Common Bloodborne Pathogens

include hepatitis B, hepatitis C, and human immunodeficiency virus (HIV).
These pathogens may be transmitted through unprotected contact with human
blood or body fluids.
~ Bloodborne Pathogens and the Law
Because certain jobs may involve contact with blood or other body fluid, the
U.S. Department of Labor's Occupational Safety and Health Administration
(OSHA) issued regulations to protect employees from bloodborne pathogens.
These regulations are known as the OSHA Bloodborne Pathogens Standard,
and they are designed to ensure employee safety through proper training and
education, safety and prevention measures, and exposure control.
This text meets all current requirements of the OSHA Bloodborne Pathogens
Standard.
~ What Are Bloodborne
..... ~~!.~.~.~~~.~! .
~ Bloodborne Pathogens
and the Law
~ What Is the OSHA
Bloodborne Pathogens
Standard?
~ Who Needs OSHA
Bloodborne Pathogens
. '!.~.~~~~~~!. .
~ Why Do I Need This
Manual?
~ Meeting OSHA
Standards
~ OSHA-Required
Categories of
Information
.~.. '!.~~.~~.~.~~.~~~ .. ~~~ .
~ OSHA-Required Record
. ~~~~~~~ .
State, county, or municipal employees
Health care professionals who are sole practitioners
or partners
Those who are self-employed
Any employee who has potential for occupational
exposure to blood or OPIMs is required to receive
training . The followingjob classifications
may be associated with tasks that have occupational
exposure to blood or OPIMs, but the standard is not
limited to employees in these positions:
Physicians, physician's assistants, nurses, nurse
practitioners, and other health care employees
in clinics and physicians' offices
Ci»
Employees of clinical and diagnostic
labora tories
Ci»
Housekeepers in health care and other
facilities
Personnel in hospital laundries or commercial
laundries that service health care or publicsafety
institutions
~ Tissue bank personnel
Ci»
Employees in blood banks and plasma centers
who collect, transport, and test blood
~ Freestanding clinic employees (eg, hemodialysis
clinics, urgent care clinics, health maintenance
organization clinics, and family
planning clinics)
Any employee who has potential for occupational exposure
to blood or OPIMs is required to receive training.
Chapter 1 Introduction
Employees in clinics in industrial, educational,
and correctional facilities (eg, those who collect
blood and clean and dress wounds)
Ci»
Employees designated to provide emergency
first aid
Dentists, dental hygienists, dental assistants,
and dental laboratory technicians
Staff of institutions for the developmentally
disabled
Hospice employees
Home health care workers
\) Staff of nursing homes and long-term care
facilities
Employees of funeral homes and mortuaries
Q
Human immunodeficier~cy virus (HIV) and
hepatitis B virus (HBV) research laboratory
and production facility workers
Employees handling regulated aste; custodial
workers required to clean u~ contaminated
sharps or spills of blood or OPIMs
Medical equipment service and repair personnel
o Emergency medical tecllnicians, paramedics,
and other emergen medical service provid rs
Fire fighters, law nforcement personnel, an
correctional offi rs
o Maintenance wo kers (eg, plumbers) in health
care facilities d erop ee of s stance
abuse clinics v
Employers and E
Employment agencies are not r q
training because the agency is not considered t
ployer. The company or institution that uses the workers
(such as a hospital) therefore is responsible for
providing training according to the standard.
Personnel Services and Multiemployer
Worksite Guidelines
Personnel service firms employ medical care staff who
are assigned to work at hospitals and other health
care facilities that contract with the firm. Often the
employees are paid by the personnel services firm,
but day-to-day supervision of the work is provided
by the medical facility. When the medical facility (host
employer) exercises day-to-day supervision over the
personnel services worker, the worker is the employee
of the host employer and the personnel service. The
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umen
Bloodborne Pathogens
sl-ated responsibilities of both employers are referred
to as multi employer worksite guidelines.
Under these circumstances, the personnel
service firm can be held accountable for meeting the
following provisions of the standard:
(t
Providing hepatitis B vaccinations
Managing postexposure evaluation and
follow-up
Keeping records
Providing generic training
(t
Exercising reasonable diligence to ensure that
the host workplace facility is in compliance
with the standard
(t
When violations of the standard at the host
workplace are known, taking reasonable steps
to have the host employer correct the violation
The host employer must comply with all provisions
0 t e standard, such as providing appropriate
engineering controls, an exposure control
plan that is clearly explained and available to the
worker, and personal protective equipment in the
appropriate size an t e. The host employer is obli
ated to take reasona measures to ensure that
t e personnel service fir has complied with the
provisions listed above.
Home Health Services
The employees of home h alth service companies
ay provide health servi es in private homes.
ecause the employer d not control the home
rk ere application of the bloodlb.
o.~~:aat gens standard is restricted in the home
health services industry.
The private home work environment is not free
from bloodborne pathogen hazards, however.
Employees should follow work practice guidelines
and use personal protective equipment to prevent
exposure.
OSHA has determined that the employer will not
be held responsible for the following site-specific
violations (such as violations occurring in a private
home):
Housekeeping requirements, such as the maintenance
of a clean and sanitary worksite
Handling and disposal of regulated waste
Ensuring the use of personal protective
equipment
Ensuring that specific work practices are followed
(such as handwashing with running
water)
Ensuring the use of engineering controls
The employer will be held responsible for all
non-site-specific requirements of the standard, such
as the following:
The non-site-specific requirements of the exposure
control plan
Providing hepatitis B vaccinations
Postexposure evaluation and follow-up
Record keeping
Providing generic training that is not workplace
specific in detail and content
Providing appropriate personal protective
equipment to employees
Physicians and Health Care Professionals
in an Independent Practice
Physicians may be employers or employees. In applying
the provisions of the standard in situations involving
physicians, the status of the physician is
important. The responsibilities under the standard
are similar to those of personnel services firms.
In general, professional corporations are the employers
of their physician-members when they work
at host employer sites and must comply with the hepatitis
B vaccination, postexposure evaluation and follow-
up, record keeping, and site-specific training
provisions. The host employer is not responsible for
these provisions for physicians with staff privileges,
but the host employer must comply with all other
provisions of the standard in accordance with the
multiemployer worksite guidelines.
Independent Contractors
Independent contractors provide a service, such as a
radiology service, to host employers. These contractors
provide supervisory personnel and other personnel
to carry out a service. Both the company and the
host employer are responsible for complying with all
provisions of the standard in accordance with multiemployer
worksite guidelines.
Other Industries
The bloodborne pathogens standard does not apply to
the construction, agricultural, marine terminal, and
longshoring industries, although these industries are
not free from the hazards of bloodborne pathogens.
Good Samaritan Assistance
Employees who do not fall within the scope of the
standard may still experience a specific exposure incident
at work that is unrelated to the performance
of their job duties. An employee may choose to aid
another person who is injured or ill, which is considered
Good Samaritan assistance.
F:YI
Good Samaritan acts are not covered under the
standard.
Chapter 1 Introduction
~ Meeting OSHA Standards
The goal of training is to educate employees regarding
bloodborne pathogen issues and how to minimize
or eliminate the exposure to bloodborne pathogens
by using a combination of universal precautions,
work practice controls, engineering controls, and personal
protective equipment.
Employees being trained must have direct access
to a qualified trainer. Educating employees so ~ly by
means of a film, video, or computer CD-ROM without
the opportunity for a discussion period is not acceptable
and constitutes a violation of the standard.
The trainer must be familiar with the manner in which
the elements in the training program relate to the
workplace practices. This may also be accomplished
by having two trainers: one to discuss generic bloodborne
pathogen issues and one to discuss sitespecific
information
All employees at the time of initial assignment to
tasks with occupational exposure to blood or OPIMs,
before actually performing any of the tasks, must receive
training on the hazards associated with blood
and OPIMs and the protective measures to be taken
to minimize the risk of occupational exposure.
Thereafter, training is provided at least annually
and must be provided within 1 year of the original
training. Whenever a hange in an employee's responsibilities,
procedures, or work situation is such that
Figure 1-3
OSHA strongly encourages employers to offer
any employee who experiences an exposure incident
at work confidential medical evaluation,
including necessary postexposure prophylaxis
and follow-up treatment.
Annual training is necessary to ensure employee
safety.
~ Why Do I Need This Manual?
This manual provides OSHA-specific bloodborne
pathogens guidelines and is used with your
worksite-specific training. You are encouraged to
gather worksite-specific details on various work
pages throughout the manual. Exercises at the end
of each chapter help you check what you have
learned and how it may be applied to your particular
worksite requirements.
This manual will not make you an expert in bloodborne
pathogens or the treatment of diseases caused
by bloodborne pathogens. The manual does give you
important and necessary information as required by
the OSHA Bloodborne Pathogens Standard. Your instructor
may expand on the information according
to worksite-specific practices. The OSHA-required
categories of information on page 6 must be included
in all training.
(
Bloodborne Pathogens
an employee's occupational exposure is affected, additional
training or, as stated in the standard, "retraining"
must take place. Retraining is not the same as
annual training. Retraining must occur when new
equipment is brought to the worksite that might affect
the employee's possible exposure.
Annual training must cover the topics listed in
the standard to the extent needed and must emphasize
new information or procedures. In other words,
if individuals are sitting through their fifth renewal
class, the instructor may not need to cover the material
to the depth that would be required in an initial
training. Additionally, the course should be tailored
to the group that the instructor is teaching.
The provisions for employee training are based
on the employee's job responsibilities, with flexibility
in training permitted to allow the program to be
tailored to the employee's background and responsibilities
or other site-specific needs. The categories of
information presented in this manual must be included
in any and all training.
OSHA requires that any training (including written
material, oral presentations, films, videotapes,
computer programs, or audiotapes) be presented in
the employee's language and at the employee's education
level. The trainer or a interpreter may convey
the information.
It is necessary to record ihformation about the
dates of training sessions, a summary of the training
content, and the nam an iobtitles of the employees
who attend the training.
Records that document employee training assist
the employer and OSHA in determining whether
the training program adequately addresses the
risks involved in each job.
~ OSHA-Required Categories
of Information
A. An accessible copy of the Standard (Appendix A)
and an explanation of its contents (this manual)
B. A general explanation of the epidemiology and
symptoms of bloodborne disease (Chapter 2)
C. An explanation of the modes of transmission of
bloodborne pathogens (Chapter 2)
D. An explanation of the employer's exposure control
plan and the means by which the employee
can obtain a copy of the written plan (supplied
by your company directly or through the instructor)
(Chapter 4)
E. An explanation of the appropriate methods for
recognizing tasks and other activities that may involve
exposure to blood and OPIMs (Chapter 3)
F An explanation of the use and limitations of methods
that will prevent or reduce exposure, including
appropriate engineering controls, work
practices, and personal protective equipment
(Chapter 3)
G. An explanation of the requirements to evaluate,
select, and use needleless systems and sharps
with engineered sharps injury protections, which
requires employee input, appropriate to circumstances
of the workplace (Chapter 3)
H. Information on the types, proper use, location, removal,
handling, decontamination, and disposal
of personal protective equipment (Chapter 3)
I. An explanation of the basis for selection of personal
protective equipment (Chapter 3)
]. Information on the hepatitis B vaccine, including
information on its efficacy, safety, method of
administration, the benefits of being vaccinated,
and that the vaccine and vaccination will be offered
free of charge to employees covered by the
standard (Chapter 2)
K. Information on the appropriate actions to take
and persons to contact in an emergency (exposure
outside the normal scope of work) involving
blood or OPIMs (Chapter 2)
L. An explanation of the procedure to follow if an
exposure incident occurs, including the method
of reporting the incident and the medical followup
that will be made available (Chapter 2)
M. Information on the postexposure evaluation and
follow-up that the employer is required to provide
for the employee following an exposure incident
(Chapter 2)
N. An explanation of the signs, labels, and/or color
coding required (Chapter 3)
O. An opportunity for interactive questions and answers
with the person conducting the training
session (during and after training session)
~ The Ryan White Act
The Centers for Disease Control and Prevention is in
the process of preparing the final list of diseases
required by the passage of the Public Law 101-381,
the Ryan White Comprehensive AIDS Resources
Emergency Act. The act creates a notification system
for emergency response employees listed as police,
fire, and EMS who are exposed to diseases such as
M tuberculosis, hepatitis B or hepatitis C, and HIY.
