Bloodborne Pathogens General Hazards OSHA Regulations Standard CFR
Bloodborne Pathogens • General Hazards • OSHA Regulations – Standard CFR 1910 1030 in 1982 to help workers avoid serious health dangers • Identifying Hazards • Protection Against Hazards • Safer Sharps • PPE • Safety Procedures • Housekeeping
Video – OSHA Bloodborne Pathogen Training – Double Click on the video to play
Bloodborne Pathogens (cont. ) General Hazards • Disease or Illness Causing Microorganisms • HIV/AIDS • HBV • HCV
General Hazards Bloodborne pathogens are microorganisms found in blood or other body fluids that can cause disease in people. One such pathogen is the human immunodeficiency virus (HIV), which causes AIDS, as you know, attacks the human immune system so it can't fight off disease. Even with some impressive advances in treatment, AIDS is usually a fatal illness. Other more common bloodborne pathogens are HBV and HCV, the Hepatitis B and C viruses. Both these illnesses affect the liver. Hepatitis C is the most chronic bloodborne infection in the U. S. People may not even know they have it because it develops slowly. Over time, however, it can lead to chronic liver disease. Pathogens that cause these and many other serious illnesses may be carried in blood or other potentially infectious materials. They include semen, vaginal secretions and cerebrospinal, synovial, pleural, pericardial, peritoneal and amniotic fluids. In situations where you really can't differentiate between body fluids, you have to assume they're potentially infectious. To prevent illness, you have to avoid having blood or other potentially infectious materials making contact with your skin, eyes or mucous membranes. Disease transmission can take the form of Among those who have to be aware of these risks and protections are health care workers who deal directly with patients as well as those who could handle or contact possibly contaminated health care equipment, patient laundry or perform housekeeping in areas that could be contaminated. Others at potential risk include lab workers, law enforcement and corrections personnel, mortuary personnel and those involved in emergency response. Because bloodborne pathogens cause such serious illnesses, it's valuable for everyone to be aware of the risks and the types of precautions needed to prevent exposure.
Bloodborne Pathogens (cont. ) OSHA Regulations OSHA takes a number of approaches to reducing the chance of bloodborne pathogen exposures and illnesses. For instance, employers covered by the standard have to: • Have a written Exposure Control Plan that, among other things, identifies job classifications and tasks with potential occupational exposures • Solicit input from non-managerial employees • Use engineering and work practice controls, including personal protective equipment (PPE) to eliminate or reduce employee exposure • Develop and follow written cleaning and decontamination schedules to reduce the chance of accidental exposures if in higher risk occupations • Offer free Hepatitis B vaccinations to employees likely to be exposed to the virus • Establish and maintain a sharps injury log • Use biohazard warning labels and signs on waste containers and other containers that could hold contaminated materials • Train employees with potential exposure to understand the hazards as well as the protective measures they must follow
Bloodborne Pathogens (cont. ) Identifying Hazards • Direct Contact Between Broken or Chapped Skin and Infected Body Fluids • Viruses (airborne and nonairborne) • Sexual Contact • Needles/Sharps
Bloodborne Pathogens (cont. ) Protection Against Hazards Universal precaution - First and foremost is a work practice known as universal precautions. Universal precautions means you treat all human blood and other potentially infectious materials as if they are infected. Some health care facilities practice standard precautions, which treat all body fluids and substances as infectious. • In addition, OSHA emphasizes the importance of washing your hands. Employers must provide accessible handwashing facilities. And employees must wash hands with soap and warm running water as soon as possible after contact with potentially infectious materials. • If fluids contact eyes or mucous membranes, flush with water promptly. • Also wash your hands thoroughly after you remove gloves or other PPE. You don't want to take a chance that anything permeated through the gloves. • In locations where soap and water can't be made available, use antiseptic hand cleaners and clean towels or antiseptic towelettes. Then be sure to wash with soap and water as soon as possible.
