1. Bloodborne Pathogens

2. IntroductionIntroduction
 Approximately 5.6 million workers in health careApproximately 5.6 million workers in health care
and other facilities are at risk of exposure toand other facilities are at risk of exposure to
bloodborne pathogens such as humanbloodborne pathogens such as human
immunodeficiency virus (HIV – the virus thatimmunodeficiency virus (HIV – the virus that
causes AIDS), the hepatitis B virus (HBV), and thecauses AIDS), the hepatitis B virus (HBV), and the
hepatitis C virus (HCV)hepatitis C virus (HCV)
 OSHA’s Bloodborne Pathogens standard prescribesOSHA’s Bloodborne Pathogens standard prescribes
safeguards to protect workers against the healthsafeguards to protect workers against the health
hazards from exposure to blood and otherhazards from exposure to blood and other
potentially infectious materials, and to reduce theirpotentially infectious materials, and to reduce their
risk from this exposurerisk from this exposure

3. Who is covered by the standard?Who is covered by the standard?
 All employees who could beAll employees who could be
“reasonably anticipated” as the result“reasonably anticipated” as the result
of performing their job duties to faceof performing their job duties to face
contact with blood and other potentiallycontact with blood and other potentially
infectious materialsinfectious materials
 ““Good Samaritan” acts such asGood Samaritan” acts such as
assisting a co-worker with a nosebleedassisting a co-worker with a nosebleed
would not be considered occupationalwould not be considered occupational
exposureexposure

4. Some Workers Who are at RiskSome Workers Who are at Risk
 Physicians, nurses and emergency room personnelPhysicians, nurses and emergency room personnel
 Orderlies, housekeeping personnel, and laundry workersOrderlies, housekeeping personnel, and laundry workers
 Dentists and other dental workersDentists and other dental workers
 Laboratory and blood bank technologists and techniciansLaboratory and blood bank technologists and technicians
 Medical examinersMedical examiners
 MorticiansMorticians
 Law enforcement personnelLaw enforcement personnel
 FirefightersFirefighters
 Paramedics and emergency medical techniciansParamedics and emergency medical technicians
 Anyone providing first-response medical careAnyone providing first-response medical care
 Medical waste treatment employeesMedical waste treatment employees
 Home healthcare workersHome healthcare workers

5. How does exposure occur?How does exposure occur?
 Most common: needle sticksMost common: needle sticks
 Cuts from other contaminated sharpsCuts from other contaminated sharps
(scalpels, broken glass, etc.)(scalpels, broken glass, etc.)
 Contact of mucous membranes (forContact of mucous membranes (for
example, the eye, nose, mouth) orexample, the eye, nose, mouth) or
broken (cut or abraded) skin withbroken (cut or abraded) skin with
contaminated bloodcontaminated blood

6. Exposure Control PlanExposure Control Plan
 Identifies jobs and tasks where occupationalIdentifies jobs and tasks where occupational
exposure to blood or other potentiallyexposure to blood or other potentially
infectious material occursinfectious material occurs
 Describes how the employer will:Describes how the employer will:
• Use engineering and work practice controlsUse engineering and work practice controls
• Ensure use of personal protectiveEnsure use of personal protective
equipmentequipment
• Provide trainingProvide training
• Provide medical surveillanceProvide medical surveillance
• Provide hepatitis B vaccinationsProvide hepatitis B vaccinations
• Use signs and labelsUse signs and labels

7. Exposure Control PlanExposure Control Plan
 Written plan requiredWritten plan required
 Plan must be reviewed at least annually to reflectPlan must be reviewed at least annually to reflect
changes in:changes in:
• tasks, procedures, or assignments which affecttasks, procedures, or assignments which affect
exposure, andexposure, and
• technology that will eliminate or reduce exposuretechnology that will eliminate or reduce exposure
 Annual review must document employer’sAnnual review must document employer’s
consideration and implementation of safer medicalconsideration and implementation of safer medical
devicesdevices
 Must solicit input from potentially exposed employeesMust solicit input from potentially exposed employees
in the identification, evaluation and selection ofin the identification, evaluation and selection of
engineering and work practice controlsengineering and work practice controls
 Plan must be accessible to employeesPlan must be accessible to employees

8. Universal PrecautionsUniversal Precautions
 Treat all human blood and certain bodyTreat all human blood and certain body
fluids as if they are infectiousfluids as if they are infectious
 Must be observed in all situationsMust be observed in all situations
where there is a potential for contactwhere there is a potential for contact
with blood or other potentiallywith blood or other potentially
infectious materialsinfectious materials

9. Engineering and Work PracticeEngineering and Work Practice
ControlsControls
 These are the primary methods used toThese are the primary methods used to
control the transmission of HBV and HIVcontrol the transmission of HBV and HIV
 When occupational exposure remains afterWhen occupational exposure remains after
engineering and work practice controls areengineering and work practice controls are
put in place, personal protectiveput in place, personal protective
equipment (PPE) must be usedequipment (PPE) must be used