~ OSHA-Required Record
Keeping
Record keeping needs to comply with 29 CFR 1904
using Log of Work-Related Injuries and Illness (Form
300) and Injury and Illness Incident Report (Form 301)
and must record the following:
Chapter 1 Introduction
1. Any needlestick injury or cut from a sharp object
that is contaminated with another person'
s blood or OPIMs
2. Any case requiring an employee to be medically
removed under the requirements of an
OSHA health standard
3. Tuberculosis infection as evidenced by a positive
skin test or diagnosis by a physician or
other licensed health care professional after
exposure to a known case of active TB
This is in accordance with CPL2-0.131, effective
January 1, 2002.
Additionally, there must be a sharps injury log
maintained independently from the OSHA 300. This
log must be confidential, and person-specific data
should not be contained on the sharps injury log. At
a minimum, the log must record the type and brand
of the device involved, department or area of incident,
and description of incident. The log should be
reviewed on a regular basis, and action should be
taken to correct any problems that are leading to
needles tick or sharps injury.
Sharps Injury Logs
The employer must maintain records in a way
that segregates sharps injuries from other types
of work-related injuries.
J
~ Vital Vocabulary
blood The term "human blood components" includes
plasma, platelets, and serosanguinous fluids (eg,
exudates from wounds). Also included are medications
derived from blood, such as immune globulins,
albumin, and factors 8 and 9.
bloodborne pathogens While HBVand HIV are specifically
identified in the standard, the term includes
any pathogenic microorganism that is present in
human blood or OPIMs and can infect and cause
disease in persons who are exposed to blood containing
the pathogen.
contaminated sharps Any contaminated object that
can penetrate the skin including, but not limited
to, needles, scalpels, broken capillary tubes, and
exposed ends of dental wires.
decontamination The use of physical or chemical
means to remove, inactivate, or destroy bloodborne
pathogens on a surface or item to the point where
they are no longer capable of transmitting infectious
particles and the surface or item is rendered
safe for handling, use, or disposal.
engineering controls Physical controls (eg, 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. Engineered sharps injury protection
means either: (1) A physical attribute built
into a needle device used for withdrawing body
fluids, accessing a vein or artery, or administering
medications or other fluids, which effectively
reduces the risk of an exposure incident by a mechanism
such as barrier creation, blunting, encapsulation,
withdrawal, or other effective mechanisms;
or (2) A physical attribute built into any other type
of needle device, or into a non-needle sharp, which
effectively reduces the risk of an exposure incident.
exposure incident A specific eye, mouth, other mucous
membrane, non-intact skin, or parenteral contact
with blood or other potentially infectious
materials that results from the performance of an
employee's duties.
hepatitis Bvirus (HBV) One of the viruses that causes
illness directly affecting the liver. It is a bloodborne
pathogen.
human immunodeficiency virus (HIV) A virus that
infects immune system blood cells in humans and
renders them less effective in preventing disease.
medical surveillance A periodic comprehensive review
of employees' health status as it relates to their
potential exposures to hazardous agents.
needleless systems Devices that do not utilize needles
for: (1) The withdrawal of body fluids after initial
venous or arterial access is established; (2) The
administration of medication or fluids; and (3) Any
other procedure involving the potential for an exposure
incident.
occupational exposure Reasonably anticipated skin,
eye, mucous membrane, or parenteral contact with
blood or other potentially infectious materials that
may result from the performance of an employee'sduties.
"Reasonablyanticipated contact" includes, among
others, contact with blood or OPIM (including regulated
waste) as well as incidents of needlesticks.
other potentially infectious materials (OPIMs)
Coverage under this definition also extends to blood
and tissues of experimental animals that are infected
with HIV or HBV
personal protective equipment Specialized clothing
or equipment worn or used by an employee for protection
against a hazard. General work clothes (eg,
uniforms, pants, shirts or blouses) not intended to
function as protection against a hazard are not considered
to be personal protective equipment.
regulated waste Liquid or semi-liquid blood or other
potentially infectious materials; contaminated items
that would release blood or other potentially infectious
materials in a liquid or semi-liquid state if
compressed; items that are caked with dried blood
or other potentially infectious materials and are capable
of releasing these materials during handling;
contaminated sharps; and pathological and microbiological
wastes containing blood or other potentially
infectious materials.
sharps Any objects used or encountered in the industries
covered by subsection (a) that can be reasonably
anticipated to penetrate the skin or any other
part of the body, and to result in an exposure incident,
including, but not limited to, needle devices,
scalpels, lancets, broken glass, broken capillary tubes,
exposed ends of dental wires and dental knives,
drills, and burs.
sharps injury Any injury caused by a sharp, including,
but not limited to, cuts, abrasions, or needlesticks.
sharps injury log A written or electronic record satisfying
the requirements of subsection (c)(2).
universal precautions An approach to infection control.
According to the concept of Universal
Precautions, all human blood and certain human
body fluids are treated as if known to be infectious
for HlY,HBY,HCY, and other bloodbome pathogens.
vaccine A suspension of inactive or killed microorganisms
administered orally or injected into a human
to induce active immunity to infectious disease.
work practice controls Controls that reduce the likelihood
of exposure by altering the manner in which
a task is performed (eg, prohibiting recapping of
needles by a two-handed technique and use of
patient-handling techniques).
~ CheckYour Knowledge
1. What kind of task would require training in bloodborne
pathogens and OPIM safety?
2. An explanation of the symptoms caused by bloodborne
pathogens is not a site-specific topic.
A. True
B. False
3. Information about the locations of the eye wash
stations is a site-specific topic.
A. True
B. False
4. Recommending and participating in the selection
of engineering controls or personal protective equipment
is an example of site-specific information.
A. True
B. False
5. There are no industries that are free from the
hazards of bloodbome pathogens.
A. True
B. False
6. Name an industry not covered by the OSHA
Bloodbome Pathogens Standard.
7. If there is a change to my work practices that
would change my exposure to bloodborne
pathogens, I would receive retraining.
A. True
B. False
8. I must receive training every year.
A. True
B. False
9. OSHA requires the use of engineering controls.
A. True
B. False
10. The sharps injury log does not need to be kept
confidential.
A. True
B. False
Answers: 1. Drawing blood, transporting blood, housekeeping
in a health care facility; 2. A; 3. A;
4. A; 5. A; 6. Construction, agriculture, marine
terminals, or longshore industries; 7. A;
8. A; 9. A; 10. B
used as required if regulated waste or contaminated
equipment is brought into the facility. Employees are
to notify if they discover regulated
waste containers, refrigerators containing blood
or OPIMs, contaminated equipment, etc., without
proper labels.
Regulated Waste Disposal
All contaminated sharps shall be discarded as soon
as feasible in sharps containers located in the facility.
Sharps containers are located in (specify
locations of sharps containers).
Regulated waste other than sharps shall be placed
in appropriate containers. Such containers are located
in (specify locations of containers).
Laundry Procedures
Laundry contaminated with blood or other potentially
infectious materials will be handled as little as
possible. Such laundry will be placed in appropriately
marked bags where it was used. Such laundry
will not be sorted or rinsed in the area of use.
All employees who handle contaminated laundry
will use personal protective equipment to prevent contact
with blood or other potentially infectious materials.
Laundry at this facility will be cleaned at:
____________ (specify location).
[(Employers should note here if the laundry is being
sent offsite. If the laundry is being sent offsite, then
the laundry service accepting the laundry is to be notified,
in accordance with section (d) of the standard.) 1
Hepatitis B Vaccine
All employees who have been identified as having
exposure to blood or other potentially infectious
materials will be offered the hepatitis B vaccine at
no cost to the employee. The vaccine will be offered
within 10 working days of their initial assignment
to work involving the potential for
occupational exposure to blood or other potentially
infectious materials unless the employee has
previously had the vaccine or wishes to submit to
antibody testing that shows the employee to have
sufficient immunity.
Employees who decline the hepatitis B vaccine
will sign a waiver that uses the wording in Appendix
A of the OSHA standard.
Appendix C Sample Exposure Control Plan
Employees who initially decline the vaccine but
who later wish to have it while still covered under
standard may then have the vaccine provided at no
cost. (Employers should list here who has responsibility
for assuring that the vaccine is offered, the
waivers are signed, etc. Also, the employer should
list who will administer the vaccine.)
Documentation of refusal of the vaccination is
kept at (list location or person responsible for this
record keeping).
Vaccination will be provided by (list health care
professional who is responsible for this part of the
plan) at (location).
After hepatitis B vaccinations, the health care professional'
s written opinion will be limited to whether
the employee requires the hepatitis vaccine and
whether the vaccine was administered.
Postexposure Evaluation and Follow-up
When the employee incurs an exposure incident, it
should be reponed to: (list who has responsibility
to maintain records of exposure incident).
All employees who incur an exposure incident
will be offered postexposure evaluation and followup
in accordance with the OSHA standard.
This follow-up will include the following:
~ Documentation of the route of exposure and
the circumstances related to the incident.
~ If possible, the identification of the source individual
and, if possible, the status of the source
individual. The blood of the source individual
will be tested (after consent is obtained) for
HIVIHBV infectivity.
~ Results of testing of the source individual will
be made available to the exposed employee
with the exposed employee informed about
the applicable laws and regulations concerning
disclosure of the identity and infectivity of
the source individual. (Employers may need
to modify this provision in accordance with
applicable local laws on this subject. Modifications
should be listed here.)
~ The employee will be offered the option ofhaving
his or her blood collected for testing of the
employee's HIVIHBV serological status. The
blood sample will be preserved for up to 90
days to allow the employee to decide whether
.....,
Bloodborne Pathogens
the blood should be tested for HIV serological
status; however, if the employee decides
before that time that testing will or will not be
conducted, then the appropriate action can be
taken and the blood sample discarded.
~ The employee will be offered postexposure
prophylaxis in accordance with the current
recommendations of the u.s. Public Health
Service. These recommendations are currently
as follows: (these recommendations may be
listed as an appendix to the plan).
The employee will be given appropriate counseling
concerning precautions to take during
the period after the exposure incident. The
employee will also be given information on
what potential illness to be alert for and to report
any related experiences to appropriate
personnel.
