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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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posted:10/22/2011
language:English
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