1 Kentucky Education and Workforce Development Cabinet Occupational Health and Safety Program Bloodborne Pathogen Exposure

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Kentucky Education and Workforce Development

Cabinet

Occupational Health and Safety Program

Bloodborne Pathogen Exposure

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OSHA’s Bloodborne Pathogens

PURPOSE-Limits occupational exposure to blood and other

potentially infectious materials, since any exposure could result in

transmission of bloodborne pathogens which could lead to

disease or death.

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OSHA’s Bloodborne Pathogens Standard

SCOPE-Covers all employees with occupational exposure to

blood or other potentially infectious materials as a

function of their jobs.

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What are Bloodborne Pathogens?

Bloodborne pathogens are micro-organisms in the bloodstream that cause

diseases.

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What are Other Potentially Infectious Materials (OPIM)?

Human body fluids listed in the standard.

Unfixed tissue or organ (other than intact skin) from a living or dead human.

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HIV containing cell or tissue cultures, organ cultures.

Blood, organs or other tissues from experimental animals infected with HIV or HBV.

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Occupational ExposureReasonably anticipated skin,

mucous membrane or parenteral contact with blood or other

potentially infectious materials that may result from the

performance of an employee’s duties.

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Occupational Exposure

Employers are to evaluate each job task and procedure to

determine which employees may be expected to be

occupationally exposed to blood or other potentially

infectious materials.

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Exposure determination is made without regard to

the use of personal protective equipment.

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Occupational ExposureOSHA expects an employer to take

into account all potential circumstances of exposure

(biting, contact with skin lesions, and/or potentially infectious

secretions) when determining occupational exposure.

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Based on potential contact with blood and other potentially

infectious materials. The employer is to select the

appropriate personal protective equipment in

accordance with the standard.

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Occupational Exposure-First Aid Trained Employees

First aid trained employees assigned to provide emergency first aid as part of their specific job duties are

covered by the Bloodborne Pathogens Standard.

GOOD SAMARITAN ACTS-Not covered by the standard.

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Kentucky OSHA requires that employers with 8 or more

employees with in the establishment have persons

adequately trained to render first aid.

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Employers with fewer than 8 employees shall, in the absence of an infirmary, clinic or hospital

in near proximity to the workplace, have a person or

persons adequately trained to render first aid.

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OSHA Enforcement Procedures for the Occupational Exposure to

Bloodborne Pathogens states an employee trained in first aid and

identified by the employer as responsible for rendering medical

assistance as part of the job duties is covered by the Bloodborne Pathogen

Standard.

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An employee who routinely provides first aid to fellow employees with the knowledge of the employer may also fall de facto under the BBP Program even if the employer has no officially

designated employee as a first aid provider.

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Employers with designated first aid providers are required to offer the hepatitis B Vaccine to the

providers before they are exposed.

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Collateral JobsThose positions that do not

have occupational exposure to blood or other potential infectious body fluids.

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Employees in Collateral Jobs• Maintenance Workers• Good Samaritan Acts

• Office Staff• Janitorial Employees

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Planning and Assessment

• Bloodborne Pathogen Plan for cabinet.

• Bloodborne Pathogen Plan for each central office-Contained in the Cabinet Safety Plan.

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Planning and Assessment

• Bloodborne Pathogen Plan for each field office-Contained in the Safety Plan for the office.

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Bloodborne PathogensThe three most significant

bloodborne pathogens found in the workplace:

HIV-Human Immunodeficiency Virus.

Hepatitis-B Virus.Hepatitis-C Virus.

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Hepatitis B ControlEach employee with occupational

exposure will within 10 days of employment shall:

Provide evidence of receiving three doses of Hepatitis B vaccine; or

Provide evidence of a positive Antibody to Hepatitis; or

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Hepatitis B Control

Sign a form consenting to be vaccinated or to finish an incomplete vaccination series; or

Specifically decline vaccination by signing a Declination Form.

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Hepatitis B Control

Provided at no cost to the employee.

Provided at a reasonable time and place and performed by or under

the supervision of a licensed physician or other health care

professional.

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Staff TrainingProvided at no cost to the

employee annually. Training Records Dates of each training session. Content specific syllabus and

any information distributed to employees.

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Staff Training

Names and job titles of all persons attending the training.

Records shall be retained for 3 years from the date of training.

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Employee Medical Records Retained by Employer

Documentation of up-to-date hepatitis B vaccination.

Incident Reports.Results of post exposure

testing and follow-up.