The following persorus) has been designated to assure
that the policy outlined here is effectively carried
out as well as to maintain records related to this policy:
Interaction With Health Care Professionals
A written opinion shall be obtained from the health
care professional who evaluates employees of this facility.
Written opinions will be obtained in the following
instances:
1. When the employee is sent to obtain the hepatitis
B vaccine
2. Whenever the employee is sent to a health
care professional after an exposure incident
Health care professionals shall be instructed to limit
their opinions to:
1. Whether the hepatitis B vaccine is indicated
and if the employee has received the vaccine,
or for evaluation following an incident.
2. That the employee has been informed of the
results of the evaluation.
3. That the employee has been told about any
medical conditions resulting from exposure
to blood or other potentially infectious materials.
(Note that the written opinion to the
employer is not to reference any personal medical
information.)
Employee Training
All employees who have occupational exposure to
bloodborne pathogens receive training conducted by
(name of responsible person or department). (Attach
a brief description of their qualifications.)
All employees who have occupational exposure
to bloodborne pathogens receive training on the epidemiology,
symptoms, and transmission ofbloodbome
pathogen diseases. In addition, the training program
covers, at a minimum, the following elements:
1. A copy and explanation of the standard
2. An explanation of our ECP and how to obtain
a copy
3. An explanation of methods to recognize tasks
and other activities that may involve exposure
to blood and OPIMs, including what constitutes
an exposure incident
4. An explanation of the use and limitations of
engineering controls, work practices, and PPE
5. An explanation of the types, uses, location,
removal, handling, decontamination, and disposalofPPE
6. An explanation of the basis for PPE selection
7. Information on the hepatitis B vaccine, including
information on its efficacy, safety,
method of administration, the benefits of being
vaccinated, and that the vaccine will be
offered free of charge
8. Information on the appropriate actions to take
and persons to contact in an emergency involving
blood or OPIMs
9. An explanation of the procedure to follow if
an exposure incident occurs, including the
method of reporting the incident and the medical
follow-up that will be made available
10. Information on the postexposure evaluation
and follow-up that the employer is required
to provide for the employee following an exposure
incident
11. An explanation of the signs and labels and/or
color coding required by the standard and
used at this facility
12. An opportunity for interactive questions and
answers with the person conducting the training
session
.-
~ Overview
Occupational exposure to blood or other potentially infectious materials
(OPIMs) means that you are at risk for infection from disease-causing organisms
that may be transmitted through direct contact with blood or OPIMs. The
hazard of exposure to infected blood or OPIMs is not restricted to the health
care industry.
The likelihood of becoming infected after a single exposure to blood containing
a disease-causing organism depends on many factors. The factors most
commonly associated with transmission of disease include the presence of the
organism in the source blood or OPIM, the type of injury or contact that you
sustained (such as splash or puncture wound), the viral level present in the
source individual, your current health (eg, if you have an illness that suppresses
your immune system), and your immunization status (eg, if you are
immunized against hepatitis B).
Many bloodborne pathogens exist. The likelihood of being exposed to a
particular disease-causing organism varies and is affected by the following:
l. The geographic region where the work occurs (certain countries anclJor
areas have a much higher incidence of diseases caused by bloodborne
pathogens). It is estimated that 16 to 18 million people in Central and
~Overview
~ What Are Bloodborne
..... ~~.~~~~~.~~? .
~Modeof
Transmission
of Bloodborne
.....~~~~.~~~~~ .
~ OSHAExpectations
..... ~~~~.~~~~.~.~~p.?.~~.~~ .....
~Reporting
.....~~.~.~.~~~.~.~~~ .
~ Specific Bloodborne
.....~~.~~~~~~~ .
11
Bloodborne Pathogens
South America are infected with Typanosoma
cruzy, a bloodbome pathogen parasite responsible
for Chagas disease; however, unless you
visit these countries or someone with the disease
from these countries comes to the United
States, the chance of contracting this disease is
slim.
2. The type of work performed (eg, work in a research
lab that investigates and cultures various
viruses and bacteria may increase the risk).
It is not possible to include every possible bloodbome
pathogen in this manual; therefore, the emphasis in
this section is on the hepatitis B virus (HBV) , hepatitis
C virus (HCV), and HIV The standard includes
any pathogenic microorganism that may be present
in human blood or OPIMs and that can infect and
cause disease in persons who are exposed to blood
containing the pathogen.
Your employer should determine whether to include
information about other bloodbome pathogens
in your training based on your geographic location and
type of potential exposure. For example, if you work
in facilities that are located near Mexico, you might
reasonably expect to have occupational exposure to
the blood of people from Mexico or Central America
and need to learn more about Chagas disease.
~ What Are Bloodborne
Pathogens?
Bloodbome pathogens are disease-causing microorganisms
(viruses, bacteria, and parasites) that may
be present in human blood. They may be transmitted
during exposure to blood or OPIMs.
~ Mode of Transmission of
Bloodborne Pathogens
Bloodbome pathogens are transmitted when blood
or OPIMs come in contact with mucous membranes
or nonintact skin. Nonintact skin includes, but is not
limited to, cuts, abrasions, burns, rashes, acne, paper
cuts, and hangnails. Bloodbome pathogens may also
be transmitted by blood splashes or sprays, handling
or touching contaminated items or surfaces, and injection
under the skin by puncture wounds or cuts
from contaminated sharps Fi ure 2-1
Always wear gloves to prevent contamination.
Most occupational transmission of HIV has occurred
through puncture injuries from contaminated
sharps; however, there have been documented transmissions
through nonintact skin and mucous membranes.
One worker became HIV positive after a splash
of HIV-contaminated blood to the eyes. Contact with
blood or OPIM should be avoided.
~ OSHA Expectations
Regarding Exposure
The objective of the standard is to minimize or eliminate
the hazard posed by exposure to blood or OPIMs;
however, occupational exposure to a bloodborne
pathogen may occur.
If there is a risk of exposure or injury, it is important
to know the following:
1. If there is a way to prevent infection as a
result of exposure to the pathogen (such as
immuniza tion)
2. The symptoms caused by infection with the
pathogen, as well as the natural course of the
infection
3. Counseling specific to the exposure incident
is available
4. The postexposure treatments and follow-up
that may be provided
If you are exposed to bloodbome pathogens, a confidential
medical evaluation is to be made immediately
available to you, the injured employee. The word immediately
is used in the standard to emphasize the im-
H
recapping or removal is only permitted for the following
procedures: (list the procedures and
also list either the mechanical device to be used or alternatively
if a one-handed technique will be used).
Containers for Reusable Sharps
Contaminated sharps that are reusable are to be placed
immediately, or as soon as possible, after use into appropriate
sharps containers. At this facility, the sharps
containers are puncture resistant, are labeled with a
biohazard label, and are leakproof. (Employers should
list here where sharps containers are located as well
as who has responsibility for removing sharps from
containers and how often the containers will be
checked to remove the sharps.)
Work-Area Restrictions
In work areas where there is a reasonable likelihood
of exposure to blood or other potentially infectious
materials, employees are not to eat, drink, apply cosmetics
or lip balm, smoke, or handle contact lenses.
Food and beverages are not to be kept in refrigerators,
freezers, shelves, cabinets, or countertops or
benchtops where blood or OPIMs are present.
Mouth pipetting/suctioning of blood or other potentially
infectious materials is prohibited.
All procedures will be conducted in a manner
that will minimize splashing, spraying, splattering,
and generation of droplets of blood or OPIMs.
Methods to accomplish this goal at this facility are:
(list methods, such as covers on centrifuges or usage
of dental dams if appropriate).
Specimens
Specimens of blood or other potentially infectious
materials will be placed in a container that prevents
leakage during the collection, handling, processing,
storage, and transport of the specimens.
The container used for this purpose will be labeled
or color coded in accordance with the requirements
of the OSHA standard. (Employers should note
that the standard provides for an exemption for specimens
from the labeling/color-coding requirement of
the standard provided that the facility uses universal
precautions in the handling of all specimens and the
Appendix C Sample Exposure Control Plan
containers are recognizable as container specimens.
This exemption applies only while the specimens remain
in the facility. If the employer chooses to use
this exemption, then it should be stated here.)
Any specimens that could puncture a primary container
will be placed within a puncture-resistant secondary
container. (The employer should list here how
this will be carried out, for example, which specimens,
if any, could puncture a primary container, which containers
can be us d as secondary containers, and where
the secondary containers are located at the facility.)
If outside contamination of the primary container
occurs, the primary container shall be placed within
a secondary container that prevents leakage during
the handling, processing, storage, transport, or shipping
of the specimen.
Contaminated Equipment
Equipment that has become contaminated with blood
or other potentially infectious materials shall be examined
before servicing or shipping and shall be decontaminated
as necessary unless the decontamination
of the equipment is not feasible. (Employers should
list here any equipment that cannot be decontaminated
before servicing or shipping.)
Personal Protective Equipment
All personal protective equipment used at this facility
will be provided without cost to employees.
Personal protective equipment will be chosen based
on the anticipated exposure to blood or other potentially
infectious materials. The protective equipment
will be considered appropriate only if it does not permit
blood or other potentially infectious materials to
pass through or reach the employees' clothing, skin,
eyes, mouth, or other mucous membranes under normal
conditions of use and for the duration of time
that the protective equipment will be used.
Protective clothing will be provided to employees
in the following manner: (list how the clothing
will be provided to employees, for example, who has
responsibility for distribution, and also list which
procedures would require the protective clothing and
the type of protections required. This could also be
listed as an appendix to this program. The employer
could use a checklist as follows):
Bloodborne Pathogens
Personal Protective Equipment Task
oGloves
oLab coat
oFace shield
oClinic jacket
oProtective eyewear
(with solid side shield)
oSurgical gown
oShoe covers
oUtility gloves
oExamination gloves
oOther (list other
personal protective equipment)
All personal protective equipment will be cleaned,
laundered, and disposed of by the employer at no
cost to employees. All repairs and replacements will
be made by the employer at no cost to employees.
All garments that are penetrated by blood shall
be removed immediately or as soon as feasible. All
personal protective equipment will be removed before
leaving the work area. The following protocol has
been developed to facilitate leaving the equipment at
the work area: (list where employees are
expected to place the personal protective equipment
on leaving the work area, and other protocols).
Gloves shall be worn where it is reasonably anticipated
that employees will have hand contact with
blood, other potentially infectious materials, nonintact
skin, and mucous membranes. Gloves will be available
from (state location and/or person who will be responsible
for distributing gloves). Gloves will be used for
the following procedures: (list procedures).
Disposable gloves used at the facility are not to
be washed or decontaminated for reuse and are to be
replaced as soon as practical when they become contaminated
or as soon as feasible if they are torn or
punctured or when their ability to function as a barrier
is compromised. Utility gloves may be decontaminated
for reuse provided that the integrity of the
glove is not compromised. Utility gloves will be discarded
if they are cracked, peeling, tom, punctured,
or exhibit other signs of deterioration or when their
ability to function as a barrier is compromised.
Masks in combination with eye protection devices,
such as goggles or glasses with solid side shield
or chin-length face shield, are required to be worn
whenever splashes, spray, splatter, or droplets of blood
or other potentially infectious materials may be
generated and eye, nose, or mouth contamination can
reasonably be anticipated. Situations at this facility
that would require such protection are as follows:
The OSHA standard also requires appropriate
protective clothing to be used, such as lab coats,
gowns, aprons, clinic jackets, or similar outer garments.
