard Precautions
• This includes cell or tissue culture, culture
  medium, solutions or tissues from humans,
  experimental animals infected with HIV/HBV/HCV
• For our research facilities, blood and tissue
  products are treated under the standard

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ENGINEERING CONTROLS

• Controls that isolate or remove the hazard from
  the workplace
• Examples
• Sharps disposal containers, self-sheathing
  needles, safer medical devices, such as sharps
  with engineered sharps injury protection and
  needle-less systems

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1910.1030(d)(2)(i) ENGINEERING CONTROLS AND WORK
PRACTICES

• Engineering and work practice controls to be
  instituted as the PRIMARY means of eliminating or
  minimizing exposure.
• The employer MUST use engineering and work
  practice controls to eliminate exposure or reduce
  it to the lowest feasible extent.

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1910.1030(d)(2)(i) ENGINEERING CONTROLS AND WORK
PRACTICES

• The employer should be using or at least have
  considered, and documented in the exposure
  control plan why he/she CANNOT use engineering
  and work practice controls for work operations
  involving exposure to blood or OPIM.

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• (d)
• Work Practices
• Hand washing
• Personal hygiene
• Personal attire
• Not wearing personal protective equipment (PPE)
  out of the work area
• Changing PPE when contaminated
• Decontaminating/cleaning regularly after spills

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Sharps Disposal Containers

• Must be labeled or color-coded, puncture
  resistant, leak-proof, and close-able
• Should have well marked fill line, be translucent
  or have translucent lid

Classified as medical device (SMDA)
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Sharps Disposal Containers

• Establish collection schedules
• Provide placement of containers
• Review disposal procedures

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NEEDLE SHIELDS THAT CONTAIN THE HAZARD
Attached to syringe needle
Attached to holder
Attached to needle
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• Housekeeping
• Written schedule for cleaning and decontaminating
• Documented eye wash checks
• Material decontamination before exit from lab
• Removal of PPE from lab is prohibited
• Home laundering of PPE is prohibited
• Segregated waste

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• Medical Prevention Plan
• (f) Vaccination, Post-Exposure Follow-up
• Hepatitis B vaccine made available to all workers
  with potential risk of exposure
• Offered within 10 days of employment
• No cost to worker
• Declination signed if employee declines
  vaccine may accept at a later date

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• (f) Vaccination, Post-Exposure Follow-up
• Report the incident immediately
• Inform supervisor
• Go to clinic/medical services provider
• Confidential medical evaluation
• Route of exposure
• Circumstances of the incident
• Source known
• Important to start drug therapy within 2 hours
• Testing of victim/source only with consent
  (baseline blood stored for 90 days)

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Decontamination

• What needs to be?
• What does not need to be?
• Create a schedule
• Requirements for medical equipment
• EPA disinfectants, 110 dilutions bleach, 2
  glutaraldehyde

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1910.1030(d)(3) PERSONAL PROTECTIVE EQUIPMENT

• (d)(3)(i) - PPE must be provided at NO COST to
  the employee
• (d)(3)(ii) This paragraph addresses that PPE
  must be used properly per training received
• (d)(3)(iii) - discusses provisions of appropriate
  PPE, including hypoallergenic gloves as readily
  available alternative to latex

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Personal Protective Equipment (PPE)

• Appropriate PPE
• Testing standards
• ASTM ES 21 and ES 22
• Types
• When used and by whom
• Special needs
• No respiratory protection required

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• Labeling and Training
• Labels must include universal biohazard symbol
  and the term Biohazard
• Wherever BBP or OPIM are
• Fluorescent orange-red
• Secured with string, tape, wire, adhesive
• Exceptions Blood products for clinical use,
  blood samples in containers, blood drawing tubes

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• Labeling and Training
• Signs posted at all work area entrances
• Biohazard symbol
• Infectious agent
• Entry requirements
• Name telephone of responsible person

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• Record Keeping
• Occupational exposure/sharps injury record
• Confidential
• Kept for duration of employment, 30 years
• Includes
• Name social security number
• Vaccination status
• Examination results

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• Record Keeping
• Training records
• Kept for 3 years
• Dates
• Contents
• Names qualifications of instructors
• Names job titles of students
• Annual documentation

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Sharps Injury Log Information

• Type and brand of device involved
• Where incident occurred
• Description of how incident occurred
• Employee confidentiality must be maintained

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Incident Reporting

• Set up a policy
• Record incidents in Sharps Injury Log
  
• Effective January 2002, Included on OSHA logs
  (positives only)

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Postexposure Evaluation and follow-up Incident
reports

• Document route of exposure
• Identify source
• Test source blood
• Give test results to worker
• Upon consent , test workers blood

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Postexposure Evaluation(cont.)

• If no consent for HIV tests save blood for 90
  days
• Advise worker to seek medical attention
• Provide counseling
• Evaluate test results to give treatment if
  needed

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Physician's Written Opinion

• Complete within 15 days
• Worker must be informed of results and risks
• Employers have access to report

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Types of Prophylaxis

• HBV
• vaccine, serum immunoglobulin
• HIV
• zidovudine
• lamivudine (3TC)
• Indinavir (IDV) when increased risk
• HCV
• None

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Needlestick Prevention Device Evaluation Program
(NPD)

• Reasons for a program
• Program Components
• NPD Evaluation Criteria

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Reasons for Program

• Regulatory
• Liability
• Ethics

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Program Components

• Collect and Analyze Data
• Evaluate Devices
• Implementation
• Collect and Analyze Data

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Collect and Analyze Data

• Review exposure records
• Target highest risk areas
• Determine device criteria and judgement scheme

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Criteria to Consider

• Safety
• Healthcare Worker (HCW)
• Patient
• Other Individuals

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Evaluate Devices

• Involve multiple users in variety of locations
• Use devices in the field
• Prepare cost analysis

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Criteria to Consider

• Human Factors
• Ease of Use
• Training
• Patient Comfort

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BIOHAZARD SYMBOL
BIOHAZARD
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Treat as regulated medical waste Follow State ,
federal and local regulations For perception
issues on uncontaminated sharps and lab
waste-discuss