Kentucky Education and Workforce Development Cabinet Occupational Health and Safety Program Bloodborne Pathogen Exposure

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Kentucky Education and Workforce Development
Cabinet Occupational Health and Safety
ProgramBloodborne Pathogen Exposure
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OSHAs Bloodborne Pathogens Standard-29 CFR
1910.1030

• PURPOSE-Limits occupational exposure to blood
  and other potentially infectious materials since
  any exposure could result in transmission of
  bloodborne pathogens which could lead to disease
  or death.

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OSHAs Bloodborne Pathogens Standard

• SCOPE-Covers all employees with occupational
  exposure to blood or other potentially infectious
  materials as a function of their jobs.

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What are Bloodborne Pathogens?

• Bloodborne pathogens are micro-organisms in the
  bloodstream that cause diseases.

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What are Other Potentially Infectious Materials
(OPIM)?

• Human body fluids listed in the standard.
• Unfixed tissue or organ (other than intact skin)
  from a living or dead human.
• HIV containing cell or tissue cultures, organ
  cultures.
• HIV or HBV containing culture medium or other
  solutions.
• Blood, organs or other tissues from experimental
  animals infected with HIV or HBV.

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Occupational Exposure

• Reasonably anticipated skin, mucous membrane or
  parenteral contact with blood or other
  potentially infectious materials that may result
  from the performance of an employees duties.
• 29 CFR 1910.1030(b)
• 803 KAR 2320

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Occupational Exposure

• Employers are to evaluate each job task and
  procedure to determine which employees may be
  expected to be occupationally exposed to blood or
  other potentially infectious materials.

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Occupational Exposure

• Exposure determination is made without regard to
  the use of personal protective equipment.

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Occupational Exposure

• OSHA expects an employer to take into account all
  potential circumstances of exposure (biting,
  contact with skin lesions, and/or potentially
  infectious secretions) when determining which, if
  any, employees have occupational exposure.

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Occupational Exposure

• Based on potential contact with blood and other
  potentially infectious materials, the employer is
  to select the appropriate personal protective
  equipment in accordance with the standard.

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Occupational Exposure-First Aid Trained Employees

• First aid trained employees assigned to provide
  emergency first aid as part of their specific job
  duties are covered by the Bloodborne Pathogens
  Standard.
• GOOD SAMARITAN ACTS-Not covered by the standard.

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Occupational Exposure

• Collateral Jobs
• Those positions that do not have occupational
  exposure to blood or other potential infectious
  body fluids.
• Employees in Collateral Jobs
• Maintenance Workers
• Good Samaritan Acts
• Office Staff
• Janitorial Employees

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Planning and Assessment

• Bloodborne Pathogen Plan for cabinet.
• Bloodborne Pathogen Plan for each central
  office-Contained in the Safety Plan.
• Written assessment of personnel to determine if
  there is occupational exposure.

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Bloodborne Pathogens

• The three most significant bloodborne pathogens
  found in the workplace
• HIV-Human Immunodeficiency Virus,
• Hepatitis-B Virus,
• Hepatitis-C Virus.

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Hepatitis B Control

• Each employee with occupational exposure will
  within 10 days of employment shall
• Provide evidence of receiving three doses of
  Hepatitis B vaccine or
• Provide evidence of a positive Antibody to
  Hepatitis or
• Sign a form consenting to be vaccinated or to
  finish an incomplete vaccination series or
• Specifically decline vaccination by signing a
  Declination Form.

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Hepatitis B Control

• Provided at no cost to the employee.
• Provided at a reasonable time and place and
  performed by or under the supervision of a
  licensed physician or other health care
  professional.

17
Staff Training

• Provided at no cost to the employee annually.
• Training Records
• Dates of each training session.
• Content specific syllabus and any information
  distributed to employees.
• The name(s) and qualifications of the person(s)
  conducting the training.
• Names and job titles of all persons attending the
  training.
• Records shall be retained for 3 years from the
  date of training.

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Employee Medical Records Retained by Employer

• Documentation of up-to-date hepatitis B
  vaccination.
• Incident Reports.
• Results of post exposure testing and follow-up.
• Copy of physicians written opinion.
• Copy of any written information provided to the
  employee.
• Records are confidential and cannot be disclosed
  without the employees express written consent.
• Records must be retained for 30 years following
  end of employment.
• Records must be kept separate from personnel
  records.

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Blood

• Defined as human blood, human blood
  components, and products made from human blood.