TIle following situations require that such
protective clothing be worn: _
Housekeeping
This facility will be cleaned and decontaminated
according to the following schedule: (list
area and time).
Decontamination will be accomplished by using the
following materials: (list the materials to be used, such
as bleach solutions or EPA-registered germicides). All
contaminated work surfaces will be decontaminated after
completion of procedures, immediately or as soon as
feasible after any spill of blood or other potentially infectious
materials, as well as at the end of the work shift
if surfaces may have become contaminated since the last
cleaning. (Employers should add any information concerning
the use of protective coverings such as plastic
wrap that keeps the surfaces free of contamination.)
All bins, pails, cans, and similar receptacles shall
be inspected and decontaminated on a regularly
scheduled basis (list frequency and by whom).
Any broken glassware that may be contaminated
will not be picked up directly with the hands. The
following procedures will be used: _
Labels
The following labeling methodes) is used in this
facility:
EQUIPMENT
TO BE LABELED
LABEL TYPE
(size, color, etc.)
(Name of responsible person or department) will
ensure that warning labels are affixed or red bags are
portance of prompt medical evaluation and prophylaxis.
An exact timeframe cannot be stated because the
effectiveness of postexposure prophylactic measures
varies depending on the infecting organism.
Medical evaluation must be confidential and protect
your identity and test results.
Activities Associated With Sharps Injuries
Needlestick and other sharps injuries are primarily
associated with the following activities: disposing
needles; administering injections;
drawing blood, including the use of glass capillary
tubes; recapping needles; and handling
trash and dirty linens.
If you go for a medical evaluation, the following
information will be made available to the health
professional:
l. A copy of the OSHA guidelines section
1910.1030. This is the OSHA standard that
dictates the requirement for all aspects of
bloodborne pathogens and infectious diseases.
The OSHA standard provides the necessary
procedures for the medical evaluation.
2. A description of how the incident occurred as
it relates to your employment
3. The results of the source individual's testing
(if available)
4. All medical records that are relevant for your
proper treatment (if treatment is necessary),
including a copy of your hepatitis B vaccination
status with the dates of all the hepatitis B
Blood Testing Results
Employers do not have a specific right to know
the actual results of the source individual's blood
testing, but they must ensure that the information
is provided to the evaluating health care
professional.
Chapter 2 Bloodborne Pathogens
vaccinations and any medical records relative
to your ability to receive the vaccination
Youand your employer should expect that current
Centers for Disease Control and Prevention (CDC)
guidelines will be used to guide postexposure prophylaxis
and treatment.
It is the employer's responsibility to ensure that
your m~cal records are kept confidential. Your
records cannot be disclosed without your express
written consent to any person within or outside the
workplace, except as required by law. Your employer
will have a copy of the health care provider's written
opinion regarding the incident.
During consultation with the health care professional,
decisions will be made about the need for hepatitis
B vaccination, and laboratory tests and
information will be provided about available postexposure
prophylaxis and treatments.
The health care professional will discuss the laboratory
test results with you. A plan will be created
that identifies any necessary follow-up or treatments,
including initiation of hepatitis B immunization, if
indicated. Postexposure treatments and follow-up
plans should be in accordance with the current CDC
guidelines.
~ Reporting Requirements
What Is an Occupational
Exposure Incident?
An occupational exposure incident occurs if you are
in a work situation and come in contact with blood
or OPIM.
For OSHA 2000 record keeping purposes, an occupational
bloodborne pathogens exposure incident
(such as a needlestick, laceration, or splash) is classified
as an injury because it is usually the result of
an instantaneous event or exposure
After an occupational exposure to blood or
OPIM has occurred, the employee's name and job
classification are listed on the OSHA 2000 log. The
job classification should be reviewed, and a determination
should be made as to which employees,
if any, in that classification should be covered under
the standard.
Figure 2-2
J
Bloodborne Pathogens
SHATips
As part of blood borne pathogen training, OSHA
requires that information on the appropriate
actions to take and persons to contact in an
emergency involvinq blood or OPIMs be
provided.
Exposure Determination
The employer must identify and document the job
classifications in which exposure occurs. The exposure
determination must have been made without
taking into consideration the use of personal protective
clothing or equipment. The exposure control plan
should identify the person responsible for the determination
and assessment of an exposure incident.
Reporting an Incident
The goal of reporting an incident is to ensure that an
employee receives timely access to medical services
and to identify and adopt other methods or devices
to prevent exposure incidents from recurring.
At sites where an exposure incident has occurred,
it should be determined whether OSHA Standards
were properly followed through interviews and reviews
of incident reports or medical records.
FYI
Emergency Measures In the Event
of an Exposure
If you have an exposure incident to another
person's blood or OPIM, immediately wash the
exposed area with warm water and soap.
If the exposed area was in your mouth, rinse
your mouth with water or mouthwash
(whichever is most readily available).
If the exposure was in your eyes, flush with
warm water (or normal saline if available). A
quick rinse is probably not adequate; you want
to irrigate the area completely with water.
Your employer will have site-specific work
practices to follow in event of an emergency.
An uncapped needle can cause an injury.
.-- ---ICALI FORNIA
California OSHA requires a
sharps injury log that records the date and time
of each sharps injury resulting in an exposure
incident, as well as the type and brand of device
involved in the exposure incident.
The employee needs to report the incident to his
or her supervisor. OSHA requires that the following
information be reported:
II
Date and time of the exposure incident
IIJob classification of the exposed employee
II
Worksite location where the exposure incident
occurred
II
Work practices being followed
II
Engineering controls in use at the time including
a description of the device in use (such as
type and brand of sharp involved in the exposure
incident)
II
Protective equipment or clothing that was used
at the time of the exposure incident
a Procedure being performed when the incident
occurred
II
Your training for the activity
The California OSHA also requires the following:
Identifying the body part involved in the exposure
incident
~ The engineering controls in use at the time if the
sharp had engineered sharps injury protection
Whether the protective mechanism was activated
and whether the injury occurred before
the protective mechanism was activated, during
activation of the mechanism, or after activation
of the mechanism, if applicable
~ If the sharp had no engineered sharps injury
protection, the injured employee's opinion as
to whether and how such a mechanism could
have prevented the injury
~ The employee's opinion about whether any
other engineering, administrative, or work practice
control could have prevented the injury
After an incident has been reported, your employer
will need to identify and document the source
individual and obtain consent and make arrangements
to have the source individual tested as soon as
possible to determine HIY, HCY, and HBV infection.
It should be documented when legally required consent
to test the blood is not obtained.
State Laws
State laws may vary. Please check with your
instructor regarding testing and test result
confidentiality laws in your state.
)
It may not always be feasible to identify the source
individual. Examples of when you may be unable to
identify the source individual include needles ticks
caused by unmarked syringes left in laundry or those
involving blood samples that are not properly labeled,
as well as incidents occurring where state or local
laws prohibit such identification.
Your blood may be tested for HBY, HCY, and/or
HIV only with your consent. OSHA encourages employees
to consent to blood collection at the time of
exposure. The results of HIV testing must be made in
person and cannot be given over the telephone or by
mail. Even if you choose not to undergo testing, coun-
Chapter 2 Bloodborne Pathogens
seling and evaluation of reported illnesses are available
to you.
You may choose to have your blood drawn but
not tested and stored for 90 days. The 90-day time
frame allows the employee to have the opportunity
to obtain knowledge about baseline serologic testing
after exposure incidents and to participate in further
discussion, education, or counseling. If you elect not
to have the blood tested, the sample will be disposed
of after 90 days.
SHATips
OSHA does not require redrawing of the source
individual's blood specifically for HBV, HCV, and
HIV testing without the consent of the source
individual.
~ Specific Bloodborne
Pathogens
Hepatitis Viruses
Hepatitis means inflammation of the liver. Hepatitis
has a variety of causes, including drugs, poisons and
other toxins, and bloodborne pathogens. This section
will focus on three causes of viral hepatitis: HAY,HBY,
andHCV
HAV
Hepatitis A is a viral disease caused by the hepatitis
A virus. Hepatitis A can affect anyone. In the United
States, hepatitis A can occur in isolated cases to widespread
epidemics.
Good personal hygiene and proper sanitation can
help prevent hepatitis A. Vaccines are also available
for long-term prevention ofHAVinfection in persons
12 months of age and older.
Infection with one form of hepatitis does not
prevent infection with another form of hepatitis.
For example, a person with an HCV infection may
still become infected with HBV.
Bloodborne Pathogens
Prevention and Control
Routine vaccination for HAYshould occur in:
~ All children 1 year (12 through 23 months)
of age.
~ Persons 1 year of age and older traveling to or
working in countries with high or intermediate
prevalence ofHAV,such as those located in
Central or South America, Mexico, Asia (except
Iapan), Africa, and eastern Europe. The
CDC website provides additional information.
~ Children and adolescents through 18 years of
age who live in states or communities where
routine vaccination has been implemented because
of high disease incidence.
~ Men who have sex with men.
~ Persons who use street drugs.
~ Persons with chronic liver disease.
~ Persons who are treated with clotting factor
concentrates.
~ Persons who work with HAY-infectedprimates
or who work with HAYin research laboratories.
The HAYvaccine may be recommended for children
or adolescents in communities where outbreaks
of hepatitis A are occurring. Hepatitis A vaccine is
not licensed for administration to children younger than
1 year.
For children, the first dose should be given at 12
to 23 months of age. Children who are not vaccinated
by 2 years of age can be vaccinated at later visits.
For travelers, the vaccine series should be started
at least 1 month before traveling to provide the best
protection. For others, the HAY vaccine series may
be started whenever a person is at risk of infection.
Two doses of the vaccine are needed for lasting
protection. These doses should be given at least
6 months apart. HAYvaccine may be given at the same
time as other vaccines.
HBV
Hepatitis B can affect anyone. Each year in the United
States, 140,000 to 320,000 people will become infected
with the virus. Studies conducted by the CDC
have shown a steady decline in the incidence of HBY
infection. This decline is attributed to the widespread
use of HBYvaccine and the implementation of other
prevention methods, such as engineering and work
practice controls, personal protective equipment, and
universal precautions.
It is estimated that 1 to 1.25 million Americans
are chronically infected with HBV
Prevention and Control
The HBY vaccine has been available since 1982. The
vaccine does not contain any live components. The
vaccine is given in a series of three shots -ilj,ji!{t..;c-.
Immunization
All people who have routine occupational exposure
to blood or OPIM have the right to receive the immunization
series against HBY at no personal expense.
The standard includes temporary and part-time
workers and volunteers.
There are several reasons why you may choose
not to receive the HBYvaccine. Among the most common
reasons are as follows:
1. Documentation exists that you have previously
received the series.
2. Antibody testing reveals that you are immune.
3. Medical evaluation shows that vaccination is
contraindicated.
4. You are allergic to any component of the
vaccine.
Immunization against HBV is possible.
Exception for HBV Vaccination
Designated first aid providers who have occupational
exposure are not required to be offered HBV vaccine
if the following conditions exist:
1. The primary job assignment of the designated
first aid provider is not the rendering of first
aid.
