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Bloodborne Pathogens Bloodborne Pathogens • Scope and Coverage – Original thrust was aimed at: • Hospitals • First Responders (ambulance, fire, police) • Dental practices – Non medical classifications: • Funeral directors and morticians • Police crime labs • Barbers and cosmetologists Bloodborne Pathogens • Scope and Coverage also effects: – Maintenance and Custodial workers – Housekeeping and Laundry services – Waste Handling and Disposal services Bloodborne Pathogens • OSHA Regulation 29CFR 1910.1030 • History & Effective Dates • Purpose of the Regulation • Employer Requirements • Scope and Coverage • Exposure Control Plan Bloodborne Pathogens • 1991- OSHA publishes the final regulation for Bloodborne Pathogens in December. • 1992- OSHA regulation effective in March • 1992- Deadline for the completion of the written Exposure Control Plan (May) • 2000- Needlestick Safety and Prevention Act Needlestick Safety and Prevention Act Timeline • P. L. 106-430 signed; November 6, 2000 • Revised Standard published in Federal Register; Jan. 18, 2001 • Effective date; April 18, 2001 • Enforcement of new provisions; July 17, 2001 • Adoption in OSHA state-plan states; October 18, 2001 Revisions to Standard • Additional definitions, paragraph (b) • New requirements in the Exposure Control Plan, paragraph (c) • Solicitation of input from non- managerial employees, paragraph (c) • Sharps injury log, paragraph (h) Bloodborne Pathogens Standard Major Provisions by Paragraph (b) Definitions (c) Exposure Control Plan (ECP) (d) Engineering and Work Practice Controls - Personal Protective Equipment (PPE) (e) HIV and HBV Research Labs (f) Vaccination, Post-Exposure Follow-up (g) Labeling and Training (h) Recordkeeping Bloodborne Pathogens • To assure that no employee will suffer material health or functional impairment due to an exposure to hazardous agents while in the course of their employment. Bloodborne Pathogens • Requirements of the Employer – Employee education and training – Protective measures and equipment – Written Documentation – Record keeping Bloodborne Pathogens • There is one exemption to the rule! • The Good Samaritan clause – A De minimus classification – No penalties for violation Bloodborne Pathogens Occupational Exposure Any reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood... .... or any other potentially infectious materials that may result from the performance of an employees duties. Exposure Determination • The employer must: – Identify worker exposures to blood or other potentially infectious material – Review all processes and procedures with exposure potential – Re-evaluate when new processes or procedures are used Bloodborne Pathogens • Determination of Exposure – “Potentially Infectious” materials include: • semen • vaginal secretions • cerebrospinal fluid • synovial fluid • pleural fluid • pericardial fluid • peritoneal fluid • amniotic fluid • saliva in dental procedures Needlestick Prevention and Bloodborne Pathogens • Needlestick incidents do happen! • Be prepared! • All needlestick incidents are preventable! Needlestick Prevention and Bloodborne Pathogens • Once the worker has been stuck he has been exposed! • Record the incident!! • Treat the worker! Bloodborne Pathogens • Employee Education and Training – Epidemiology of bloodborne diseases is the study of the incidence, distribution and control of Hepatitis B and HIV/AIDS • Hepatitis is an inflammation of the liver • HIV/AIDS destroys the ability to fight infections Bloodborne Pathogens • Employee Education and Training – Symptoms of Hepatitis B • Yellow Eyes & Skin (Jaundice) • Abdominal pain • Fever and Vomiting • Dark Urine • Fatigue Bloodborne Pathogens • Employee Education and Training – Symptoms of AIDS • Fever • Swollen Glands • Diarrhea • Extreme Weight Loss • Skin Lesions • Mental Disorientation Needlestick Prevention and Bloodborne Pathogens • Needles come in all shapes and sizes. • Check manufacturers for the safest needle! Methods of Compliance • Universal Precautions • Engineering Controls • Work Practice Controls • Personal protective equipment • Housekeeping Bloodborne Pathogens • Employee Education and Training – Modes of Transmission of Bloodborne Pathogens • Parenteral • Intravenous Injection • Accidental Needlestick • Sexual – Unprotected Sex • Mucous Membrane – Respiratory tract – Alimentary tract (Nutrition/Digestive) Bloodborne Pathogens • Control Measures – Engineering Controls • Serve to reduce employee exposure in the workplace by either isolating the worker from the exposure or removing the hazard – Examples • Surgical gloves • Self retracting needles • Sharps Containers