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Other Potentially Infectious Materials (OPIM)

• Saliva in dental procedures.
• Semem.
• Vaginal secretions.
• Internal body fluids.
• Body fluids visibly contaminated with blood.
• Body fluids in situations where it is difficult
  or impossible to identify type of fluid.

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Other Potentially Infectious Materials (OPIM)

• Amniotic Fluid-Bacteria and Fungal Germs.
• Cerebrospinal Fluid-Bacteria, Fungi, Viruses.
• Feces-Bacteria, Rotavirus, Hepatitis A Virus.
• Nasal Discharge-Common cold virus, Influenza
  Virus, HIV and Hepatitis B Virus.
• Pericardial Fluid-Organisms that can cause
  infections.
• Peritoneal Fluid-Organisms that can cause
  infections.
• Pleural Fluid-Organisms that can cause disease.
• Saliva-Common cold virus, Influenza Virus.

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Other Potentially Infectious Materials (OPIM)

• Semen-Gonorrhea, Hepatitis B Virus, Hepatitis C
  Virus, HIV.
• Synovial-Bacteria, Fungi, Viruses, Blood in
  Fluid.
• Urine-Cytomegalovirus, Mononucleosis Virus.

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How Bloodborne Pathogens are Transmitted

• An employee must make contact with contaminated
  fluids and permit a way to enter the body.

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How Bloodborne Pathogens Enter the Body

• Direct blood inoculation-placenta, transfusion,
  blood products.
• Accidental injury which breaks, punctures or cuts
  the skin or mucous membranes (Parenteral
  Contact).
• Non-sterile technique when tattooing, body
  piercing, sharing injections.
• Open cuts, nicks, and skin abrasions, even
  dermatitis and acne.

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How Bloodborne Pathogens Enter the Body

• Mucous membranes (i.e. mouth, eyes (contact
  lenses), nose.
• Sexual intercourse (any type).
• Indirect transmission (touching something that is
  contaminated and then touching an opening in the
  skin).

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Virus Survival

• HIV-can survive only a short time outside the
  body.
• HBV-can survive up to a week outside the body at
  room temperature.
• HCV-unknown.

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Hepatitis-B (HBV)

• Hepatitis means inflammation of the liver.
• HBV is the major infectious bloodborne hazard on
  the job.
• Affects approximately 8,700 employees a year,
  resulting in more than 400 hospitalizations and
  200 deaths.
• Flu-like symptoms, becoming so severe as to
  require hospitalization.

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Hepatitis-B (HBV)

• Illness may last 6 months to 2 years. In some
  cases, HBV damages the liver so severely it leads
  to cirrhosis and possible death.
• Some people exhibit no symptoms at all and most
  people recover in time.
• A small percentage of people become carriers.
• Blood testing is available.

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Hepatitis C (HCV)

• HVC is different from Hepatitis B.
• HCV is transmitted directly by blood, but unknown
  if other body fluids like sexual fluids or saliva
  will carry the virus.
• Flu like symptoms can show up within days or
  years after exposure.
• HCV can be ACUTE requiring liver transplant or
  death within weeks or months.

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Hepatitis C (HCV)

• CHRONIC requiring intensive medical therapy.
• 70 of those infected will eventually develop
  chronic liver disease, cirrhosis of the liver,
  and almost certain death.
• Blood test is available.
• There is no vaccine for HCV at this time.

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Human Immunodeficiency Virus (HIV)

• HIV attacks the immune system and eventually
  causes AIDS.
• HIV infection is treatable, but not curable.
• HIV continues to be infectious in blood and
  sexual fluids even during treatment.
• Blood testing is available.
• There is no vaccine for HIV at this time.

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Employees-Providing First Aid

• If employees are trained and designated as
• responsible for rendering first aid or medical
• assistance as part of their job duties, they are
• covered by the OSHA Bloodborne Pathogen
• Standard.

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Employees-Providing First Aid

• Employees, who administer first aid as a
  collateral duty
• to their routine work assignments, need not be
  offered
• the pre-exposure hepatitis B vaccination,
  provided that a
• number of conditions are met.

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Employees-Providing First Aid

• All first aid providers who provide assistance
  in any situation involving the presence of blood
  or other potentially infectious materials,
  regardless of whether or not a specific exposure
  incident occurs, must have the vaccine made
  available to them as soon as possible, but in no
  event later than 24 hours after exposure.

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Employees-Providing First Aid

• In an exposure incident as defined in the
  standard has taken place, other post exposure
  follow-up procedures must be initiated
  immediately, per the OSHA Standard.

