OSHA Bloodborne Pathogens Disclaimer The following slides cover

OSHA Bloodborne Pathogens

Disclaimer The following slides cover the basic components of the OSHA Bloodborne Pathogens Standard, 29 CFR 1910. 1030. These slides can be used as a reference for USC academic programs that provide bloodborne pathogens awareness training to their non-paid students. Additional guidance on bloodborne pathogens training for academic programs is posted on USC’s Biological Safety Training webpage. Academic programs that place students in work environments where the student may have an occupational exposure to bloodborne pathogens are responsible for providing training to these students. Bloodborne pathogens awareness training will be most effective if these slides are customized to apply to the workplace that the training will address. Each academic program should maintain training records for students upon completion of training.

I. Bloodborne Pathogen Diseases II. OSHA Bloodborne Pathogen Standard III. Exposure Control Plan IV. Recognition of Exposure Incident V. Engineering Controls and Work Practices VI. Personal Protective Equipment VII. Hepatitis B Vaccination VIII. Emergencies Involving Blood or OPIM IX. Procedure for Exposure Incidents X. Post-Exposure Evaluation and Follow-up XI. Housekeeping, Laundry, Signs and Labels XII. Recordkeeping XIII. Questions and Answers

OSHA Bloodborne Pathogens Training

Important Definition • Bloodborne Pathogens means pathogenic microorganisms that are present in human blood and can cause disease in humans. • These pathogens include, but are not limited to, HBV (hepatitis B virus), and HIV (human immunodeficiency virus).

Hepatitis B Virus • “Hepatitis” means inflammation of the liver. The liver is a vital organ. • Hepatitis B can be a serious liver disease from infection with the hepatitis B virus. – Acute Hepatitis B: short-term infection • Occurs within 6 months • Range in severity: no symptoms to serious condition • Many adults can clear the virus without treatment – Chronic Hepatitis B: lifelong HBV infection • ~5% of infected adults develop chronic HBV. • Chronic HBV can cause serious health problems

Hepatitis B Virus • Epidemiology – Many people don’t know they are infected. Rates of acute infection have declined ~82% since 1991. Estimated 850, 000 -2. 2 million people have chronic hepatitis B. • Symptoms – Many people have no symptoms. Possible symptoms include: fever, feeling tired, not wanting to eat, upset stomach, dark urine, grey stool, joint pain, and yellow skin and eyes. • Transmission – HBV virus is spread when blood or body fluids from an infected person enters the body of an uninfected person. – Percutaneous injury (e. g. needlestick or laceration)

Hepatitis C Virus • Epidemiology – For some people, HCV is a short-term illness but for 70%– 85% infected with HCV, it becomes a long-term infection. • Symptoms – Chronic Hepatitis C is a serious disease that can result in long-term health problems. Majority of infected persons may not be aware of their infection (not clinically ill). • Transmission – HCV is a blood-borne virus. Estimated risk for infection after needlestick or cut exposure to HCV-infected blood is ~1. 8% • There is no vaccine for Hepatitis C.

Human Immunodeficiency Virus • Epidemiology – In 2014, ~44, 073 people diagnosed with HIV. Annual new diagnoses declined 19% (2005– 2014). • Symptoms – Weakens a person’s immune system by destroying important cells that fight disease and infection. No effective cure, but with proper medical care, HIV can be controlled. • Transmission – Risk of workers exposed to HIV on the job is very low. Main risk of HIV transmission is being stuck with HIV-contaminated needle or other sharps. Estimated risk of HIV infection from being stuck with a needle used on an HIV-infected person is less than 1%.

OSHA Bloodborne Pathogens Training

Important Definitions • Blood means human blood, human blood components, and products from human blood. • Other Potentially Infectious Materials (OPIM): 1) Body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, any body fluid that is visibly contaminated with blood 2) Any unfixed human tissue or organ 3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing cultures or solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV

Important Definition • Universal Precautions means all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

Occupational Safety and Health Administration • OSHA’s Mission – save lives, prevent injuries and protect health of workers • BBP Standard – protects employees from exposure to blood or OPIM. – 29 CFR 1910. 1030 – Copy online at www. osha. gov

OSHA Bloodborne Pathogens Training

Important Definitions • Occupational Exposure means 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's duties. • Parenteral means piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions.