Safer Sharps - Bloodborne Pathogens (cont. ) Another way we can protect ourselves is to use engineering controls that eliminate or minimize the chance of exposure to pathogens. Needlestick injuries are the biggest cause of exposure and at least one large study found that most such injuries were caused by items that lacked a shielded, recessed or retractable needle. Recapping is also a continued cause of needlesticks, although it is prohibited by OSHA in almost all instances. Other needlestick injury hazards include: • Needle devices that must be taken apart or manipulated after use • Needles attached to a length of flexible tubing • Missing the target when transferring blood or other bloody fluids from a syringe to a specimen container • Failing to properly dispose of used needles Fortunately, there are more and more devices and procedures that can prevent needlesticks. Whenever possible, use needleless devices. Also look for safer needle devices that: • Provide a barrier between the hands and the needle after use • Allow or require hands to stay behind the needle at all times • Are an integral part of the device, rather than an accessory • Remain protective before disassembly and after disposal • Are easy to operate, requiring little or no training Among the safer devices that you may encounter are: • IV connectors that have no needle or protect the connector (e. g. , permanently recessing the IV connector needle in a rigid plastic housing that fits over the IV port) • Needles that retract into a syringe or vacuum tube holder • Sliding needle shields attached to disposable syringes and vacuum tube holders • Hinged or sliding shields attached to phlebotomy needles, winged-steel needles and blood gas needles • Protective encasements to receive an IV stylet as it is withdrawn from the catheter • Blunt suture needles • Capillary tubes that avoid breakage because they're made of plastic or are wrapped in puncture-resistant film or whose sealing method doesn't require pushing one end of the tube into putty to form a plug or that allow the blood hematocrit to be measured without centrifugation
Bloodborne Pathogens (cont. ) PPE - A crucial form of protection against bloodborne pathogens is personal protective equipment (PPE). Employers must provide and employees must use PPE to prevent blood or other body fluids from contacting skin, eyes, mucous membranes or street clothing. OSHA requires employers to provide PPE to employees at no cost, in appropriate sizes and in accessible locations. PPE usually begins with gloves. Wear them: • If you expect to handle or touch contaminated surfaces or items • If your hands might contact blood or other potentially infectious materials • To perform vascular access procedures Gloves have traditionally been made of natural rubber latex, which provides effective protection. Some people, however, are allergic to latex, so gloves should be available for them, too. By the way, the plastic film gloves used in food handling are NOT appropriate for this purpose. In addition to gloves, other PPE might include eye protection when there's a risk of splashes, surgical masks to protect mucous membranes , protective lab coats, surgical caps or other clothing. Be sure to wear gowns or a Hazmat suit with long sleeves for procedures likely to expose your arm to blood or other potentially infectious materials. Whatever PPE you use, inspect it before you use it to make sure it's not damaged and that it fits properly. Take these precautions so you don't spread contamination: • Don't wear contaminated clothing out of the work area. Suppose, for instance, your contaminated gloves or clothes touched a phone, pen, chair or surface. The next person to touch them would be contaminated without even knowing it or taking proper precautions. • Remove PPE so that the contaminated parts don't touch your skin or street clothes. • Place contaminated PPE in the proper containers for cleaning or disposal. Don't take it home or mix it with uncontaminated laundry!
Bloodborne Pathogens (cont. ) Safety Procedures • General Guidelines • Housekeeping
Safety Procedures Hand washing is, as we already mentioned, one of our most important bloodborne pathogens safety procedures. OSHA calls for other hygiene practices as well. Below are some other important hygiene practices – • Don't suction or pipette blood or other potentially infectious materials by mouth. • Minimize spraying, splashing, spattering and droplet generation in all procedures involving blood or other potentially infectious materials. Protect yourself and others and try not to contaminate surfaces in the work area. • Don't eat, drink, smoke, apply cosmetics or lip balm or handle contact lenses in work areas where they could be exposed to bloodborne pathogens. • Don't keep food or drinks where blood or other potentially infectious materials are present. That means refrigerators, cabinets, shelves, countertops, etc. A spill, spray or other contact could contaminate the food or beverage containers without your realizing it. When you touch the container, you risk exposure to the pathogens. By the way, you should always know where blood or other potentially infectious materials are kept. OSHA requires proper labels on refrigerators and freezers used to store these materials, as well as containers used to store, transport or ship blood, other potentially infectious materials and the waste they contaminate. A number of OSHA safety procedures are designed to prevent contact with contaminated sharps which, as we've mentioned, are the most common source of exposure. Always remember that you may not shear or break contaminated sharps. Bending, recapping or removing contaminated needles is also generally prohibited. About the only exceptions are those limited situations where the employer