2. Any first aid rendered by the first aid provider
is rendered only as a collateral duty responding
solely to injuries resulting from workplace
incidents and generally at the location where
the incident occurred.
3. This provision does not apply to designated
first aid providers who render assistance on a
regular basis, for example, at a first aid station,
clinic, dispensary, or other location where
injured employees routinely go for such assistance,
and emergency or public safety personnel
who are expected to render first aid in
the course of their work.
Prescreening antibody testing is not required, and
your employer may not make prescreening a requirement
for receiving the vaccine. If an employer wishes
prescreening, it must be made available to you at no
cost. If you choose to have prescreening, the testing
must be done at an accredited laboratory.
The standard requires that your employer offer
the vaccine at a convenient time and place to you,
during normal work hours. If travel is required away
from the worksite, your employer is responsible for
that cost. The standard includes temporary and parttime
workers.
HBV Vaccine
Immunization with HBV vaccine should be
made available within 10 working days of initial
assignment to the job.
Your employer cannot require you to use your
health insurance or your family insurance to
pay for the cost of the vaccine.
To learn more about CDC recommendations
visit http://www.cdc.gov/ncidod/dhqp/bp.html.
Chapter 2 Bloodborne Pathogens
Your employer cannot require you to pay for testing
and then reimburse you if you remain employed
for a specific time. Nor are you required to reimburse
your employer for the cost of the vaccine if you leave
your job.
First Aid Providers
The employer's exposure control plan must
specifically address the provisions of the standard
as they apply to first aid providers.
The exposure control plan must include the following:
Provision for a reporting procedure that ensures
that all first aid incidents involvinq the
presence of blood or OPIM will be reported to
the employer before the end of the work shift
during which the incident occurred.
The report must include the names of all first aid
providers who rendered assistance, regardless of
whether personal protective equipment was used
and must describe the first aid incident, including
time and date. The description must include a determination
of whether or not, in addition to the
presence of blood or other potentially infectious
materials, an "exposure incident." as defined by
the standard, occurred. This determination is necessary
in order to ensure that the proper postexposure
evaluation, prophylaxis, and follow-up
procedures required by the standard are made
available immediately, whenever there has been
an "exposure incident" as defined by the standard.
A report that lists all such first aid incidents
must be readily available, upon request, to all
employees and to the assistant secretary.
Provision for the bloodborne pathogens training
program for designated first aid providers to include
the specifics of this reporting procedure.
Provision for the full hepatitis B vaccination
series to be made available as soon as possible,
but in no event later than 24 hours, to all
unvaccinated first aid providers who have rendered
assistance in any situation involving the
presence of blood or OPIM, regardless of
whether or not a specific "exposure incident,"
as defined by the standard, has occurred.
·'
g."' ..•... u.. ..
Bloodborne Pathogens
OSHA'sintent is to have your employer eliminat
obstacles to your acceptance of the vaccine; however,
the term "made available" emphasizes that you may
refuse the series by signing the HBY vaccine declination
form (Appendix B). If you change your mind
while still covered under the standard at a later date,
you may still receive the vaccine at no cost.
If your job requires you to have ongoing contact
with patients or blood and you are at ongoing risk for
injuries with sharp instruments or needles ticks, the
CDC recommends that you be tested for antibody to
HBY surface antigen (HBsAg) 1 to 2 months after the
completion of the three-dose vaccination series. If
you do not respond to the primary vaccination series,
you must be re-vaccinated with a second three-dose
vaccine series and re-tested for HBsAg. Nonresponders
must be medically evaluated.
Contraindications
You should not receive the vaccine if you are sensitive
to yeast or any other component of the vaccine.
Consultation with a physician is required for persons
with heart disease, fever, or other illness. If
you are pregnant or breastfeeding an infant, you
should consult your physician before receiving the
vaccine.
Side Effects of the Vaccine
The side effects of the vaccine are minimal and may
include localized swelling, pain, bruising, or redness
at the injection site. The most common systemic reactions
include flu-like symptoms such as fatigue,
weakness, headache, fever, or malaise.
About the Vaccines
Recombivax HB (Merck) or Engerix-B (GlaxoSmith-
Kline Biologicals) are the vaccines used to prevent infection
with the HBY The vaccine against hepatitis B,
prepared from recombinant yeast cultures, is free of
association with human blood or blood products. In
1999, manufacturers began producing vaccines that
are free of the preservative thimerosal. Thimerosal
consists of approximately 50% mercury by weight and
has raised toxicity concerns.
The vaccine is given in three doses over a 6-month
period. The first is given at an agreed-on date and
within 10 working days of the initial assignment; the
second is given 1 month later, and the third dose is
given 5 months after the second dose. The vaccine is
administered by needle into a large muscle such as
the deltoid in the upper arm; however, for persons at
risk of hemorrhage after intramuscular injection, the
vaccine may be administered subcutaneously.
In persons receiving the vaccine, 87% will develop
immunity after the second dose of the vaccine,
and 96% will develop immunity after the third dose.
Clinical Features and History of Hepatitis B
The symptoms of HBY infection typically last 4 to
6 weeks and include the following:
~ Jaundice (your eyes or skin may turn yellow)
~ Fatigue
~ Abdominal pain
Q
Loss of appetite
o Intermittent nausea
o Yomiting
It is expected that 70,000 to 160,000 people will
develop symptomatic infections with HBY,and 8,400
to 19,000 of these people will require hospitalization.
Each year, as many as 320 persons will die of the acute
infection with HBY
The incubation period for HBY (the time from exposure
to developing the disease) averages 12 weeks,
with a range of 4 weeks to 6 months. In the majority
(90% to 94%) of the cases, infection with HBY resolves
without further complication; however, about 8,000
to 32,000 (6% to 10%) of all the annual infections will
progress, and the individuals will suffer chronic infection
with HBY Over time, chronic infection causes
Significant injury to the liver; 5,000 to 6,000 deaths
occur each year from chronic HBY liver disease.
Postexposure Prophylaxis and Follow-up
forHBV
There is no cure for infection with HBY HBY vaccination
is the best protection.
All decisions about postexposure prophylaxis are
made in consultation with your health care professional,
Postexposure treatment for HBY infection should
begin within 24 hours and no later than 7 days.
The postexposure treatments available include
HBY immunization and the use of immune globulin,
which has been shown to be effective for passive immunization
against HBV if given within hours after
the exposure incident.
The decision to provide postexposure prophylaxis
takes into account whether the source of the
blood is available, the HBsAg status of the source
blood, and the HBVvaccination and vaccine-response
status of the exposed employee.
For any occupational exposure to blood or OPIM
of a person not previously vaccinated, HBV vaccination
is recommended.
The CDC reports that for an unvaccinated person,
the risk from a single needles tick or cut exposure
to HBV-infected blood ranges from 6% to 30%
and depends on the hepatitis B e antigen (HBeAg)
status of the source blood.
Chronic HBVinfection treatment options include
antiviral medications and/or liver transplantation.
HCV
Hepatitis C is the most common chronic bloodborne
infection in the United States. HCV is transmitted primarily
through large or repeated direct percutaneous
exposures to blood (meaning passed through the
skin).
The incidence of HCV infection has declined.
Transfusion-associated cases occurred before blood
donor screening and are now rare. Injectable drug
abuse has accounted for a substantial proportion of
HCV infections and currently accounts for 60% of
HCV transmission in the United States.
It is estimated that 3.9 million Americans (1.8%)
have been infected with HCY, of whom 2.7 million
are chronically infected; 36,000 new infections occur
in the United States each year.
Prevention and Control
There is no vaccination for HCY
Prevention recommendations are directed toward
the use of engineering and work practice controls, personal
protective equipment, and universal precautions.
Clinical Features and History of Hepatitis C
Most patients (70% to 75%) with acute hepatitis Care
asymptomatic. Symptoms may include the following:
Chapter 2 Bloodborne Pathogens
FYI
Hepatitis C Virus
• HCV has specifically been included wherever
HIV and HBV are mentioned in the regulation.
The CDC reports that the prevalence of HCV
infection among health care workers is no
greater than the general population, averaging
1% to 2%, and is 10 times lower than the
prevalence of HBV infection among health
care workers.
Needlestick injury is the only occupational risk
factor that has been associated with HCV infection.
Referral to a specialist in liver disease may be
necessary to manage an infection with HCV
properly.
In follow-up studies of health care workers who
sustained percutaneous exposures to blood
from anti-HCV-positive patients, the incidence
of anti-HCV conversion averaged 3.5%.
g
Jaundice (eyes or skin may turn yellow)
Fatigue
g
Abdominal pain
Loss of appetite
Intermittent nausea
Vomiting
The incubation period (the time from exposure to
developing the disease) averages 7 weeks (range, 3 to
20 weeks). Chronic infection is common, affectingmore
than 85% of people infected. Chronic liver disease may
occur in 70% of those infected with HCY It is estimated
that 8,000 to 10,000 deaths occur each year as a result
of HCV-associated liver disease. HCV is the major cause
of liver disease requiring liver transplantation.
Postexposure Prophylaxis and Follow-up
There is no cure for infection with HCY
All decisions about postexposure laboratory testing
and prophylaxis are made in consultation with
your health care professional. The test for HCV and
liver function tests should occur as soon as possible
after exposure and should be repeated at 4 to 6 months
after the exposure.
Bloodborne Pathogens
Currently, there is no recommendation for postexposure
prophylaxis of HCV Immune globulin is
not effective in providing passive immunization
against the disease.
When HCV infection is identified early, referral
for medical management is necessary. Limited
data indicate that antiviral therapy might be beneficial
when started early in the course of the HCV
infection; however, no guidelines currently exist
for the use of antiviral medications in the acute
phase of the infection.
The CDC reports that the risk for infection after
a needlestick or cut exposure to HCV-infected blood
is about 1.8%.
Chronic HCV infection treatment options include
antiviral medications and liver transplantation.
HIV
Human immunodeficiency virus (HIV) is the virus
that causes AIDS. Two types of HI V have been identified
(HIV-l and HIV-2). HIV infection causes suppression
of the immune system and can lead to
opportunistic infections and unusual types of cancer.
The differences between HIV-l and HIV-2 should
be noted. HIV-2 AIDS develops more slowly and may
be milder. There are few reported cases of HIV-2 in
the United States. HIV-2 is predominately found in
Africa. Hereafter, all references to HIV mean HIV-l.
The CDC reports that in 2003 there were an estimated
1,039,000 people in the United States with
HIV/AIDS. Approximately 25% of infected persons
are undiagnosed and unaware of their infection.
The annual rate of infection with HIV is 16.5 cases
per 100,000 population d!ii(*4-.
Prevention and Control
There is no vaccination for HIV
Prevention recommendations are directed toward
the use of engineering and work practice controls,
personal protective equipment, and universal
precautions.
Clinical Features and History of HIV
The only way to determine for sure whether you are
infected is to be tested. The incubation period with
HIV from the time of HIV infection to the develop-
FYI
Risk of HIV Infection From
Percutaneous Exposure
The average risk for HIV infection from all types
of reported percutaneous exposure to HIV infected
blood is 0.3%.
The risk is increased in exposures involvinq:
Deep injury to health care worker
Visible blood on the device causing the injury
A device previously placed in the source patient'
s vein or artery
A source patient who died as a result of AIDS
within 60 days after exposure
FYI
Antiviral Drugs
Advances in the field of antiviral therapy and
the use of protease inhibitors might change the
recommendations for treatment and follow-up
for HCV and HIV infection; therefore, it is important
to work closely with your health care
professional and use current CDC guidelines.