Exposure Control Plan (ECP) • ECP is provided to eliminate or minimize occupational exposure to bloodborne pathogens • ECP template available on Environmental Health and Safety website (ehs. sc. edu) on the Biological Safety page • Template must be tailored to be specific for your work area or department

ECP Contents v Determination of employee exposure v Implementation of exposure control methods § § Universal precautions Engineering and work practice controls Personal protective equipment Housekeeping v Hepatitis B vaccination v Post-exposure evaluation and follow-up v Procedures for evaluating exposure incidents v Communication of hazards and training v Recordkeeping

ECP Availability & Review • Written (site-specific) plan must be accessible to all employees • Employees must be provided a free copy within 15 days if requested • Must be reviewed and updated: – At least annually – More frequently if necessary to reflect new or modified tasks or positions that affect exposure

Exposure Determination • List of job classifications in which all or some employees at an institution have occupational exposure. – May include a list of tasks and procedures in which occupational exposure may occur • Part-time, temporary, contract and per diem employees are covered by the BBP standard.

Program Administration • Site-specific ECP should document who is responsible for the following duties: – Implementation of the ECP – Providing and maintaining PPE, engineering controls, labels and red bags – Ensuring all medical actions are performed, and employee health and OSHA records maintained – Training, documentation of training, and making the ECP available to employees • Employees must comply with procedures and work practices outlined in the ECP

OSHA Bloodborne Pathogens Training

Important Definitions • Engineering Controls means controls that isolate or remove the bloodborne pathogens hazard from the workplace. Work Practice Controls means controls that reduce the likelihood of exposure by altering the manner in which a task is performed.

Engineering Controls & Work Practice Controls • Used to prevent or minimize exposure to bloodborne pathogens • Specific controls described in ECP • Examine, maintain or replace engineering controls regularly to ensure effectiveness

Handwashing • Handwashing facilities readily accessible to employees • When not feasible, provide antiseptic hand cleaner with cloth/paper towels or antiseptic towelettes • Wash hands and other skin with soap and water or flush mucous membranes with water following contact with blood or OPIM

Contaminated Sharps • Contaminated needles or other sharps shall not be bent, recapped, or removed, unless the user can demonstrate no alternative is feasible or action is required by a procedure – Such activities must be approved by a safety professional and accomplished using a mechanical device or one-handed technique – Shearing or breaking needles is prohibited • Contaminated sharps shall immediately be placed in containers – containers shall be: – Puncture-resistant, labeled or color-coded, and leak-proof on sides and bottom

Work Practices & Procedures • Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where occupational exposure may occur • Food and drink not kept where blood or OPIM are present • Procedures involving blood or OPIM performed to minimize splashing, spraying, spattering, and droplets • Mouth pipetting/suctioning of blood or OPIM is prohibited

Containers & Equipment • Place specimens of blood or OPIM in a container that prevents leakage • If outside contamination of primary container, place it in second container that prevents leakage – Second container should be red or have biohazard label • If specimen could puncture primary container, place it in puncture-resistant secondary container • Examine equipment that may be contaminated prior to servicing or shipping

Engineering Controls & Work Practice Controls • Identify need for changes in controls • Evaluate new procedures/products • Involve front-line works and management in evaluation process

OSHA Bloodborne Pathogens Training

Important Definition • Personal Protective Equipment is specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes not intended to function as protection against a hazard are not considered to be personal protective equipment.

Personal Protective Equipment (PPE) • • Provided at no cost to employees Training in proper PPE for tasks ECP describes PPE available ECP describes location of PPE and who makes PPE available

Personal Protective Equipment (PPE) • Wash hands immediately after removing gloves or other PPE • Remove PPE when contaminated and before leaving work area • Remove in such a way as to avoid contact with the outer surface • ECP describes proper PPE disposal

PPE: Gloves • Wear gloves when there may be hand contact with blood or OPIM, and when touching contaminated items or surfaces • Replace gloves if torn, punctured or contaminated, or if compromised • Never wash or decontaminate disposable gloves for reuse

PPE: Utility Gloves, Face and Eye Protection • Utility gloves - may be decontaminated for reuse if not compromised; discard if signs of cracking, peeling, tearing, puncturing, or deterioration • Face and eye protection – wear when splashes, sprays, spatters, or droplets of blood or OPIM pose a hazard to eyes, nose, or mouth

OSHA Bloodborne Pathogens Training

Hepatitis B Vaccination • Efficacy – Safe & effective to prevent infection • Safety – No known serious side effects – Most have no side effects, but mild side effects can occur (e. g. low fever or sore arm from shot) • Method of administration – HBV vaccine given as 3 shot series over 6 months – Entire series needed for long-term protection • Benefits – HBV vaccine is the best protection