10. These controls reduce
employee exposure by
either removing the hazard
or isolating the worker.
Examples:
Engineering ControlsEngineering Controls
 Sharps disposal containersSharps disposal containers
 Self-sheathing needlesSelf-sheathing needles
 Safer medical devicesSafer medical devices
• Needleless systemsNeedleless systems
• Sharps with engineered sharps injurySharps with engineered sharps injury
protectionsprotections

11. Safer Medical DevicesSafer Medical Devices
 Needless Systems:Needless Systems: a device that does not usea device that does not use
needles for the collection or withdrawal of bodyneedles for the collection or withdrawal of body
fluids, or for the administration of medication orfluids, or for the administration of medication or
fluidsfluids
 Sharps with Engineered Sharps Injury Protections:Sharps with Engineered Sharps Injury Protections:
a non-needle sharp or a needle device used fora non-needle sharp or a needle device used for
withdrawing body fluids, accessing a vein or artery,withdrawing body fluids, accessing a vein or artery,
or administering medications or other fluids, with aor administering medications or other fluids, with a
built-in safety feature or mechanism thatbuilt-in safety feature or mechanism that
effectively reduces the risk of an exposure incidenteffectively reduces the risk of an exposure incident

12. Work Practice ControlsWork Practice Controls
 Wash hands afterWash hands after
removing gloves and asremoving gloves and as
soon as possible aftersoon as possible after
exposureexposure
 Do not bend or breakDo not bend or break
sharpssharps
 No food or smoking inNo food or smoking in
work areaswork areas
These controls reduce the
likelihood of exposure by
altering how a task is
performed. Examples:

13. Personal Protective EquipmentPersonal Protective Equipment
 Specialized clothing orSpecialized clothing or
equipment worn by anequipment worn by an
employee for protectionemployee for protection
against infectious materialsagainst infectious materials
 Must be properly cleaned,Must be properly cleaned,
laundered, repaired, andlaundered, repaired, and
disposed of at no cost todisposed of at no cost to
employeesemployees
 Must be removed whenMust be removed when
leaving area or uponleaving area or upon
contaminationcontamination

14. Examples of PPEExamples of PPE
 GlovesGloves
 GownsGowns
 Face shieldsFace shields
 Eye protectionEye protection
 Mouthpieces andMouthpieces and
resuscitationresuscitation
devicesdevices

15. HousekeepingHousekeeping
 Location within the facilityLocation within the facility
 Type of surface to be cleanedType of surface to be cleaned
 Type of soil presentType of soil present
 Tasks or procedures beingTasks or procedures being
performedperformed
Must develop a written schedule for cleaning and
decontamination at the work site based on the:

16. HousekeepingHousekeeping (cont’d)(cont’d)
 After completion ofAfter completion of
procedures,procedures,
 When surfaces areWhen surfaces are
contaminated, andcontaminated, and
 At the end of theAt the end of the
work shiftwork shift
Work surfaces must be
decontaminated with an
appropriate disinfectant:

17. Regulated WasteRegulated Waste
 Must be placed in closeable,
leak-proof containers built to
contain all contents during
handling, storing, transporting
or shipping and be
appropriately labeled or color-
coded.

18. LaundryLaundry
 Handle contaminatedHandle contaminated
laundry as little as possiblelaundry as little as possible
and use PPEand use PPE
 Must be bagged orMust be bagged or
containerized at locationcontainerized at location
where usedwhere used
 No sorting or rinsing atNo sorting or rinsing at
location where usedlocation where used
 Must be placed andMust be placed and
transported in labeled ortransported in labeled or
color-coded containerscolor-coded containers

19. Hepatitis B Vaccination RequirementsHepatitis B Vaccination Requirements
 Must make available, free of chargeMust make available, free of charge
at a reasonable time and place, to allat a reasonable time and place, to all
employees at risk of exposure withinemployees at risk of exposure within
10 working days of initial assignment10 working days of initial assignment
unless:unless:
• employee has had the vaccinationemployee has had the vaccination
• antibody testing reveals immunityantibody testing reveals immunity
 The vaccination must be performedThe vaccination must be performed
by a licensed healthcare professionalby a licensed healthcare professional

20. Hepatitis B Vaccination RequirementsHepatitis B Vaccination Requirements
(cont’d)(cont’d)
 Must be provided even if employee initiallyMust be provided even if employee initially
declines but later decides to accept thedeclines but later decides to accept the
vaccinationvaccination
 Employees who decline the vaccination must signEmployees who decline the vaccination must sign
a declination forma declination form
 Employees are not required to participate inEmployees are not required to participate in
antibody prescreening program to receiveantibody prescreening program to receive
vaccination seriesvaccination series
 Vaccination booster doses must be provided ifVaccination booster doses must be provided if
recommended by the U.S. Public Health Servicerecommended by the U.S. Public Health Service