All antiviral drugs have been associated with
significant side effects. Protease inhibitors
may interact with other medications and
cause serious side effects.
ment of AIDS may take 8 to 10 years. This time varies
greatly from person to person.
You cannot rely on symptoms to know whether
you are infected with HIV Many people who are infected
with HIV experience no symptoms for many
years. The symptoms of AIDS are similar to the symptoms
of many other infections and might include night
sweats, weight loss, fever, fatigue, gland pain or
swelling, and muscle or joint pain.
Postexposure Prophylaxis and Follow-up
for HIV
There is no cure for infection with HIV
All decisions about postexposure laboratory testing
and prophylaxis are made in consultation with
Chapter 2 Bloodborne Pathogens
NM
Puerto Rico
your health care professional. Testing for the HIV antibody
should be done as soon as possible after exposure
and, thereafter, periodically for at least
6 months. Antibodies usually become detectable
within 3 months of infection.
Decisions regarding treatment need to be made
after discussion with an infectious diseases specialist.
Postexposure treatment is not recommended for
00
c,.,.
oS;>
HI • {)
oLess than 1,000
o1,000 to 2,999
3,000 to 8,000
• More than 8,000
Guam
u.s. Virgin Islands
Estimated number of persons living with AIDS.
Source: The Kaiser Family Foundation, statehealthfacts.org. Data Source: HIV/AIDS Surveillance Report: Cases of HIV Infection and
AIDS in the United States, 2005, Volume 16, National Center for HIV, STD and TB Prevention, Centers for Disease Control and
Prevention, Department of Health and Human Services, 2006,
all occupational exposures; 99.7% of the exposures
do not lead to HIV infection, If treatment with antiviral
medications plus a protease inhibitor is recommended,
treatment should begin within hours of the
exposure.
The CDC reports that the risk of infection after
a needlestick or cut exposure to HIV-infected blood
is about 0.3%.
~ Overview
The Occupational Safety and Health Administration (OSHA) defined four principal
strategies to prevent or reduce exposure to bloodborne pathogens. These
strategies are used in combination to offer you maximum protection. It is
OSHAS view that preventing exposures requires a comprehensive program, including
engineering controls (such as needleless devices, shielded needle devices,
and plastic capillary tubes) and proper work practices (such as no-hands
procedures in handling contaminated sharps). If engineering and work practice
controls do not eliminate exposure, the use of personal protective equipment
(PPE) (such as eye protection) and universal precautions is required.
Your employer's exposure control plan describes the engineering controls
in use at your worksite. Significant improvements in technology are most evident
in the growing market of safer medical devices that minimize, control,
or prevent exposure incidents. Employee participation in the selection of new
devices is required by OSHA. OSHA does not advocate the use of one particular
device over another. An annual review of your employer's exposure control
plan should include identification of new safety devices. Adoption of
engineering controls requires changes to your employer's plan and retraining
in the proper use of the control.
~Overview
.~.~~g~~.~~~.~~g.~.~~~~~~.~ ..
~ WorkPractice
Controls
~ Personal Protective
..... ~.~~f..~~~.~ .
~ Universal Precautions
~ Body Substance
Isolation
25
Bloodborne Pathogens
According to California OSHA, the use of needleless
systems, needle devices with engineered sharps
injury protection, and nonneedle sharps with engineered
sharps injury protection is required except
under four conditions:
1. Lack of market availability
2. Information that the device will jeopardize
patient care
3. Information indicating that the device is not
more effective in reducing sharps injuries than
the device currently used by the employer
4. A lack of sufficient information to determine
whether a new device on the market will effectively
reduce the chances of a sharps injury
When the potential for exposure exists in spite
of engineering and work practice controls, employers
must provide PPE. PPE is used to protect you from
contamination of skin or mucous membranes and
puncture wounds. Universal precautions is a strategy
to structure your approach to working with all human
blood and certain body fluids. All of these strategies
combined promote worker safety and provide a
safer working environment.
~ Engineering Controls
Engineering controls refers to any effort to design safety
into the tools and workspace organization. Examples
include handwashing facilities, eye stations, sharps
containers, biohazard labels, self-sheathing needles
on syringes, and needleless IV systems. Engineering
controls include any object that comes between you
and the potential infectious material.
Your employer is responsible for the full cost of
instituting engineering and work practice controls.
Your employer is also responsible for regularly examining
and repairing and/or replacing engineering controls
as often as necessary to ensure that each control
VI
Engineering Controls
For situations in which engineering controls will
reduce employee exposure by removing, eliminating,
or isolating the hazard, they must be used.
)
Work practice controls must be evaluated and
updated on a regular schedule to ensure their
effectiveness. Your organization violates the
standard if it fails to engage in effective
monitoring.
is maintained and that it provides the protection intended.
Regularly scheduled inspections are required
to confirm, for instance, that engineering controls
such as safer devices continue to function effectively,
that protective shields have not been removed or broken,
and that physical, mechanical, or replacementdependent
controls are functioning as intended. Your
employer may assign this task to you.
Labeling Regulated Waste
What Is Regulated Waste?
The term regulated waste refers to the following categories
of waste that require special handling, at a
minimum:
Liquid or semiliquid blood or other potentially
infectious materials (OPIMs)
Items contaminated with blood or OPIMs and
that would release these substances in a liquid
or semiliquid state if compressed
Items that are caked with dried blood or OPIMs
and are capable of releasing these materials
during handling
Contaminated sharps
Pathological and microbiological wastes containing
blood or OPIMs
When Is Labeling Regulated
Waste Necessary?
Labels must be provided on containers of regulated
waste, on refrigerators and freezers that are used to
store blood or OPIMs, and on containers used to store,
dispose of, transport, or ship blood or OPIMs.
Equipment that is being sent to another facility
for servicing or decontamination must have a label attached
stating which portions of the equipment remain
contaminated to warn other employees of the
hazard and encourage them to use proper precautions.
Labeling Regulated Waste
Regulated waste containers must be labeled with the
biohazard label or color coded to warn individuals
who may have contact with the containers of the potential
hazard posed by their contents.
Even if your facility considers all of its waste to
be regulated waste, the waste containers must still
bear the required label or color coding in order to
protect new employees and individuals and employees
from outside facilities.
Regulated waste that has been decontaminated
need not be labeled or color coded; however, your
employer must have controls in place to determine
whether the decontamination process is successful.
Blood and blood products that bear an identifying
label as specified by the Food and Drug Administration
and that have been screened for hepatitis B
virus (HBV), hepatitis C virus (HCV) , and HIV antibodies
and released for transfusion or other clinical
uses are exempted from the labeling requirements.
When blood is being drawn or laboratory procedures
are being performed on blood samples, the individual
containers housing the blood or OPIMs do
not have to be labeled, provided the larger container
into which they are placed for storage, transport, shipment,
or disposal (such as a test tube rack) is labeled.
When there is an overlap between the OSHAmandated
label and the Department of
Transportation (DOT)-required label, the DOT label
will be considered acceptable on the outside
of the transport container, provided that the
OSHA-mandated label appears on any internal
containers that may be present.
Biohazard Labels
Biohazard labels may be attached to bags containing
potentially infectious materials. These labels must be
fluorescent orange or orange-red with letters or symbols
in a contrasting color. These are attached to any
container that is used to store or transport potentially
infectious materials Figure 3-1
Chapter 3 Prevention
Biohazard labels may be attached to bags containing
potentially infectious materials. The label must be
fluorescent orange or orange-red in color and
clearly visible.
ns
The Needlestick Safety Prevention Act
The Needlestick Safety Prevention Act became effective
April 200 1 and requires employers to
() Implement new developments in control
technology
() Solicit nonmanagerial employees with direct
patient care who are exposed to these potential
hazards for input in the identification, evaluation,
and selection of engineering and work
practice controls
() Maintain a log of percutaneous injuries from
contaminated sharps
Specific procedures for obtaining employee input
might include informal problem-solving groups, participation
of employees in safety audits, workplace inspection,
evaluation of devices, pilot testing devices,
and membership on a committee that consistently
meets to review and audit reports of these activities.
-
Bloodborne Pathogens
Remember that your participation is critical in
creating a safe work environment. Participation in
these activities ensures safer medical devices and the
training to properly use these devices, as well as the
identification of compatibility problems. In many instances,
employee contribution has led to important
decisions that result in the most appropriate engineered
sharps being selected.
SESIP and Needleless Systems
The term SESIP or Sharps with Engineered Sharps
Injury Protections means a needleless sharp or needle
device used for withdrawing body fluids, accessing a
vein or artery, or administering medications or other
fluids with built-in safety features that effectively reduce
the risk of an exposure incident diiii#O'•.
SESIP devices are available as
Syringes with retractable needles
Blunt-tipped blood-drawing needles
Resheathing disposable scalpels
Retracting finger prick lancets
Needleless systems are used for withdrawal of
body fluids or administration of medications or fluids
after the initial venous or arterial access is established
or whenever a needleless system is available
~I
Needles
Needles that will not become contaminated by
blood during use (such as those used only to
draw medication from vials) are not required to
have engineering controls under the standard.
IV needle with auto sharp injury prevention.
The standard prohibits the removal of contaminated
needles from medical devices. When
performing a blood-drawing procedure, it is
necessary to dispose of the blood tube holder
with a safety needle attached after each
patient's blood is drawn.
J
~---------------------------
Evaluating Safety Systems
Your employer must evaluate existing engineering
and work practice controls and assess the feasibility
of implementing new safety technology yearly. There
are many new products introduced each year. at all
products may be correct for your work environment;
however, these products should be evaluated with input
from nonmanagerial employees who have patient
care responsibilities. There are many new types of
needleless systems. Examples of the new types of injection
equipment, IV equipment, and laboratory
equipment include the following:
Needle guard-sliding sheath/sleeve
Needle guard-hinged recap
Needleless jet injection
Retractable needles
Needleless IV access-blunted cannulas
Recessed protected needle
Plastic blood collection tubes
Self-blunting needle
o Lancets-laser and retracting
Retracting scalpels
Quick-release scalpel blade handles
Blunted suture needle
Needleless system.
The specific process for evaluating safety technology
is not prescribed by the standard; however,
experience has shown that a productive review process
might include the following:
~ Form a multidisciplinary team that follows a
timetable for completing timely evaluations.
~ Identify priority areas, and give the highest priority
assessment to any work area or practice
in which percutaneous injuries have occurred.
Emphasize safety devices with features that
will have the greatest impact on preventing occupational
injury.
Conduct the evaluation with participants who
will actually use the selected device.
~ Train the workers in the proper use of the device.
Establish clear criteria and measures for evaluation,
including attempts to circumvent the
safety features.
~ Conduct follow-up and obtain informal feedback;
identify problems, and offer additional
guidance.
~ Monitor the use of the device to determine
whether additional training is necessary or for
any possible adverse effects of the device on
patient care.
Your employer must document consideration and
implementation of appropriate commercially available
and effective engineering controls designed to
eliminate or minimize exposure.
Many different evaluation forms can be used. The
employer should maintain a file of the forms after
they are completed with the action taken regarding
the device.
