1	BLOODBORNE PATHOGENS OSHA 29 CFR 1910.1030
2	BLOODBORNE PATHOGENS Credits This program was developed using information and resources available on websites from the following agencies: Occupational Safety & Health Administration Center for Disease Control & Prevention National Institute of Occupational Safety & Health
3	Introduction Per OSHA, there are approximately 5.6 million workers in health care and other facilities are at risk of exposure to blood borne pathogens such as human immunodeficiency virus (HIV – the virus that causes AIDS), the hepatitis B virus (HBV), and the hepatitis C virus (HCV) OSHA’s Bloodborne Pathogens standard prescribes safeguards to protect workers against the health hazards from exposure to blood and other potentially infectious materials, and to reduce their risk from this exposure
4	Who is covered by the standard? All employees who could be “reasonably anticipated” as the result of performing their job duties to face contact with blood and other potentially infectious materials “Good Samaritan” acts such as assisting a co-worker with a nosebleed would not be considered occupational exposure
5	Some Workers Who are at Risk Physicians, nurses and emergency room personnel Orderlies, housekeeping personnel, and laundry workers Dentists and other dental workers Laboratory and blood bank technologists and technicians Medical examiners & Morticians Law enforcement personnel Firefighters, Paramedics and EMT’s Anyone providing first-response medical care Medical waste treatment employees Home healthcare workers
6	Blood-Borne Pathogens (BBP’s) Pathogenic micro- organisms present in human blood that can lead to diseases Examples: Human immuno- deficiency virus (HIV) Hepatitis B (HBV) Hepatitis C (HCV)
7	Human immuno-deficiency virus (HIV) HIV is the virus that leads to AIDS HIV depletes the immune system HIV does not survive well outside the body HIV is found in very low quantities in saliva and tears in some AIDS patients. HIV has not been found in the sweat of HIV-infected persons. Contact with saliva, tears, or sweat has never been shown to result in the transmission of HIV.
8	Hepatitis B Virus (HBV) 1–1.25 million Americans are chronically infected Symptoms include: jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea, vomiting May lead to chronic liver disease, liver cancer, and death Vaccination available since 1982 HBV can survive for at least one week in dried blood
9	Hepatitis C Virus (HCV) An estimated 3.9 million Americans have been infected with HCV of whom 2.7 million are chronically infected. Persons chronically infected with HCV may not be aware of it because they are not clinically ill. Sometimes it can take two decades before symptoms are recognized. Chronic liver disease occurs in approximately 70 percent of infected persons. 8,000–10,000 deaths occur each year as a result of the chronic liver disease. There are some drugs that have been licensed for treatment of HCV; however, they are only effective in 10–40 percent of persons.
10	Potentially Infectious Bodily Fluids Blood Saliva, vomit, urine Semen or vaginal secretions Skin, tissue, cell cultures Other bodily fluids
11	Potential Transmission Contact with another person’s blood or bodily fluid that may contain blood Mucous membranes: eyes, mouth, nose Non-intact skin Contaminated sharps/needles
12	Potential Exposure Industrial accident Administering first aid Postaccident cleanup Janitorial or Maintenance work Health care Lab work with Blood
13	How does exposure occur? Most common: needle sticks (600-800 K /yr) Cuts from other contaminated sharps (scalpels, broken glass, etc.) Contact of mucous membranes (for example, the eye, nose, mouth) or broken (cut or abraded) skin with contaminated blood
14	Exposure Control Plan (ECP) Potential exposure determination Safe work practices Decontaminating equipment Selecting and using PPE Handling biowaste Labels and signs Training requirements Recordkeeping requirements
15	Exposure Control Plan (ECP) Review and update annually Reflect changes in technology Document use of safer medical devices Ask employees for their input
16	Who Must Be Trained All employees with occupational exposure to blood or other potentially infectious material (OPIM) Employees who are trained in first aid and CPR
17	Training Requirements Provide at no cost to employees during working hours Provide at time of initial assignment to a job with occupational exposure and at least annually thereafter Additional training needed when existing tasks are modified or new tasks are required which affect the worker’s occupational exposure Maintain training records for 3 years
18	Training Elements Copy of the standard Modes of transmission Site-specific exposure control plan Hazard recognition Use of engineering controls, work practices and PPE Live question and answer sessions
19	Universal Precautions Treat all blood and bodily fluids as if they are contaminated Proper cleanup and decontamination
20	Engineering and Work Practice Controls These are the primary methods used to control the transmission of HBV and HIV When occupational exposure remains after engineering and work practice controls are put in place, personal protective equipment (PPE) must be used
21	Engineering Controls Sharps disposal containers Self-sheathing needles Safer medical devices Needle-less systems Sharps with engineered sharps injury protections