can prove that it's medically required. Even then, OSHA bans two-handed recapping; use a mechanical device or forceps. Once a needle or other sharp has been used, you must place it in an assigned, closable puncture-resistant leak-proof container for disposal. These containers are easy to spot. They're usually red, display the biohazard symbol, and sometimes also say "Biohazard. “ OSHA requires employers to have these containers as close as possible to locations where sharps are used. Even reusable sharps such as scalpels or saws must be placed in similar containers. The farther you have to carry a used sharp, the greater the chance for an accidental needlestick. In areas where security is an issue, OSHA suggests lockable containers, locking containers on to mobile carts or designs that prevent removal of syringes. There are other procedures to follow that can help you avoid getting stuck by a sharp – • Never reach by hand into a container of sharps. Use tongs or other equipment. • Don't place sharps directly into soapy water in a sink. Use strainer-type baskets to hold the items. When you have to remove them, use forceps rather than placing your hands in the water. • Keep sharps containers upright. • Take care to place used sharps in the disposal container so they don't stick out. • Never overfill a sharps container. Trying to force too many sharps in is a common cause of needlesticks. • Use tongs or a brush and pan, not your hands, to clean up broken glass. If the glass is or may be contaminated, don't use a vacuum cleaner for the cleanup, either. After picking up the glass, decontaminate or properly dispose of the tools used. • Use an automated cleaning system to clean reusable sharps containers. OSHA does not permit opening, emptying or cleaning those containers by hand.
Housekeeping Other safety procedures to prevent bloodborne pathogen exposure relate to housekeeping. OSHA requires employers to have a written schedule for cleaning and decontamination and to follow these practices: • Clean and decontaminate all equipment and environmental and working surfaces after they've had contact with blood or other potentially infectious materials. Be sure to clean up after completing any procedure that could contaminate a surface so the next person in the work area won't be exposed unwittingly. • Use protective coverings on equipment that would be difficult to decontaminate. Once they're contaminated or the procedure is done, remove the plastic wrap, aluminum foil or other covers. • Follow an inspection, cleaning and decontamination schedule for bins, pails and other containers you reuse. Clean them as soon as possible, of course, if they're visibly contaminated. Follow the rules when choosing the product you use for cleaning and decontamination. Diluted bleach solutions, made fresh daily, are sometimes used to decontaminate after spills are wiped up or cleaned with soap and water solution. Bleach may damage some medical instruments, however, so be sure you check before using it. Contaminated laundry is another source of potential exposure to bloodborne pathogens. OSHA tells us to: • Minimize handling of contaminated laundry. Wear gloves when you remove and bag it. • Bag contaminated laundry where it was used and sort and rinse it elsewhere. • Use identified color-coded bags to hold and transport contaminated laundry. • Using leak-proof bags for wet contaminated laundry. Other concerns arise when transporting blood or other potentially infectious materials or items contaminated by them. For example, OSHA requires closing the containers of used contaminated sharps before they're moved or replaced. If necessary, duct tape can be used to secure the lid, but can't be used as the lid itself. If there's a risk that a sharps container could leak, place it into a secondary closable leak-proof, properly identified container. Other waste, such as contaminated specimens, must also be transported in similar closed, leak-proof, properly identified containers. Check these containers carefully and place them in secondary containers if there's a chance of breakage or leaking. If, for instance, a bag containing contaminated waste breaks during transport or disposal, it could contaminate both the employees and the area with blood or other potentially infectious materials. Double bagging or similar protections are also called for if a container becomes contaminated on the outside—for instance, when handled by an employee with bloody gloves. Following all these precautions and keeping the risk of bloodborne pathogen exposure in mind at all times, should help prevent accidents from happening. However, there's always the chance of exposure, through a needlestick, splash or other accident. If that occurs, report it immediately. You're entitled to, and should take advantage of, a confidential medical evaluation and follow-up, including testing for bloodborne pathogens if you wish. Where possible, the person who is the source of blood or other potentially infectious material will be identified and tested and you'll be told of the results. The chance that you'll contract a bloodborne disease on the job is small. By taking proper precautions, you can minimize the risk even more.
In the unfortunate event that exposure does occur, employees are required to contact Human Resources immediately to facilitate the incident reporting process. Information will be collected to assist with a post-exposure evaluation to include a referral for a medical consultation including a blood test at no cost to the employee. All findings and diagnoses will remain confidential and excluded from the written report. Employees will be provided with as much information as possible as the law allows, should treatment be necessary.
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