Bloodborne Pathogens • Control Measures – Work Practice Controls • Reduce the likelihood of exposure through the alteration of the manner in which the task is performed. – Examples • Using Gloves • Handwashing • Method of removing contaminated gloves • Recapping needle procedures Bloodborne Pathogens • Control Measures – Personal Protective Equipment (PPE) • Minimizes the risk of infectious materials entering into the workers body through – skin lesions or – entry through the eyes, nose, or mouth – Examples • Gloves • Gowns • Face Shields Bloodborne Pathogens • Control Measures – Universal Precautions • An approach to infection control • All human blood and human body fluids are treated as if they are infected! Bloodborne Pathogens • HBV Vaccinations – HBV Vaccinations are the most important part of HBV infection control – Gloves and other PPE do not prevent puncture wounds or unanticipated exposures. – Set of three inoculations – Good for ten years Bloodborne Pathogens • Post Exposure Evaluation & Follow Up – Exposure Incident means a specific eye, mouth, other mucous membrane, non- intact skin, or parenteral contact with blood or other infectious materials that result from the performance of an employees duties. Bloodborne Pathogens • Post Exposure Evaluation & Follow Up – Following a report of an exposure incident, the employer provide a confidential medical evaluation which will include: • Documentation of route of exposure • HIV/HBV status of the source individual • Serological testing of the blood ASAP • Post exposure vaccine (HBIG) if indicated • Medical evaluation of the reported illness • Counseling of the exposed individual Bloodborne Pathogens • Regulated Waste Disposal – Contaminated items that: – Would release blood or other potentially infectious materials • IF they are – Pourable – Drippable – Compressible Bloodborne Pathogens • Housekeeping and Laundry – Keep the worksite clean and sanitary – Use a hospital grade VIRUCIDE – OR a 1:10 bleach to water solution Bloodborne Pathogens • Tags, Labels & Bags – Tags and Labels • Fluorescent orange or red-orange • Lettering in a contrasting color • Biohazard symbol in a contrasting color. – Bags must have this label on them (or they must be red in color) and leak proof. Bloodborne Pathogens • Record keeping – The employer shall establish and maintain an accurate record for each employee with an occupational exposure incident. – Records shall include: • Name & Social Security Number of employee • Copy of employees HBV vaccination records • Copy of all medical testing and findings • Copy of physicians written opinion Bloodborne Pathogens • Record keeping – The employer shall maintain records for: • The duration of the employment • PLUS 30 years • Records must be kept CONFIDENTIAL! Bloodborne Pathogens • Exposure Control Plan Must Address: – Exposure Determination – Employee Education and Training – Control Measures – HBV Vaccinations – Post Exposure Evaluation and Follow Up – Regulated Waste Disposal – Tags, Labels, and Bags – Housekeeping and Laundry – Record keeping Needlestick Prevention and Bloodborne Pathogens • Contaminated needles and sharps – Account for 20 infectious agents – OSHA’s primary concern • HIV • HBV • HCV Needlestick Prevention and Bloodborne Pathogens • CDC – Hospital workers- 348,000 sticks a year! – Non-Hospital Healthcare- 590,000 sticks a year • OVER 1600 needle sticks daily! Needlestick Prevention and Bloodborne Pathogens • OSHA Bloodborne Pathogen Standard – Published in 1991 – Did not address safer devices – Did not address safer “best practices” Needlestick Prevention and Bloodborne Pathogens • Needlestick Safety and Prevention Act – November 6, 2000 – Directed OSHA to revise their standard – Federal Register can be found at www.osha.gov Needlestick Prevention and Bloodborne Pathogens • Four changes to OSHA’s regulation – Refined definitions – Exposure Control Plan modificiation – Mandatory employee input – Updated recordkeeping Exposure Control Plan: 1910.1030(c) New Provisions The ECP must be updated to include: • Changes in technology that reduce/eliminate exposure • Annual documentation of consideration and implementation of safer medical devices • Solicitation of input from non-managerial employees Engineering Controls New Definition “… means controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace.” • Engineering Controls - includes additional definitions and examples: – Sharps with Engineered Sharps Injury Protections - [SESIP] – Needleless Systems Solicitation of Non-Managerial Employees New Provision • Identification, evaluation, and selection of engineering controls • Must select employees that are: – Responsible