21. What to do if an exposure occurs?What to do if an exposure occurs?
 Wash exposed area with soap and waterWash exposed area with soap and water
 Flush splashes to nose, mouth, or skinFlush splashes to nose, mouth, or skin
with waterwith water
 Irrigate eyes with water or salineIrrigate eyes with water or saline
 Report the exposureReport the exposure
 Direct the worker to a healthcareDirect the worker to a healthcare
professionalprofessional

22. Post-Exposure Follow-UpPost-Exposure Follow-Up
 Document routes of exposure and how exposureDocument routes of exposure and how exposure
occurredoccurred
 Record injuries from contaminated sharps in a sharpsRecord injuries from contaminated sharps in a sharps
injury log, if requiredinjury log, if required
 Obtain consent from the source individual and theObtain consent from the source individual and the
exposed employee and test blood as soon as possibleexposed employee and test blood as soon as possible
after the exposure incidentafter the exposure incident
 Provide risk counseling and offer post-exposureProvide risk counseling and offer post-exposure
protective treatment for disease when medicallyprotective treatment for disease when medically
indicated in accordance with current U.S. Publicindicated in accordance with current U.S. Public
Health Service guidelinesHealth Service guidelines
 Provide written opinion of findings to employer andProvide written opinion of findings to employer and
copy to employee within 15 days of the evaluationcopy to employee within 15 days of the evaluation

23. Biohazard Warning LabelsBiohazard Warning Labels
 Warning labels required on:Warning labels required on:
• Containers of regulatedContainers of regulated
wastewaste
• Refrigerators and freezersRefrigerators and freezers
containing blood andcontaining blood and
other potentiallyother potentially
infectious materialsinfectious materials
• Other containers used toOther containers used to
store, transport, or shipstore, transport, or ship
blood or other potentiallyblood or other potentially
infectious materialsinfectious materials
 Red bags or containers mayRed bags or containers may
be substituted for labelsbe substituted for labels

24. Training RequirementsTraining Requirements
 Provide at no cost to employeesProvide at no cost to employees
during working hoursduring working hours
 Provide at time of initialProvide at time of initial
assignment to a job withassignment to a job with
occupational exposure and at leastoccupational exposure and at least
annually thereafterannually thereafter
 Additional training needed whenAdditional training needed when
existing tasks are modified or newexisting tasks are modified or new
tasks are required which affect thetasks are required which affect the
worker’s occupational exposureworker’s occupational exposure
 Maintain training records for 3Maintain training records for 3
yearsyears

25. Training ElementsTraining Elements
 Copy of the standardCopy of the standard
 Modes of transmissionModes of transmission
 Site-specific exposure control planSite-specific exposure control plan
 Hazard recognitionHazard recognition
 Use of engineering controls, workUse of engineering controls, work
practices and PPEpractices and PPE
 Live question and answer sessionsLive question and answer sessions

26. Medical Recordkeeping RequirementsMedical Recordkeeping Requirements
 Employee’s name and social security numberEmployee’s name and social security number
 Employee’s hepatitis B vaccination statusEmployee’s hepatitis B vaccination status
 Results of examinations, medical testing, and post-Results of examinations, medical testing, and post-
exposure evaluation and follow-up proceduresexposure evaluation and follow-up procedures
 Health care professional’s written opinionHealth care professional’s written opinion
 Information provided to the health care professionalInformation provided to the health care professional
 Employee medical records must be kept confidentialEmployee medical records must be kept confidential
and not disclosed or reported without the employee’sand not disclosed or reported without the employee’s
written consent (unless required by law)written consent (unless required by law)
 Medical records must be maintained for duration ofMedical records must be maintained for duration of
employment plus 30 years according to OSHA’s ruleemployment plus 30 years according to OSHA’s rule
governing access to employee exposure and medicalgoverning access to employee exposure and medical
recordsrecords

27. Sharps Injury LogSharps Injury Log
 Employers must maintain a sharps injury logEmployers must maintain a sharps injury log
for the recording of injuries from contaminatedfor the recording of injuries from contaminated
sharpssharps
 The log must be maintained in a way thatThe log must be maintained in a way that
ensures employee privacy and must contain, atensures employee privacy and must contain, at
a minimum:a minimum:
• Type and brand of device involved in theType and brand of device involved in the
incidentincident
• Location of the incidentLocation of the incident
• Description of the incidentDescription of the incident

28. SummarySummary
 OSHA’s Bloodborne Pathogens standardOSHA’s Bloodborne Pathogens standard
prescribes safeguards to protect workersprescribes safeguards to protect workers
against the health hazards from exposure toagainst the health hazards from exposure to
blood and other potentially infectiousblood and other potentially infectious
materials, and to reduce their risk from thismaterials, and to reduce their risk from this
exposureexposure
 Implementation of this standard not only willImplementation of this standard not only will
prevent hepatitis B cases, but also willprevent hepatitis B cases, but also will
significantly reduce the risk of workerssignificantly reduce the risk of workers
contracting AIDS, Hepatitis C, or othercontracting AIDS, Hepatitis C, or other
bloodborne diseasesbloodborne diseases