Hepatitis B Vaccination • HBV vaccine series is available at no cost after initial training and within 10 days of assignment to all employees with occupational exposure • Vaccination is encouraged unless: 1) Documentation employee previously received the series 2) Antibody testing reveals immunity 3) Medical evaluation shows contraindicated

Hepatitis B Vaccination • If an employee declines vaccination, they must sign a declination form • Employees who decline may request to be vaccinated at a later date at no cost • Documentation must be kept of refusal of vaccination (location defined in ECP)

Hepatitis B Vaccination • Location to be provided vaccination is defined in ECP (may vary by campus) – Columbia campus: Student Health Services – SOM campus: Family Medicine Clinic • Health care professional’s written opinion provided to employee within 15 days of completing the evaluation. – Limited to whether employee requires HBV vaccine and if vaccine was administered

OSHA Bloodborne Pathogens Training

Important Definition • Exposure Incident means 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.

Post-Exposure First Aid & Medical Evaluation • ECP describes who to contact if an exposure occurs • Follow initial first aid procedures – Clean wound, flush eyes, etc. • A confidential medical evaluation and follow-up will be conducted

Post-Exposure Evaluation & Follow-up • Document routes of exposure • Identify and document source individual • Obtain consent and make arrangements to have source individual tested to determine HIV, HCV & HBV infectivity – Convey test results to healthcare provider • No testing required if source is already known to be HIV, HCV or HBV positive

Post-Exposure Evaluation & Follow-up (continued) • Assure exposed employee is provided source individual’s test results • After consent, collect exposed employee’s blood – test HBV & HIV serological status • If employee does not give consent for HIV testing during initial blood collection, preserve baseline sample for at least 90 days – Perform testing if exposed employee elects to have sample tested during waiting period

Administration of Post-Exposure Evaluation & Follow-up • Healthcare professional(s) responsible for employee’s HBV vaccination & post-exposure evaluation are given copy of BBP standard • Health care professional evaluating an exposure incident receives the following: – Description of employee’s relevant job duties – Route(s) of exposure – Circumstances of exposure – If possible, results of source blood test – Relevant employee medical records (e. g. vaccinations) • Employee is provided copy of health care professional’s written opinion within 15 days

Procedures for Evaluating the Circumstances Surrounding an Exposure Incident • Circumstances of all exposure incidents will be reviewed to determine: – – – – Engineering controls used at the time Work practices followed Description of device used (type & brand) PPE or clothing used at time of exposure Location of incident Procedure performed when incident occurred Employee’s training • Percutaneous injuries from contaminated sharps will be recorded in Sharps Injury Log • If necessary, make revisions to the ECP

OSHA Bloodborne Pathogens Training

Housekeeping • Regulated waste is placed in closable containers constructed to contain contents – Labeled or color-coded & closed prior to removal • Contaminated sharps are discarded in closable, puncture-resistant, leak proof containers that are labeled or color-coded • Bins and pails are cleaned & decontaminated • Broken glassware is only picked up using a mechanical device

Laundry • ECP describes who does laundering • Laundering requirements must be met: – Handle contaminated laundry as little as possible – Place wet contaminated laundry in leakproof, labeled or color-coded containers before transport – ECP indicates appropriate PPE when handling/sorting contaminated laundry

Signs & Labels • Warning labels affixed to regulated waste containers, refrigerators and freezers containing blood or OPIM; and other containers used to store or transport blood or OPIM • Labels include biohazard symbol • Labels affixed close to container to prevent loss or unintentional removal • Red bags/containers may be substituted for labels • Exemptions to labeling requirements may apply – Blood released for transfusion, individual containers placed in labeled containers, regulated waste after decontamination

Signs and Labels • ECP includes the following: – Type of equipment to label & label type – Who is responsible for affixing labels or using red bags when appropriate – Who employees notify if they discover anything without proper labels

OSHA Bloodborne Pathogens Training

Training Records • Each employee is provided a training record at completion of training – Keep training records at least 3 years • Training records include: – – Dates of training sessions Contents or summary of training sessions Names & qualifications of training provider Names & job titles of persons attending training • Records provided upon request to employee or representative within 15 working days

Medical Records • Medical records maintained for each employee with occupational exposure • ECP indicates who maintains medical records and where records are kept for duration of employment plus 30 years • Employee medical records provided upon request within 15 working days – Written consent is required for records

Sharps Injury Log • Percutaneous injuries from contaminated sharps are recorded in Sharps Injury Log • Incidences must include at least: – – Date of injury Type & brand of device involved Work area where incident occurred Explanation of how incident occurred • Log is reviewed during annual program evaluation and maintained at least 5 years – Personal identifiers must be removed from

OSHA Bloodborne Pathogens Training