for direct patient care – Representative sample of those with potential exposure Engineering and Work Practice Controls • The employer must: – Evaluate available engineering controls (safer medical devices) – Train employees on safe use and disposal – Implement appropriate engineering controls/devices Engineering and Work Practice Controls • The employer must: – Document evaluation and implementation in ECP – Review, update ECP at least annually – Review new devices and technologies annually – Implement new device use, as appropriate and available Engineering and Work Practice Controls The employer must: – Train employees to use new devices and/or procedures – Document in ECP Needlestick Prevention and Bloodborne Pathogens • Definitions – Engineering Controls – Needleless Systems – Sharps with Engineered Sharps Injury Protection Needlestick Prevention and Bloodborne Pathogens • Definition – “Engineering Control” – Revised to include: • Safer medical devices • All control methods to isolate or remove hazards • Includes blunt suture needles, plastic wrapped capillary tubes • Includes sharps containers and biosafety cabinets Engineering and Work Practice Controls: 1910.1030(d) Employers must select and implement appropriate engineering controls to reduce or eliminate employee exposure. “Where engineering controls will reduce employee exposure either by removing, eliminating, or isolating the hazard, they must be used.” CPL 2-2.44D Engineering and Work Practice Controls Selection of engineering and work practice controls is dependent on the employer’s exposure determination. Needlestick Prevention and Bloodborne Pathogens • Definition – “Sharps with Engineered Sharps Injury Protection” – A needle device or a non-needle device with a built in safety feature Non-needle sharp or a needle with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident. Needlestick Prevention and Bloodborne Pathogens • Definition – “Needleless Systems” – New methods that do not use needles to collect bodily fluids, blood or deliver medication Hypodermic syringes with “Self-Sheathing” safety feature Self-sheathed protected position Hypodermic syringes with “Retractable Technology” safety feature Retracted protected position Phlebotomy needle with “Self-Blunting” safety feature Blunted protected position “Add-on” safety feature Attached to syringe needle Attached to blood tube holder Retracting lancets with safety features Before During After Before During After In use After use Disposable scalpels with safety features Retracted position Protracted position Protracted position Needlestick Prevention and Bloodborne Pathogens • Changes to the Exposure Control Plan – Annual review must reflect changes in technology – Review of commercially available devices must be addressed Needlestick Prevention and Bloodborne Pathogens • Non-managerial employees must have input to Exposure Control Plan Review • May include: – Lab technicians – Housekeeping Staff – Maintenance Workers – Direct patient care providers Needlestick Prevention and Bloodborne Pathogens • Employee Input – A representative sample – A range of exposure situations – Document it! Needlestick Prevention and Bloodborne Pathogens • Recordkeeping • Needlestick Log!! – Confidential – Use to determine high risk areas – Evaluate devices Sharps Injury Log At a minimum, the log must contain, for each incident: • Type and brand of device involved • Department or area of incident • Description of incident • Only mandatory for those keeping records under 29 CFR 1904 Needlestick Prevention and Bloodborne Pathogens • Recordkeeping- • Needlestick Log must contain: – Type of device – Brand of device – Department or work area – Explanation of how the incident occurred Needlestick Prevention and Bloodborne Pathogens • OSHA 200 system – Separate needlestick log required – May or may not be recordable! – OSHA 200 to be replaced by OSHA 300 Needlestick Prevention and Bloodborne Pathogens • OSHA 300 system – Sharps injuries recorded on OSHA 300. • Must include brand and type of device • Must be able to segregate sharps injuries – Use a separate OSHA 300 form for the needlestick log – OSHA 301 form for each incident! – Computers must be able to sort by needlesticks! Bubonic and Pneumonic Plague! Hanta Virus • 46 year old elementary school teacher • Colorado’s fifth Hanta Virus victim in a year • She lasted five days – • Lived on a ranch with husband and 3 children • 200 cases nationwide Wash Your Hands • After using toilet: – Women 74% – Men 61% • New York City- 60% • Chicago- 78% • New Orleans- 69% • Atlanta Braves Game- – Women 89% – Men 46% – Pass the popcorn!!
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