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


1
Kentucky Education and Workforce Development
Cabinet Occupational Health and Safety
ProgramBloodborne Pathogen Exposure
2
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.

3
OSHAs Bloodborne Pathogens Standard
  • SCOPE-Covers all employees with occupational
    exposure to blood or other potentially infectious
    materials as a function of their jobs.

4
What are Bloodborne Pathogens?
  • Bloodborne pathogens are micro-organisms in the
    bloodstream that cause diseases.

5
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.

6
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

7
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.

8
Occupational Exposure
  • Exposure determination is made without regard to
    the use of personal protective equipment.

9
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.

10
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.

11
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.

12
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

13
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.

14
Bloodborne Pathogens
  • The three most significant bloodborne pathogens
    found in the workplace
  • HIV-Human Immunodeficiency Virus,
  • Hepatitis-B Virus,
  • Hepatitis-C Virus.

15
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.

16
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.

18
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.

19
Blood
  • Defined as human blood, human blood
    components, and products made from human blood.

20
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.

21
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.

22
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.

23
How Bloodborne Pathogens are Transmitted
  • An employee must make contact with contaminated
    fluids and permit a way to enter the body.

24
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.

25
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).

26
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.

27
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.

28
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.

29
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.

30
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.

31
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.

32
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.

33
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.

34
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.

35
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.

36
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.

37
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.

38
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.

39
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.

40
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.

41
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.

42
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.

43
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.

45
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.

46
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.

47
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.

48
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.

49
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.

50
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.

51
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.

52
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.

53
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.

54
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.

55
Procedures for Reporting and Managing Exposure
Incidents
  • Employee and First Line Supervisor
  • Initiate a consent form for treatment, if
    indicated.

56
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.

57
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.

58
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.

59
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.

60
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.

61
Clean-Up Procedures When Blood or Body Fluids are
Present
  • Never Remove Sharps, Broken Glass, Etc. By Hand.

62
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.

63
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.

64
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.

65
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.

66
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.

67
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.

68
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.

69
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
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