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Copy of physician’s written opinion.

Copy of any written information provided to the employee.

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Records are confidential and cannot be disclosed without the employee’s express written consent.

Records must be retained for 30 years following end of employment.

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Records must be kept separate from personnel records.

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Blood

Defined as human blood, human blood components, and products made from

human blood.

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Other Potentially Infectious Materials (OPIM)

Saliva in dental procedures.

Semen.Vaginal secretions. Internal body fluids.

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Body fluids visibly contaminated with blood.

Body fluids in situations where it is difficult or impossible to identify type of fluid.

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Amniotic Fluid-Bacteria and Fungal Germs.

Cerebrospinal Fluid-Bacteria, Fungi, Viruses.

Feces-Bacteria, Rotavirus, Hepatitis A Virus.

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Nasal Discharge-Common cold virus, Influenza Virus, HIV and Hepatitis B Virus.

Pericardial Fluid-Organisms that can cause infections.

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Peritoneal Fluid-Organisms that can cause infections.

Pleural Fluid-Organisms that can cause disease.

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Saliva-Common cold virus, Influenza Virus.

Urine-Cytomegalovirus, Mononucleosis Virus.

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Semen-Gonorrhea, Hepatitis B Virus, Hepatitis C Virus, HIV.

Synovial-Bacteria, Fungi, Viruses, Blood in Fluid.

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How Bloodborne Pathogens are Transmitted

An employee must make contact with contaminated fluids and permit a way to

enter the body.

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How Bloodborne Pathogens Enter the Body

Direct blood inoculation-placenta, transfusion, blood products.

Accidental injury which breaks, punctures or cuts the skin or mucous membranes (Parenteral Contact).

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Non-sterile technique when tattooing, body piercing, sharing injections.

Open cuts, nicks, and skin abrasions, even dermatitis and acne.

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Mucous membranes (i.e. mouth, eyes (contact lenses), nose.

Sexual intercourse (any type).

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Indirect transmission (touching something that is contaminated and then touching an opening in the skin).

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Virus SurvivalHIV-can survive only a short

time outside the body.HBV-can survive up to a

week outside the body at room temperature.

HCV-unknown.

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Hepatitis-B (HBV)

Hepatitis means “inflammation of the liver.”

HBV is the major infectious bloodborne hazard on the job.

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Hepatitis-B (HBV)

Affects approximately 8,700 employees a year, resulting in more than 400 hospitalizations and 200 deaths.

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Hepatitis-B (HBV)

Flu-like symptoms, becoming so severe as to require

hospitalization.

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Hepatitis-B (HBV)

Illness may last 6 months to 2 years. In some cases, HBV damages the

liver so severely it leads to cirrhosis and possible death.

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Hepatitis-B (HBV)

Some people exhibit no symptoms at all and most

people recover in time.

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Hepatitis-B (HBV)

A small percentage of people become carriers.

Blood testing is available.

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Hepatitis C (HCV)

• HVC is different from Hepatitis B.• HCV is transmitted directly by

blood, but unknown if other body fluids like sexual fluids or saliva will carry the virus.

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Hepatitis C (HCV)• Flu like symptoms can show up

within days or years after exposure.

• HCV can be ACUTE requiring liver transplant or death within weeks or months.

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Hepatitis C (HCV) CHRONIC requiring intensive

medical therapy. 70% of those infected will

eventually develop chronic liver disease, cirrhosis of the liver, and almost certain death.

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Hepatitis C (HCV)

• Blood test is available.• There is no vaccine for HCV at

this time.

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Human Immunodeficiency Virus (HIV)

• HIV attacks the immune system and eventually causes AIDS.

• HIV infection is treatable, but not curable.

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• HIV continues to be infectious in blood and sexual fluids even during treatment.

• Blood testing is available.

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• There is no vaccine for HIV at this time.

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Employees-Providing First AidIf employees are trained and

designated as responsible for rendering

first aid or medical assistance as part of their job

duties, they are covered by the OSHA Bloodborne

Pathogen Standard.

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Employees-Providing First Aid

All first aid providers who provide assistance in any situation involving the presence of blood or other potentially

infectious materials, regardless of whether or not a specific exposure incident occurs, must have the vaccine made available to them as soon as possible, but in no event

later than 24 hours after exposure.

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Employees-Providing First Aid

In an exposure incident as defined in the standard has

taken place, other post exposure follow-up procedures must be initiated immediately,

per the OSHA Standard.

