Bloodborne Pathogens OSHA Bloodborne Pathogen Standard December 2018

Bloodborne Pathogens OSHA Bloodborne Pathogen Standard December 2018 | South Region EMS

OSHA Bloodborne Pathogen Standard

Description This lesson covers the requirements for annual bloodborne pathogens training as outlined by the Occupational Safety and Health Administration of the U. S. Department of Labor (OSHA). It is designed to prepare nurses to comply with OSHA’s Bloodborne Pathogens standard and the Centers for Disease Control and Prevention’s (CDC’s) guidelines regarding risks and precautions associated with exposure to blood and other potentially infectious materials (OPIM) within a health care setting.

Objectives Describe the employer requirements of OSHA’s Bloodborne Pathogens standard Explain the chain of infection as it applies to bloodborne diseases Identify the risk of exposure to blood and OPIM Discuss bloodborne diseases of concern to health care practitioners in the United States, including types, modes of transmission, prevention strategies, and exposure control • Identify how standard precautions protect against bloodborne pathogens • Describe the various personal protective equipment (PPE), work practices, and engineering controls that can reduce the risk of exposure to bloodborne pathogens • Explain procedures for reporting and follow-up after an exposure incident • •

OSHA’s Bloodborne Pathogens Standard • OSHA, part of the U. S. Department of Labor, first published the Bloodborne Pathogens standard in 1991 in Title 29 of Code of Federal Regulations 1910. 1030 • In 2015, OSHA revised the Bloodborne Pathogens standard in response to the Needlestick Safety and Prevention Act • The standard details what employers must do to protect workers whose jobs put them at risk for exposure to blood and OPIM

OSHA’s Bloodborne Pathogens Standard (cont. ) • Defines “blood” as: ◦ Human blood ◦ Components of human blood ◦ Products made from human blood • Covers other potentially infectious materials (OPIM)

OSHA’s Bloodborne Pathogens Standard (cont. ) • Requires employers to follow these steps • Establish a written exposure control plan • Update the exposure control plan annually • Implement the use of universal precautions • Identify and use engineering controls • Identify and ensure the use of work practice controls • Provide PPE

OSHA’s Bloodborne Pathogens Standard (cont. ) • • • Make hepatitis B vaccinations available to all workers at risk for occupational exposure Make available postexposure evaluation and follow-up to any occupationally exposed worker after an exposure incident Use labels and signs to communicate hazards Provide information and annual training to employees Maintain employee training and medical records, including a sharps injury log

Chain of Infection • • • The process of transmission of an infectious agent is called the chain of infection An infectious disease results from links that occur between an agent, a host, and the environment Transmission occurs when the infectious agent leaves the reservoir or host through a portal of exit, travels by some mode of transmission, and enters through a portal of entry to infect a susceptible host

Bloodborne Diseases of Concern in the United States • Bloodborne pathogens specifically addressed by the OSHA standard: ◦ Hepatitis B virus (HBV) ◦ Human immunodeficiency virus (HIV) ◦ Ebola virus (EVOB) • Other common bloodborne pathogens: ◦ Hepatitis C virus (HCV) ◦ Malaria ◦ Syphilis

Hepatitis B Virus • • • Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV) The illness can range in severity from mild to severe In the United States, approximately 2. 2 million people have chronic hepatitis B An estimated 19, 200 people became infected with HBV in 2014 The number of new cases of hepatitis B has decreased 82% since implementation of a routine HBV vaccination in 1991

Hepatitis C Virus • • Hepatitis C is a serious infection of the liver caused by the hepatitis C virus (HCV) An estimated 2. 7 to 3. 9 million people in the United States have chronic hepatitis C; most are unaware of their infection HCV infection is the most common bloodborne chronic infection in the United States HCV transmission to health care workers in the health care setting is low; however, it may occur with a large exposure to infected blood

Human Immunodeficiency Virus (HIV) • • • HIV attacks the body's immune system HIV causes acquired immunodeficiency syndrome (AIDS) AIDS can take many years to develop after infection with HIV AIDS is a fatal disease with no known cure The CDC estimates that more than 1. 2 million people are living with HIV in the United States

Ebola Virus (EBOV) • Ebola, also known as Ebola hemorrhagic fever, is a rare and deadly infection with one of the EBOV species • In 2014, the largest and most serious epidemic of EBOV occurred; the disease spread from Africa to other countries, including the United States

Modes of Transmission • • Bloodborne pathogens can be transmitted through contact with infected blood and OPIM Infectious blood and body fluids can enter through open sores, cuts, and abrasions; acne; any other damaged or broken skin; and mucous membranes Health care practitioners are at high risk for exposure to bloodborne pathogens due to routine exposure to blood and OPIM Transmission commonly occurs because of accidental puncture from contaminated needles and other sharps, contact between broken skin and infected body fluids, or contact between mucous membranes and infected body fluids

Prevention Strategies • Employers are required to develop and share an exposure control plan (ECP) • Employees should know where their facility’s ECP is located and what it includes

Exposure Control Plan (ECP) • The ECP should include information about: • People responsible for implementing the plan • Determination of employee exposure incidents • Communication of hazards to employees • Methods of exposure control • Hepatitis B vaccination programs • Postexposure evaluation and follow-up • Postexposure counseling • Training and recordkeeping

