OSHA’s Bloodborne Pathogens StandardOSHA’s Bloodborne Pathogens Standard

Bonnie DiSalvo, MS

ASHMUSDA/ARS/NAA

BLOODBORNE PATHOGENS

Pathogenic organisms that are present in human blood and can cause disease in humans. These include, but are not limited to: Hepatitis B Virus (HBV), HCV and Human Immunodeficiency Virus (HIV)

““Occupational Exposed Worker”Occupational Exposed Worker”

“Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious material that may result from the performance of employee duties.”

““Occupational Exposed Worker”Occupational Exposed Worker”

“Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious material that may result from the performance of employee duties.”

OTHER POTENTIALLY INFECTIOUS MATERIAL (OPIM for

short)

• Saliva in dental procedures• Any body fluid visibly

contaminated with blood• All body fluids in situations where

it is difficult or impossible to differentiate between body fluids

Standard Requirements

• Written Exposure Control Plan

• Universal Precautions

• Engineering and work practice controls

Standard Requirements (con’t)

• Basic housekeeping

• Medical prevention plan

• Training

• Labeling requirements and record keeping

• PPE

EXPOSURE CONTROL PLAN1910.1030(c)

• Employee exposure determination• The schedule and method of implementing

paragraphs (d) to (h) of the standard• The procedures for evaluating

circumstances surrounding an exposure incident

To eliminate or minimize employee exposure, the employer shall develop a written Exposure Control Plan that contains

EXPOSURE CONTROL PLAN• Reviewed and

updated annually• Reflect changes in

technology that would reduce or eliminate exposure

• Document consideration of devices

EXPOSURE CONTROL PLAN• Solicit input from

non-managerial employees– Identification–Evaluation–Selection

• Effective engineering and work practice controls

• Document (c)(1)(v)

The Written ECP Should* Include:

• Use of universal precautions• Engineering and work practice controls• PPE• Medical evaluations and vaccinations• Training

*These elements are required by the standard, but not necessarily in the ECP

November 2000 Law Requires

• Sharps Injury Log

• Documented non-managerial employee input on safer medical devices

• Documented evaluation and implementation of “safer medical devices” at least annually

UNIVERSAL PRECAUTIONS

An approach to infection control. According to the concept of Universal Precautions, all human blood and body fluids are treated as if known to be infectious for HIV, HBV, HCV and other bloodborne pathogens.

Universal/Standard Precautions:

This includes cell or tissue culture, culture medium, solutions or tissues from humans, experimental animals infected with HIV/HBV/HCV

For our research facilities, blood and tissue products are treated under the standard

Universal/Standard Precautions:

This includes cell or tissue culture, culture medium, solutions or tissues from humans, experimental animals infected with HIV/HBV/HCV

For our research facilities, blood and tissue products are treated under the standard

ENGINEERING CONTROLS

• Controls that isolate or remove the hazard from the workplace

• Examples:–Sharps disposal containers, self-

sheathing needles, safer medical devices, such as sharps with engineered sharps injury protection and needle-less systems

1910.1030(d)(2)(i) ENGINEERING CONTROLS AND WORK

PRACTICES• Engineering and work practice controls

to be instituted as the PRIMARY means of eliminating or minimizing exposure.–The employer MUST use engineering

and work practice controls to eliminate exposure or reduce it to the lowest feasible extent.

1910.1030(d)(2)(i) ENGINEERING CONTROLS AND WORK

PRACTICES

The employer should be using or at least have considered, and documented in the exposure control plan why he/she CANNOT use engineering and work practice controls for work operations involving exposure to blood or OPIM.

(d) Work Practices:

Hand washing Personal hygiene Personal attire Not wearing personal protective equipment

(PPE) out of the work area Changing PPE when contaminated Decontaminating/cleaning regularly & after

spills

(d) Work Practices:

Hand washing Personal hygiene Personal attire Not wearing personal protective equipment

(PPE) out of the work area Changing PPE when contaminated Decontaminating/cleaning regularly & after

spills

Work Practice ControlsWork Practice Controls

Sharps Disposal Containers

• Must be labeled or color-coded, puncture resistant, leak-proof, and close-able

• Should have well marked fill line, be translucent or have translucent lid

Classified as medical device (SMDA)