Both active and passive safety features are available
in safe needle systems. An integrated system is
preferable because the safety feature is built in and is
not dependent on employee compliance. _m!l!'J'De
lists the engineering features for devices designed to
prevent sharps injury.
FYI
Self-Sheathing Needle Products
Even after activation, self-sheathing needle
products and other SESIPs must be disposed
of in a sharps container that conforms to the
requirements of the standard.
Chapter 3 Prevention
Table 3-1 Engineering Features
for Devices Designed
to Prevent Sharps
Injury
A fixed safety feature provides a barrier
between the hands and the needle after
use; the safety feature should allow or require
the worker's hands to remain behind
the needle at all times.
The safety feature is an integral part of
the device, not an accessory.
The safety feature is in effect before disassembly
and remains in effect after disposal
to protect users and trash handlers,
and for environmental safety.
• The safety feature is as simple as possible
and requires little or no training to use
effectively.
.-- ~CALIFORNIA
CaIOSHA's regulation requires
that hospitals, physicians, and other health care
providers switch to safe needle systems.
In Case of Injury
According to the National Institute of Occupational
Safety and Health, an estimated 600,000 needles tick
injuries occur annually in the hospital setting. Hospital
studies reveal that one third of all sharps injuries are
related to the disposal process of the sharps.
If you are stuck by a needle containing blood or
OPIMs, OSHA recommends the following:
~ An HIV test and counseling
Q
A test for HIV periodically for at least 6 months
Q
Practice "safe" sex
Q
Stop breastfeeding
Get immediate evaluation of any illness
Youcan also call the Needlestick Hotline (National
Clinicians Postexposure Prophylaxis Hotline), which
is run by the Department of Health and Human
Services and which offers up-to-date, free advice in
an emergency: (888) 448-4911.
Bloodborne Pathogens
Contaminated Sharps
OSHA defines contaminated sharps as any contaminated
object that can penetrate the skin, including,
but not limited to, needles, scalpels, broken capillary
tubes, and exposed ends of dental wires diiii#'Z_.
Contaminated needles or other contaminated
sharps must not be bent, recapped, or removed unless
it can be demonstrated that no alternative is feasible
or that such action is required by a specific
medical procedure.
If a procedure requires shearing or breaking of
needles, this procedure must be specified in the company'
s exposure control plan. An acceptable means
of demonstrating that no alternative to bending, recapping,
or removing contaminated needles is feasible
or that such action is required by a specific medical
procedure would be a written justification (supported
by reliable evidence). This also needs to be included
as part of the exposure control plan. The justification
must state the basis for the determination that
no alternative is feasible or must specify that a particular
medical procedure requires, for example, the
bending of the needle and the use of forceps to accomplish
this.
Contaminated sharps.
Needle removal or recapping needles must be accomplished
through a one-handed technique or the
use of a mechanical device .131,,·rnilt0e:
1. Remove and recap needles through the use of
a mechanical device or one-handed technique
to prevent puncture wounds (Step 0).
2. Using one hand, gently slide the needle into
the needle cover (Step e).
3. Press the tip of the needle against the wall for
support. Apply gentle pressure to secure the
needle cover (Step e).
Nurses (RNs and LPNs) were injured more often
than any other type of health care worker. An overwhelming
majority (93%) of the injuries were caused
by needles that did not have a safe design. The needles
were not shielded, recessed, or retractable.
Reusable Sharps
Reusable sharps must be placed in clearly labeled,
puncture-resistant, leak-proof containers immediately
or as soon as possible after use until they can
be reprocessed. The containers for reusable sharps
are not required to be closable because it is anticipated
that containers used for collecting and holding
reusable sharps will be reused.
Reusable sharps, including pointed scissors that
have been contaminated, must be decontaminated
before reuse. Before cleaning, store the sharps in a
container with a wide opening, and encourage people
to use care in removing items.
Proper decontamination requires all visible blood
or OPIMs to be rinsed off. Large amounts of organic
debris interfere with the efficacy of the disinfecting!
sterilization process.
Use a mechanical means (forceps or tongs) to
remove contaminated sharps from containers; never
reach into any container containing contaminated
sharps with your hands. For example, employees
must not reach into sinks filled with soapy water
into which sharp instruments have been placed; appropriate
controls in such a circumstance would include
the use of strainer-type baskets to hold the
instruments and forceps to remove and immerse the
items tiLlili#a:.-..
#4
Chapter 3 Prevention
3-1 One-Handed Recapping Technique
\ Needle removal or recapping must be ac,,
1 complished through the use of a mechanical
device or one-handed technique to prevent
puncture wounds.
design performance elements for sharps disposal containers.
According to the standard, a sharps container
must meet four criteria to be considered acceptable.
It must be closable, puncture resistant, leakproof on
sides and bottom, and labeled or color coded in accordance
with the standard diiii#U.
A sharps container may be made of a variety of
products, including cardboard or plastic, as long as
the four criteria are met. Duct tape may be used to secure
a sharps container lid, but it is not acceptable if
it serves as the lid itself.
When it is necessary to examine the contents of a
container, pour the contents of the container out onto
a surface for inspection. An example is inspecting a bag
for illegal drugs that might contain a contaminated needle
or syringe. The intent is to provide conditions in
which the contents can be seen and safely handled.
Acceptable Sharps Containers
The Food and Drug Administration regulates sharps
disposal containers as Class II medical devices. OSHA's
bloodborne pathogens standard establishes minimum
Bloodborne Pathogens
Use forceps to remove sharp objects from a container.
Biohazard symbols must be fluorescent orange or
orange-red with letters or symbols in a contrasting
color. These are attached to any container that is used
to store or transport potentially infectious materials.
A sharps container must have a warning label affixed
to it. The standard requires that warning labels
"be affixed to containers of regulated waste, refrigerators
and freezers containing blood or other potentially
infectious material; and other containers used
to store, transport, or ship blood or other potentially
infectious materials."
FYI
Food and Drug Administration Classification
of Medical Devices
Class I devices (such as tongue depressors) are
subject only to general regulatory controls and
receive little agency oversight.
Class II devices (such as infant incubators) are
subject to special controls, such as performance
standards, to ensure their safe and effective use.
Class III devices (such as implantable pacemakers)
are generally life sustaining or life supporting
and are implanted in the body; they present
an unreasonable risk of illness of injury.
National Institute of Occupational Safety and
Health Criteria for Safety Performance of Sharps
Containers
1. Functionality: Containers should remain functional
during their entire use. They should be
durable, closable, leak resistant on their sides
and bottoms, and puncture resistant until final
disposal. A sufficient number of sharps disposal
containers should be provided. Individual
containers should have adequate volume and
safe access to the disposal opening.
2. Accessibility: Containers should be accessible
to workers who use, maintain, or dispose of
sharp devices. Containers should be conveniently
placed and (if necessary) portable
within the workplace.
3. Visibility: Containers should be plainly visible to
the workers who use them. Workers should be
able to see the degree to which the container is
full, proper warning labels, and color coding.
4. Accommodation: Container designs should be
accommodating or convenient for the user
and the facility, and they should be environmentally
sound (eg, free of heavy metals and
composed of recycled materials).
Accommodation also includes ease of storage
and assembly and simplicity of operation.
.!
Using Sharps Containers
Contaminated sharps must be discarded immediately
or as soon as feasible into an acceptable sharps container.
Sharps containers must be easily accessible
to personnel and located as close as feasible to the
immediate area where sharps are used or can be reasonably
anticipated to be found. Sharps containers
mounted onto walls should be 52 to 56 inches from
the floor.
Sharps containers must be maintained upright
throughout use, routinely replaced, and not overfilled.
The replacement schedule must be clearly outlined
in the exposure control plan. When contaminated
sharps are being moved from the area of use,
the container must be closed immediately before removal
or replacement to prevent spillage or protrusion
of contents during handling, storage, transport,
or shipping.
If leakage is possible or if the outside of the container
has become contaminated, the sharps container
must be placed in a secondary container that is closable
and constructed to contain all contents and prevent
leakage during handling, storage, transport, or
shipping.
Areas such as correctional facilities, psychiatric
units, or pediatric units may have difficulty placing
sharps containers in the immediate use area. If workers
in these units use a mobile cart to hold the sharps
container, it is necessary to lock the sharps container
to the cart.
Laundries that handle contaminated laundry must
have sharps containers easily accessible because of
the incidence of needles mixed with laundry.
Facilities that handle shipments of waste that may
contain contaminated sharps must also have sharps
containers easily accessible in the event a package accidentally
opens and releases sharps. All containers
must be appropriately labeled with the owner of the
container and their address.
The standard requires that reusable containers
(such as those used to transport contaminated sharps
for cleaning) not be opened, emptied, or cleaned manually
or in any other manner that would expose employees
to the risk of percutaneous injury. Finally, it
is important to remember that whatever goes into a
disposable sharps container stays in the sharps container.
At no time is anyone allowed to go into a disposable
sharps container. In many states, there are
significant fines for anyone who tries to or goes into
a disposable sharps container.
Chapter 3 Prevention
FYI
Needle Sheaths
A needle sheath of a self-sheathing needle is not
to be considered a "waste container." A selfsheathing
needle must be disposed of in a
sharps container.
~ Work Practice Controls
Work practice controls are the behaviors necessary
to use engineering controls effectively.These include,
but are not limited to, using sharps containers, using
an eye-wash station, and washing your hands after
removing PPE. An example of a work practice control
would be to immediately place contaminated
sharps into a sharps container.
All procedures involving blood or OPIMs must
be performed in a manner that minimizes or eliminates
splashing, spraying, splattering, and generation
of droplets of these substances. Not only does this
decrease the chances of direct exposure through spraying
or splashing of infectious materials onto you, but
it also reduces contamination of surfaces in the general
work area.
Work practice controls must be evaluated
and updated on a regular schedule to ensure their
effectiveness.
Mouth pipetting or suctioning of blood or OPIMs
is prohibited. This procedure should never occur unless
it is part of a specialized procedure such as Del.ee
suctioning; however, even then there must be a oneway
valve between the patient and the practitioner.
Eating, drinking, smoking, applying cosmetics
or lip balm, and handling contact lenses are prohibited
in work areas where there is a reasonable likelihood
of occupational exposure to blood or OPIMs.
Employees are permitted to eat and drink in an
ambulance cab, for example, as long as the employer
has implemented procedures to permit employees to
wash up and change contaminated clothing before
entering the ambulance cab and to ensure that patients
and contaminated material remain behind the
separating partition.
immediate area where sharps are used or can be reasonably
anticipated to be found. Sharps containers
mounted onto walls should be 52 to 56 inches from
the floor.
Sharps containers must be maintained upright
throughout use, routinely replaced, and not overfilled.
The replacement schedule must be clearly outlined
in the exposure control plan. When contaminated
sharps are being moved from the area of use,
the container must be closed immediately before removal
or replacement to prevent spillage or protrusion
of contents during handling, storage, transport,
or shipping.
If leakage is possible or if the outside of the container
has become contaminated, the sharps container
must be placed in a secondary container that is closable
and constructed to contain all contents and prevent
leakage during handling, storage, transport, or
shipping.
Areas such as correctional facilities, psychiatric
units, or pediatric units may have difficulty placing
sharps containers in the immediate use area. If workers
in these units use a mobile cart to hold the sharps
container, it is necessary to lock the sharps container
to the cart.