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Other General Industry Employees

• While OSHA does not generally consider
  maintenance and janitorial staff employed in
  non-health care facilities to have occupational
  exposure, it is the employers responsibility to
  determine which job classification or specific
  tasks and procedures involve occupational
  exposure.

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Universal Precautions

• UNIVERSAL PRECAUTIONS is the term used when
  handling all blood or other potentially
  infectious material as if it were, in fact,
  infectious.
• Since there is no way of know if an injured
  person or body fluid is infected, employees in
  ALL CASES must use universal precautions when
  exposed to anothers body fluids.

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Universal Precautions for Home Visits

• Universal Precautions for home visits must be
  observed.
• Employer and employee are to assume that all
  human blood and human body fluids are infectious
  for HIV, HBV, and other bloodborne pathogens.
• Where differentiation between types of body
  fluids is difficult or impossible, all body
  fluids are to be considered potentially
  infectious.

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Universal Precautions for Home Visits

1. Treat all blood and body fluids as being
   potentially infectious.
2. Use appropriate Personal Protective Equipment.
3. Do not bend, break, shear or recap needles.
4. Wash hands thoroughly before and after each home
   visit.
5. Do not clean blood spills in a clients home.
6. Keep mouthpieces and resuscitation equipment
   readily available if use if likely.
7. No visits if customer has draining sores.
8. No visits if customer has an infection
   transmissible by the airborne route.
9. Restrict eating, drinking, smoking, apply
   cosmetics or lip balm, and handling contact
   lenses during a customers home visit.

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Universal Precautions

• Wash hands.
• Wear gloves (wash hands after glove removal).
• Wear impervious apron when splashing is possible.
• Wear mask and eye protection.
• Handle sharp objects carefully and dispose
  properly.
• Dispose of all spills properly.

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Hand Washing

• Wash hands with soap and running water.
• Rinse hands under running water.
• Dry hands well with paper towel.
• Use a paper towel to turn off faucet.
• Dispose of single use towel.
• Wash/disinfect cloth towels.

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Hand Washing

• Apply hand cream after frequent washing to
  prevent skin irritation, breakdown, and
  subsequent infection.
• Use waterless soap/wipes when soap and water are
  not available.

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Hand Washing

• When antiseptic hand cleansers or towelettes are
  used, hands will be washed with soap and running
  water when the employee returns to a location
  where hand washing facilities are available.

44
Hand Washing

• Wash hands immediately or as soon as feasible
  after removal of gloves or other protective
  equipment.

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Hand Washing

• Employer must ensure that employees wash hands
  and any other skin with soap and water, or flush
  mucous membranes with water immediately, or as
  soon as feasible, following contact with blood or
  body fluid.

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Personal Protective Equipment

• Employers will provide to employees with
  occupational exposure PPE appropriate for the
  risk.
• No cost to the employee.
• PPE will be available for use at each site.

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Personal Protective Equipment

• PPE will be considered appropriate only if it
  does not permit blood or other potentially
  infectious materials to pass through to reach the
  employees work clothes, street clothes,
  undergarments, skin, eyes, mouth, and/or other
  mucous membranes.

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Personal Protective Equipment-Eye Protection

• Eye protection is to be worn whenever splashes,
  spray, spatter or droplets of blood or other
  potentially infectious materials may be generated
  and eye, nose, and/or mouth contamination can be
  reasonably anticipated.

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Personal Protective Equipment-Gloves

• Gloves will be worn when it can be reasonably
  anticipated that the employee may have hand
  contact with blood, other potentially infectious
  materials, mucous membranes, and/or non-intact
  skin.

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Personal Protective Equipment-Gloves

• Wear gloves when
• Actual or potential touching blood and/or body
  fluids
• Actual or potential touching mucous membranes
• Actual or potential touching non-intact skin
• Actual or potential handling items or surfaces
  soiled by blood and/or other body fluids.

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Personal Protective Equipment-Gloves

• Using gloves
• Hands should be washed before gloving
• Gloves must be changed after each contact
• Hands or other body parts must be thoroughly
  washed with soap and water if contaminated with
  blood or body fluids.

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In the Event of an Accident

• There is a Hepatitis-B vaccine that can be used
  post
• exposure. It is about 90 effective and must be
  received as soon as possible.

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In the Event of Actual or Potential Exposure

• Stop work and wash the affected body areas
  thoroughly.
• If eyes or mouth are affected, flood with water
  at least 10 minutes.