Sharps Disposal Containers

• Establish collection schedules

• Provide placement of containers

• Review disposal procedures

NEEDLE SHIELDS THAT CONTAIN THE HAZARD

Attached to syringe needle

Attached to holder

Attached to needle

Housekeeping Written schedule for cleaning

and decontaminating Documented eye wash checks Material decontamination before

exit from lab Removal of PPE from lab is

prohibited Home laundering of PPE is

prohibited Segregated waste

Housekeeping Written schedule for cleaning

and decontaminating Documented eye wash checks Material decontamination before

exit from lab Removal of PPE from lab is

prohibited Home laundering of PPE is

prohibited Segregated waste

Medical Prevention Plan

(f) Vaccination, Post-Exposure Follow-up Hepatitis B vaccine made available to all

workers with potential risk of exposure Offered within 10 days of employment No cost to worker “Declination” signed if employee

declines vaccine; may accept at a later date

Medical Prevention Plan

(f) Vaccination, Post-Exposure Follow-up Hepatitis B vaccine made available to all

workers with potential risk of exposure Offered within 10 days of employment No cost to worker “Declination” signed if employee

declines vaccine; may accept at a later date

(f) Vaccination, Post-Exposure Follow-up Report the incident immediately

Inform supervisor Go to clinic/medical services provider

Confidential medical evaluation Route of exposure Circumstances of the incident Source known

Important to start drug therapy within 2 hours Testing of victim/source only with consent

(baseline blood stored for 90 days)

(f) Vaccination, Post-Exposure Follow-up Report the incident immediately

Inform supervisor Go to clinic/medical services provider

Confidential medical evaluation Route of exposure Circumstances of the incident Source known

Important to start drug therapy within 2 hours Testing of victim/source only with consent

(baseline blood stored for 90 days)

Medical Prevention PlanMedical Prevention Plan

Decontamination

• What needs to be?

• What does not need to be?

• Create a schedule

• Requirements for medical equipment

• EPA disinfectants, 1:10 dilutions bleach, 2% glutaraldehyde

1910.1030(d)(3) PERSONAL PROTECTIVE EQUIPMENT

• (d)(3)(i) - PPE must be provided at NO COST to the employee

• (d)(3)(ii) This paragraph addresses that PPE must be used properly per training received

• (d)(3)(iii) - discusses provisions of appropriate PPE, including hypoallergenic gloves as readily available alternative to latex

Personal Protective Equipment (PPE)

• Appropriate PPE– Testing standards

• ASTM ES 21 and ES 22

– Types– When used and by whom– Special needs– No respiratory protection required

(g) Labeling and Training Signs posted at all work area entrances:

Biohazard symbol Infectious agent Entry requirements Name & telephone # of responsible

person

(g) Labeling and Training Signs posted at all work area entrances:

Biohazard symbol Infectious agent Entry requirements Name & telephone # of responsible

person

ComplianceCompliance

(h) Record Keeping Occupational exposure/sharps injury

record Confidential Kept for duration of employment,

+ 30 years Includes:

Name & social security number Vaccination status Examination results

(h) Record Keeping Occupational exposure/sharps injury

record Confidential Kept for duration of employment,

+ 30 years Includes:

Name & social security number Vaccination status Examination results

ComplianceCompliance

(h) Record Keeping Training records

Kept for 3 years Dates Contents Names & qualifications of instructors Names & job titles of students Annual documentation

(h) Record Keeping Training records

Kept for 3 years Dates Contents Names & qualifications of instructors Names & job titles of students Annual documentation

ComplianceCompliance

Sharps Injury Log Information

• Type and brand of device involved

• Where incident occurred

• Description of how incident occurred

• Employee confidentiality must be maintained

Incident Reporting

• Set up a policy

• Record incidents in Sharps Injury Log

• Effective January 2002, Included on OSHA logs (positives only)

Postexposure Evaluation and follow-up Incident reports

• Document route of exposure

• Identify source

• Test source blood

• Give test results to worker

• Upon consent , test worker’s blood

Postexposure Evaluation(cont.)

• If no consent for HIV tests save blood for 90 days

• Advise worker to seek medical attention

• Provide counseling

• Evaluate test results to give treatment if needed

Physician's Written Opinion

• Complete within 15 days

• Worker must be informed of results and risks

• Employers have access to report

Types of Prophylaxis• HBV

– vaccine, serum immunoglobulin

• HIV– zidovudine– lamivudine (3TC)– Indinavir (IDV) when increased risk

• HCV– None

BIOHAZARD SYMBOL

BIOHAZARD

Treat as regulated medical waste

Follow State , federal and localregulations

For perception issues on uncontaminated sharps and lab waste-discuss