Laundries that handle contaminated laundry must
have sharps containers easily accessible because of
the incidence of needles mixed with laundry.
Facilities that handle shipments of waste that may
contain contaminated sharps must also have sharps
containers easily accessible in the event a package accidentally
opens and releases sharps. All containers
must be appropriately labeled with the owner of the
container and their address.
The standard requires that reusable containers
(such as those used to transport contaminated sharps
for cleaning) not be opened, emptied, or cleaned manually
or in any other manner that would expose employees
to the risk of percutaneous injury. Finally, it
is important to remember that whatever goes into a
disposable sharps container stays in the sharps container.
At no time is anyone allowed to go into a disposable
sharps container. In many states, there are
Significant fines for anyone who tries to or goes into
a disposable sharps container.
Chapter 3 Prevention
FYI
Needle Sheaths
A needle sheath of a self-sheathing needle is not
to be considered a "waste container." A selfsheathing
needle must be disposed of in a
sharps container.
~ Work Practice Controls
Work practice controls are the behaviors necessary
to use engineering controls effectively.These include,
but are not limited to, using sharps containers, using
an eye-wash station, and washing your hands after
removing PPE. An example of a work practice control
would be to immediately place contaminated
sharps into a sharps container.
All procedures involving blood or OPIMs must
be performed in a manner that minimizes or eliminates
splashing, spraying, splattering, and generation
of droplets of these substances. Not only does this
decrease the chances of direct exposure through spraying
or splashing of infectious materials onto you, but
it also reduces contamination of surfaces in the general
work area.
Work practice controls must be evaluated
and updated on a regular schedule to ensure their
effectiveness.
Mouth pipetting or suctioning of blood or OPIMs
is prohibited. This procedure should never occur unless
it is part of a specialized procedure such as Delee
suctioning; however, even then there must be a oneway
valve between the patient and the practitioner.
Eating, drinking, smoking, applying cosmetics
or lip balm, and handling contact lenses are prohibited
in work areas where there is a reasonable likelihood
of occupational exposure to blood or OPIMs.
Employees are permitted to eat and drink in an
ambulance cab, for example, as long as the employer
has implemented procedures to permit employees to
wash up and change contaminated clothing before
entering the ambulance cab and to ensure that patients
and contaminated material remain behind the
separating partition.
Bloodborne Pathogens
Hand cream is not considered a cosmetic and is
permitted under the standard; however, some petroleum-
based hand creams can adversely affect glove
integrity.
Food or drink must not be kept in refrigerators,
freezers, shelves, cabinets, countertops, or benches
where blood or OPIMs are present.
You must remove all PPE and wash your hands before
leaving the work area. To prevent contamination
of employee eating areas, you should not enter eating
or break areas while wearing PPE dll"#R-.
Handwashing and Handwashing Facilities
Handwashing is one of the most effective methods of
preventing transmission of blood borne pathogens. It
is required that you wash your hands after removal
of gloves and other PPE 011"#0:_.
Waterless Handwashlnq Systems
OSHA states that if there has been no occupational
exposure to or contact with blood or
OPIMs (as defined in the standard), the use of
alcohol-based swabs described in the CDC's
October 2002 guidelines would be appropriate.
Employers are required to provide handwashing
facilities that are readily accessible to all employees.
The standard specifies that the handwashing facility
must be situated so that you do not have to use stairs,
doorways, and corridors, which might result in environmental
surface contamination.
When the provision of handwashing facilities is
not feasible (such as in an ambulance or police car),
the employer must provide either an appropriate antiseptic
hand cleanser with clean cloth or paper towels
or antiseptic towelettes. If you use antiseptic hand
cleansers or towelettes, you must wash your hands
(or other affected area) with soap and warm water as
soon as possible after contact with blood or OPIMs
tiLii1i#D.
Employers must ensure you wash your hands,
and any other contaminated skin, with soap and at
least tepid running warm water (or flush mucous
membranes with water) as soon as possible after
Properly dispose of protective equipment in
biohazard containers.
Handwashing is a primary means of preventing
transmission of blood borne pathogens.
contact with blood or OPIMs. Groups that may need
to use alternative washing methods such as antiseptic
hand cleansers and towelettes are ambulance-based
EMTs, fire fighters, police, and mobile blood collection
personnel.
Handwashing is required after the removal of
gloves because although gloves (vinyl or latex) form
a barrier they are not completely impermeable.
Cleaning Work Surfaces
The term work area means the area where work involving
exposure or potential exposure to blood or
Antiseptic wipes can be used when hand washing is
not an option.
OPIMs exists, along with the potential contamination
of surfaces.
The term worhsite not only refers to permanent
fixed facilities such as hospitals, dental/medical offices,
or clinics, but also covers temporary nonfixed
workplaces. Examples of such facilities include, but
are not limited to, ambulances, bloodmobiles, temporary
blood collection centers, and any other nonfixed
worksites that have a reasonable possibility of
becoming contaminated with blood or OPIMs.
Your employer will identify which work surfaces
require inspection for contamination with blood or
OPIMs and have regularly scheduled decontamination.
This could include, but is not limited to, wastebaskets,
exam tables, counters, floors, ambulance
interiors, and police cars.
After a regular inspection and cleaning schedule
is established, it will need to be followed. The schedule
must consider location (exam room versus
Chapter 3 Prevention
Handwashlng and Cleaning Work Surfaces
There is no requirement for handwashing
upon leaving the work area unless contact
with blood or OPIMs has occurred or if you
have removed gloves or other PPE.
Employees must wash hands and skin surfaces
after the removal of gloves or other PPE.
Although extraordinary attempts to disinfect
or sterilize environmental surfaces such as
walls or floors are rarely indicated, routine
cleaning and removal of soil are required.
patient waiting area), type of surface (carpet versus
hard floor), type of soil present (gross contamination
versus minor splattering), and procedure and tasks
performed (laboratory analysis versus patient care).
The cleaning schedule must occur at least weekly or
after completion of tasks or procedures, after contamination
of surfaces, or at the end of a shift if there
is a possibility of contamination.
Proper Device Operation
Surgical power tools, lasers, and electrocautery
devices may generate aerosols as well as be a
source for splashing and spattering. Some of
these devices include labeling recommendations
such as local exhaust ventilation. Your employer
is responsible for ensuring appropriate operation
of these devices, including proper training
and use of the controls recommended by the
manufacturer.
Receptacles
All bins, pails, cans, and similar receptacles intended
for reuse that have a reasonable likelihood for becoming
contaminated with blood or OPIMs should
be inspected and decontaminated on a regularly
scheduled basis. These receptacles should be cleaned
and decontaminated immediately or as soon as feasible
upon visible contamination.
Bloodborne Pathogens
Protective Coverings
Protective coverings, such as plastic wrap, aluminum
foil, or imperviously backed absorbent paper used to
cover equipment and environmental surfaces, should
be removed and replaced as soon as feasible when
they become overtly contaminated or at the end of
the work shift if they may have become contaminated
during the shift.
Work Practices
Work surface decontamination should be performed
at the end of the work shift if the work surface may
have become contaminated since the last cleaning by,
for example, setting down contaminated instruments
or specimens on the work surface. This requirement
is based on the existence of a contaminated work surface
rather than a particular worksite location. It does
not, for example, encompass desks or countertops
that remain uncontaminated.
Where procedures are performed on a continual
basis throughout a shift or a day, as may be the case
with a clinical laboratory technician performing blood
analyses, it is not necessary for the work surface to
be decontaminated before the technician can proceed
to the next analysis. Rather, the contaminated work
surfaces must be decontaminated after the procedures
are completed (in this example, a set of analyses).
The completion of procedures might also occur when
the employee is going to leave the work area for a period
of time.
VI
Cleaning Grossly Contaminated Surfaces
Whenever there is obvious contamination of
a surface, first clean with a soap and water
solution to ensure that the disinfectant is
completely effective.
)
While cleaning up potentially infectious materials,
you must wear disposable medical exam gloves
and use an Environmental Protection Agencyapproved
solution. Follow the label instructions regarding
the amount of disinfectant and the length of
time it must remain wet on the surface. The effectiveness
of a disinfectant is governed by strict adherence
to the instructions on the label.
Cleansing Solutions
An example of an inexpensive approved solution is
10% bleach and water. Fresh solutions of diluted household
bleach made up daily (every 24 hours) are also
considered appropriate for disinfecting environmental
surfaces and for decontamination of sites following
initial cleanup of spills of blood or OPIMs. You
should use disposable towels to clean up the spill and
then dispose of the towels in a biohazard-labeled bag.
Do not clean up with your hands any broken glass
that may be contaminated. Instead, use a dustpan and
brush, cardboard, or tongs .''311 I.rollCo-", . The tools
used in cleanup (such as forceps) must be properly
decontaminated or discarded after use. Contaminated
broken glass must be placed in a biohazard sharps
container. Placing broken glass in a plastic bag may
put others at risk for an occupational exposure incident.
You must be given specific information and
training with respect to this task.
1. When cleaning up broken glass, wear gloves
and/or other PPE (step 0).
2, Do not clean up broken glass with your hands.
Instead use a dust pan and brush, cardboard,
or tongs (Step G).
3. Broken glass must be placed in an appropriate
sharps container. Placing broken glass in
plastic bag may put others at risk for exposure
(Steps
eand e).
FYI
Decontamination Issues
Decontamination is not automatically required
after each procedure, but is required after procedures
that result in surface contamination. There
may be some instances in which "immediate"
decontamination of overt contamination and spills
may not be practical. More stringent decontarnination
rules, such as cleaning equipment or changing
coverings between patients, may be prudent intection
control policy but do not fall under OSHA's
mandate to safeguard employee (not patient) health. )
• HBV is able to survive for at least a week in
dried blood on environmental surfaces or
contaminated instruments.
Vacuum cleaners are prohibited for the
cleaning of broken glass under the standard.
)
A
-
• Bloodborne Pathogens
Laundry
Contaminated laundry should be sent to a facility following
the OSHA standard. Your employer must determine
whether the facility to which laundry is shipped
uses universal precautions when handling all laundry:
If not, all bags or containers of contaminated laundry
must be labeled or color coded. Because red bags can
indicate materials for disposal, many agencies use yellow
bags with the biohazard symbol affixed to them to
avoid confusion. The biohazard symbol must be affixed
to any biohazard waste or contaminated materials such
as laundry:
Do not handle laundry any more than necessary.
Reducing the amount of manual handling of contaminated
laundry reduces the risk of exposure to blood
or OPIMs and will also reduce contamination of work
surfaces in the laundry area.
Contaminated laundry should be bagged or placed
in an approved container at the location where it was used
and should not be sorted or rinsed in the location of use.
Contaminated laundry should be placed and
transported in bags or containers labeled or color
coded in accordance with the standard. When a facility
uses universal precautions in the handling of
all soiled laundry, alternative labeling or color coding
is sufficient if it permits all employees to recognize
that universal precautions are required in
handling the containers Willi#Oi ••.
Whenever contaminated laundry is wet and presents
a reasonable likelihood of soaking through or
leaking from the bag or container, the laundry should
be placed and transported in bags or containers that
prevent soak-through and/or leakage of fluids to the
exterior.