Universal Precautions • • Universal precautions is the term used to describe a prevention strategy in which all blood and OPIM are treated as if they are infectious, regardless of the perceived status of the source individual This approach is used in all situations in which exposure to blood or OPIM is possible

Standard Precautions • • Standard precautions refers to an infection control strategy to prevent transmission of infectious agents that is recommended for all patient care delivery settings Based on the concept that all blood, body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes may contain transmissible infectious agents Standard precautions include proper hand hygiene, use of appropriate PPE, and safe injection practices Application of standard precautions is determined by the type of care interaction anticipated

Personal Protective Equipment • Wearing PPE can significantly reduce health risks for employees exposed to blood and OPIM • Latex-free PPE must be made available on request

Types of PPE • • • • Gloves Utility gloves Gown Tyvek suit Face shield Goggles Mask (surgical) Head covering Booties Turnout gear Steel-toed shoes/boots Hard hats Body armor

Guidelines for PPE Use • • • The key principle for health care practitioners to remember when removing personal protective equipment is to avoid contact with blood, body fluids, secretions, excretions, and other contaminants When hands become contaminated, wash or decontaminate them as soon as possible Additional tips

Gloves: The First Defense • Wear gloves when contact with blood, OPIM, or contaminated surfaces is anticipated • Cover cuts and sores with a bandage or similar protection before donning gloves • Inspect gloves for tears and punctures before putting them on; don’t use a damaged glove • Follow careful procedure when taking off contaminated gloves; don’t touch the outside of the gloves to bare skin, and dispose of the gloves in a proper container

Safe Removal of PPE • • Using gloved hands, untie the gown string and remove shoe covers Remove gloves (fingers under cuff of second glove to avoid contact between skin and outside of gloves); discard appropriately Wash hands Remove gown without contaminating clothing underneath Touch only the inside of the gown during removal, and place in appropriate disposal bag Remove goggles, mask, and cap, and place in appropriate container Remove boots (if worn), and place in appropriate container Wash hands up to the wrists thoroughly

Work Practice Controls • Proper and timely hand washing • Minimizing splashing and spraying of any potentially infectious material • Properly decontaminating and sterilizing equipment and supplies • Providing for cleanup, care, and maintenance of supplies and equipment • Properly disposing of used supplies and equipment • Keeping all food and drink away from areas where blood or OPIM is present

Decontamination • Bloodborne pathogens: Use 10% household bleach solution, Lysol, or another EPA-approved label disinfectant • Blood or OPIM spill: o Wear protective gloves or other appropriate PPE for the task o Carefully cover the spill with rags or paper towels o Pour disinfectant solution over the rags or towels o Let it sit for 10 minutes o Discard the towels in appropriately labeled bags or containers

Hand Washing • Wet hands with water • Apply enough soap product to cover all hand surfaces • Rub hands palm to palm • Rub right palm over left dorsum with interlaced fingers, and vice versa • Rub palm to palm with fingers interlaced • Rub backs of fingers to opposing palms with fingers interlocked

Hand Washing (cont. ) • Rub left thumb rotationally while clasped in right palm, and vice versa • Rub clasped fingers of right hand rotationally in left palm, backward and forward, and vice versa • Rinse hands with tepid water • Dry hands thoroughly with a single-use towel • Use a clean towel to turn off the faucet

Engineering Controls Engineering controls isolate or remove bloodborne pathogens hazards from the workplace • Examples include: ◦ Sharps disposal containers ◦ Self-sheathing needles ◦ Safer medical devices, such as needleless systems •

Sharps Handling • Sharps are anything that can puncture the skin, including needles, blades, scissors, and broken glass • A needlestick or cut from a contaminated sharp can lead to infection from a bloodborne pathogen

Warning Labels • Warning labels need to be affixed to containers for sharps disposal, blood, and OPIM • Bags used to dispose of regulated waste must be red or orange-red and must have the biohazard symbol in a contrasting, visible color

Handling of Exposure Incidents • ◦ ◦ ◦ When exposure to blood or OPIM occurs, follow these steps: Wash needlesticks and cuts with soap and water Flush splashes to the nose, mouth, or skin with water If the eyes were involved in the exposure, irrigate them with clean water, saline, or sterile irrigation solution for 10 minutes Report the incident to a supervisor Immediately seek medical treatment

Post exposure Follow-Up • • Employers must provide a written report explaining how a bloodborne pathogen might have entered the health care worker’s body and a description of the risk caused by the exposure The employer must identify the source individual (the patient involved in the exposure), unless unknown or state or local law prohibits disclosure The health care worker’s blood must be collected and tested after consent has been given; all test records are confidential Medical care resulting from an exposure is provided by the employer at no charge to the health care worker

Summary • Protection of health care practitioners against bloodborne pathogens is of vital importance • Standard precautions, PPE, safe work practices, and environmental engineering can break the chain of infection, reduce the risk of exposure, and ensure a safe working environment

Resources • CDC’s National Healthcare Safety Network (NHSN) http: //www. cdc. gov/nhsn/ • CDC’s PEPline Occupational Exposures Poster http: //www. cdc. gov/niosh/topics/bbp/PEPline_poster. pdf • OSHA’s Bloodborne Pathogens Standard http: //www. osha. gov/pls/oshaweb/owadisp. show_document? p_tabl e=STANDARDS&p_id=10051