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Procedures for Reporting and Managing Exposure
Incidents

• Employee
• Report the date, time, and type of exposure to
  first line supervisor.
• Treatment in accordance with recommended
  guidelines, based on the type of exposure.
• Adhere to follow-up treatment regimen and/or
  testing as prescribed by the physician.
• Follow-up will be paid for through Workers
  Compensation.

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Procedures for Reporting and Managing Exposure
Incidents

• Employee and First Line Supervisor
• Initiate a consent form for treatment, if
  indicated.

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Procedures for Reporting and Managing Exposure
Incidents

• First Line Supervisor
• Complete and submit Cabinet Accident Report.
• Complete Workers Compensation First Report of
  Injury.
• Enter appropriate information into OSHA 300 Log.
• File and retain reports in employees medical
  files.
• Obtain physicians written opinion within 15
  working days of the completion of the evaluation.
• Provide to the physician 1) copy of the BBP Plan
  and 2) description of the affected employees
  duties as they relate to the occupational
  exposure.

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Procedures for Reporting and Managing Exposure
Incidents

• First Line Supervisor
• Report the incident to the Kentucky Department
  for Public Health, Division of Epidemiology and
  Health Planning.
• All employees who are involved in any situation
  where there was the presence of blood or OPIM,
  regardless of whether a specific exposure
  incident occurred, must be offered the full
  Hepatitis B vaccination series as soon as
  possible, but no later than 24 hours after the
  incident.

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Procedures for Reporting and Managing Exposure
Incidents

• Time Line
• If an exposure incident occurs, all other post
  exposure follow-up procedures according to the
  BBP Standard must be initiated immediately.
• Employer must ensure that the medical provider is
  familiar with and follows the recommendations for
  post exposure follow-up.

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Bloodborne and Body Fluid Cleanup

• These procedures are based on OSHA standard 29
  CFR 1910.1030 for all employees who have come in
  contact with infected blood, blood products
  and/or body fluids at work.
• Occurs most often when performing first aid or
  coming into contact with someone who has been
  injured on the job.

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Clean-Up Procedures When Blood or Body Fluids are
Present

• Put on disposable gloves and appropriate personal
  protective equipment.
• Remove any broken glass or sharp objects from the
  area using mechanical means forceps, needle nose
  pliers, and/or broom and dust pan.

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Clean-Up Procedures When Blood or Body Fluids are
Present

• Never Remove Sharps, Broken Glass, Etc. By Hand.

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Clean-Up Procedures When Blood or Body Fluids are
Present

• Contain the area by covering with paper towels
  and carefully pouring appropriate disinfectant
  solution around and on the area.
• EXAMPLE-110 mixture of household bleach and
  water.

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Clean-Up Procedures When Blood or Body Fluids are
Present

• Take care not to splash disinfectant solution or
  create aerosols while pouring.
• Remove the paper towels and repeat the process
  until all visual material is removed.
• Re-wet the cleaned area with disinfectant and air
  dry until all visual material is removed.

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Clean-Up Procedures When Blood or Body Fluids are
Present

• Blood contaminated items used for first aid and
  care of lacerations, nose bleeds, etc. shall be
  contained in a plastic lined container, closed,
  and disposed of with the daily trash in a large,
  heavy duty plastic bag of sufficient strength to
  preclude bursting and tearing during handling,
  storage or transport.

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First Aid Site Clean-Up Procedures When Blood or
Body Fluids are Present

• Items such as gauze, bandages, band-aids, and/or
  cotton balls are not required to have special
  hazard labels, only double bagging.

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First Aid Site Clean-Up Procedures When Blood or
Body Fluids are Present

• If the first aid supplies are saturated to the
  point where liquid can be squeezed in
  considerable amount, the supplies must be soaked
  in a disinfectant solution to decontaminate them.
  
• They may be double bagged and included with the
  normal waste disposal.

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Clean-Up Procedures When Blood or Body Fluids are
Present

• Remove all personal protective equipment,
  dispose, and immediately wash hands and other
  contaminated body parts.

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Clean-Up Procedures When Blood or Body Fluids are
Present

• Place any soiled linen in a laundry bag. Soiled
  linen should be handled carefully as if it were
  contaminated. Pre-soak linen with disinfectant
  cleaning solution and launder with soap and
  water.
• Linen and clothing contaminated with blood or
  body fluids must be handled with gloves.

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Thank You For Your Participation

• For additional assistance contact
• Richard T. Owen
• Education Cabinet Safety Coordinator
• 601 East Main Street
• Frankfort, Kentucky 40601
• 502-564-7346
• Richard.Owen_at_ky.gov