22	Safer Medical Devices Needless Systems: a device that does not use needles for the collection or withdrawal of body fluids, or for the administration of medication or fluids Sharps with Engineered Sharps Injury Protections: a non-needle sharp or a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident
23	Work Practice Controls Wash hands after removing gloves and as soon as possible after exposure Do not bend or break sharps No food or smoking in work areas
24	Personal Protective Equipment (PPE) Specialized clothing or equipment worn by an employee for protection against infectious materials Must be properly cleaned, laundered, repaired, and disposed of at no cost to employees Must be removed when leaving area or upon contamination
25	Examples of PPE Gloves Gowns Face shields Eye protection Mouthpieces and resuscitation devices
26	Selecting PPE Bleeding control—latex gloves Spurting blood—latex gloves, protective clothing (smocks or aprons), respiratory mask, eye/face protection (goggles, glasses, or face shield) Postaccident cleanup— latex gloves Janitorial work—latex gloves
27	Decontamination Wear protective gloves Disinfectant/cleaner provided in bodily fluid disposal kit Solution of ¹/₄ cup bleach per gallon of water Properly dispose of contaminated PPE, towels, rags
28	Safe Work Practices Remove contaminated PPE or clothing as soon as possible Clean and disinfect contaminated equipment and work surfaces as soon as possible Thoroughly wash up immediately after exposure Properly dispose of contaminated items
29	Regulated Medical Waste Liquid or semiliquid blood or OPIM Contaminated items that would release blood or OPIM when compressed Contaminated sharps Pathological and microbiological waste containing blood or OPIM
30	Labels and Signs Labels must include the universal biohazard symbol, and the term “Biohazard” must be attached to: containers of regulated biohazard waste refrigerators or freezers containing blood or OPIM containers used to store, transport, or ship blood or OPIM
31	HBV Vaccination Strongly endorsed by medical communities Shown to be safe for infants, children, and adults Must be offered to all employees with occupational exposure Must be provided at no cost to employees Employee must sign a declination form if they choose not to take the vaccination
32	Exposure Incident A specific incident of contact with potentially infectious bodily fluid If there are no infiltrations of mucous membranes or open skin surfaces, it is not considered an occupational exposure Report all accidents involving blood or bodily fluids Postexposure medical evaluations are offered
33	What to do if an exposure occurs? Wash exposed area with soap and water Flush splashes to nose, mouth, or skin with water Irrigate eyes with water or saline Report the exposure Direct the worker to a healthcare professional
34	Postexposure Evaluation Confidential medical evaluation Document route of exposure Identify source individual Test source individual’s blood (with individual’s consent) Provide results to exposed employee Exposed employee may need post-exposure prophylaxis if determined by physician
35	Recordkeeping Records include: Sharps Injury Log OSHA 300 Log Medical records Training records
36	Summary Universal precautions PPE and safe work practices Decontamination Exposure incident
37	Could You Be Exposed to BBP’s at KU? Administering first aid? Cleaning the restrooms? Using a tool covered with dried blood? A co-worker sneezes on you?
38	KU BBP Program KU University Safety & Health Manual Blood Borne Pathogens covered in Section 6 – pages 11-13 www.ehs.ku.edu
39	KU BBP Program Assignment of all KU employees to one (1) of three (3) categories for potential exposure: Category I, II or III. A Category I employee performs tasks that involve exposure to blood, body fluids or tissue. A Category II employee normally performs tasks that do not involve exposure to blood, body fluids or tissue; however, their work may require the unplanned performance of such tasks. A Category III employee does not perform tasks that require contact with blood, body fluids or tissue.
40	KU BBP Program Methods of Potential Transmission. Both HBV and HIV can be transmitted by the following body fluids, including: Blood, Semen,Vaginal Secretions, Saliva (HBV only if blood is visible), Vomitus (HBV only if blood is visible), * Protection may be required by certain departments. Transmission occurs when any of these body fluids comes in contact with a mucous membrane (eyes, mouth, nose or genitals) or non-intact skin. Transmission can also occur through punctures by sharp objects such as needles, broken glass, etc., which have any of the above listed body fluids on them. Despite similarities in modes of transmission, the risk of HBV infection far exceeds that for HIV infection.
41	KU BBP Program Methods of Protection. Category I employees will receive the series of HBV immunizations. The shots will be given at Watkins Health Center. Category I employees and Category II employees who could come in contact with blood or body fluids must be provided with and utilize barrier protection equipment that is appropriate to work tasks performed (SOP's). This protection may include disposable latex or reusable rubber gloves, disposable gowns, disposable face masks, or foot protection. Face masks and gowns should be worn, particularly, if there is the potential for splattering or splashing of blood or body fluid. Wash hands thoroughly and frequently.
42	KU BBP Program Actions To Take When a Person is Exposed To Blood or Body Fluids In The Performance of Work Tasks. Stop what you are doing. Remove contaminated clothing (disposable or otherwise) immediately. Non-disposable clothing should be placed in an approved bag and laundered (at university expense). Disposable clothing should be placed in an approved bag or container for disposal. Disposal suits will be provided for temporary use if an employee's regular clothing should become contaminated. Wash the exposed skin area for two minutes with soap and water. If water is not immediately available, you may use hand cleaner, towelettes, etc. Then, when water is available, wash hands thoroughly. Report the incident to your supervisor. Any employee who has been exposed to blood or body fluids or suffers a wound as a result of contact with a sharp object or equipment that is contaminated should go to the LMH Occupational Health Clinic or Emergency Room for treatment immediately (WITHIN TWENTY-FOUR (24) HOURS). The treatment may include the necessity to start the series of HBV inoculations.
43	KU BBP Program Action to Take With Contaminated Materials, Equipment or Disposable Clothing. All contaminated materials, including sanitary napkins and tampons, equipment or disposable clothing must be placed in approved, marked bags or containers for proper disposal. Sharp objects, including needles, glassware, etc., must be placed in containers that will prevent injury to employees who are removing such material for disposal. If necessary, items, particularly those involving liquids, may need to be placed in double bags to reduce the possibility of leakage. Use appropriate barrier protection when handling contaminated materials. Spills should be cleaned using ten (10) percent chlorox solution or EPA approved* disinfectant (you would not want to use chlorox solution on carpet, upholstered furniture, etc.) If maintenanceand service employees or non-laboratory personnel find blood or fluid contaminated materials, sharps (glass, syringes, etc.) in the trash or room, leave it alone. Contact laboratory personnel to have it removed. If laboratory personnel are not available or chose not to remove contaminated materials, contact the Environment, Health and Safety Dept. (EHS) at 864-4089.
44	KU BBP Program Exposure Reporting Supervisors must also take prompt action to deal with their employees exposure to bloodborne pathogens. If barrier protection equipment and other precautions do not prevent direct contact with blood or body fluids, as listed above, the supervisor must ensure the employee goes to LMH as described previously. Contact with vomitus or body fluids that do not contain visible blood does not require treatment at LMH. Wash the exposed area thoroughly and remove contaminated barrier protection equipment or clothing (and launder) as a precaution. Lawrence Memorial Hospital will conduct post exposure evaluation & counseling. Exposure must also be reported to Human Resources as quickly as possible. Exposure to bloodborne pathogens that results in medical treatment necessitates handling this situationjust as you would any other occupational injury or illness. Contact HR and complete an accident report (1101a) form.
45	KU BBP Program Supervisor Responsibilities Supervisors of classified, unclassified and student employees are responsible for ensuring their employees receive the necessary training in the bloodborne pathogen handling requirements. Supervisors must enforce compliance by their employees with established standard operating procedures (work tasks) as they involve contact or the potential for contact with blood or body fluids, sharp objects or other contaminated equipment, management of contaminated clothing, use of barrier protective equipment, and the management of spills, leakage, etc. Supervisors must provide appropriate barrier protection equipment and enforce the use of such equipment according to SOP's. Disposable replacement clothing must be readily available, particularly in areas where there is a risk of contamination and regular clothing must be removed if contamination occurs. Supervisors are responsible for documenting any training that is provided related to bloodborne pathogen procedures. A record of such training must be kept in the departmental office and copies to Human Resources. Likewise, training conducted centrally by EHS, HR or other providers will be recorded with copies to the department.
46	KU BBP Program Employee Responsibilities Employees must adhere to bloodborne pathogen program requirements at all times. Employees must: Wear necessary barrier protective equipment, Follow prescribed disposal procedures, Report any possible or actual exposure to your supervisor immediately and Erequest appropriate medical treatment (go to LMH within 24 hours). Report exposure to HR.
47	KU BBP Program List of Disinfectants For questions or information regarding approved disinfectants contact KU-EHS Dept. at 864-4089.
48	The End You have now completed your general KU blood-borne pathogen training. You should now meet with your supervisor to go over BBP information specific to your unit and the job you are expected to perform. If you have any questions regarding BBP do not hesitate to discuss with your supervisor and/or EHS. Please Make a Choice: Return to KU-EHS Training Page Return to KU-EHS Home Page