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Other General Industry EmployeesWhile OSHA does not generally consider

maintenance and janitorial staff employed in non-health care facilities to

have occupational exposure, it is the employer’s responsibility to determine which job classification or specific tasks

and procedures involve occupational exposure.

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Universal Precautions

UNIVERSAL PRECAUTIONS is the term used when handling all blood or other potentially

infectious material as if it were, in fact, infectious.

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Universal PrecautionsSince there is no way of

knowing if an injured person or body fluid is infected, employees in ALL CASES must use universal

precautions when exposed to another’s body fluids.

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Universal Precautions for Home Visits

Universal Precautions for home visits must be observed.

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Employer and employee are to assume that all human blood and human body fluids are infectious

for HIV, HBV, and other bloodborne pathogens.

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Where differentiation between types of body fluids is difficult

or impossible, all body fluids are to be considered potentially

infectious.

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Treat all blood and body fluids as being potentially infectious.

Use appropriate Personal Protective Equipment.

Do not bend, break, shear or recap needles.

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Wash hands thoroughly before and after each home visit.

Do not clean blood spills in a client’s home.

Keep mouthpieces and resuscitation equipment.

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No visits if customer has draining sores.

No visits if customer has an infection transmissible by the airborne route.

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Restrict eating, drinking, smoking, apply cosmetics or lip balm, and handling contact lenses during a customer’s home visit.

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Universal Precautions• Wash hands.• Wear gloves (wash hands after

glove removal).• Wear impervious apron when

splashing is possible.

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Universal Precautions• Wear mask and eye protection.• Handle sharp objects carefully

and dispose properly.• Dispose of all spills properly.

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Hand Washing• Wash hands with soap and

running water.• Rinse hands under running

water.• Dry hands well with paper

towel.

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Hand Washing• Use a paper towel to turn off

faucet.• Dispose of single use towel.• Wash/disinfect cloth towels.

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Hand WashingApply hand cream after frequent

washing to prevent skin irritation, breakdown, and subsequent infection.

Use waterless soap/wipes when soap and water are not available.

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Hand Washing

When antiseptic hand cleansers or towelettes are used, hands will

be washed with soap and running water when the employee

returns to a location where hand washing facilities are available.

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Hand Washing

Wash hands immediately or as soon as feasible after removal of gloves or other protective

equipment

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Hand Washing

Employer must ensure that employees wash hands and any

other skin with soap and water, or flush mucous membranes with

water immediately, or as soon as feasible, following contact with

blood or body fluid.

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Personal Protective Equipment• Employers will provide to

employees with occupational exposure PPE appropriate for the risk.

• No cost to the employee.• PPE will be available for use at

each site.

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Personal Protective EquipmentPPE will be considered appropriate

only if it does not permit blood or other potentially infectious materials to pass through to reach the employee’s work

clothes, street clothes, undergarments, and body.

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Personal Protective Equipment-Eye Protection

Eye protection is to be worn whenever splashes, spray, spatter

or droplets of blood or other potentially infectious materials may be generated and eye, nose, and/or

mouth contamination can be reasonably anticipated.

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Personal Protective Equipment-Gloves

Gloves will be worn when it can be reasonably anticipated that the

employee may have hand contact with blood, other potentially infectious materials, mucous

membranes, and/or non-intact skin.

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Wear gloves when:Actual or potential touching

blood and/or body fluids.Actual or potential touching

mucous membranes.

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Wear gloves when:Actual or potential touching non-

intact skin. Actual or potential handling

items or surfaces soiled by blood and/or other body fluids.

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Using gloves:Hands should be washed before gloving.Gloves must be changed after each contact.

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Using gloves:Hands or other body parts must

be thoroughly washed with soap and water if contaminated with blood or body fluids.

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In the Event of an AccidentThere is a Hepatitis-B vaccine that

can be used post exposure.

It is about 90% effective and must be received as soon as possible.

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In the Event of Actual or Potential Exposure

• Stop work and wash the affected body areas thoroughly.

• If eyes or mouth are affected, flood with water at least 10 minutes.

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Procedures for Reporting and Managing Exposure Incidents

EmployeeReport the date, time, and type of

exposure to first line supervisor.Treatment in accordance with

recommended guidelines, based on the type of exposure.

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EmployeeAdhere to follow-up treatment

regimen and/or testing as prescribed by the physician.

Follow-up will be paid for through Worker’s Compensation.

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Employee and First Line Supervisor

Initiate a consent form for treatment, if indicated.

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First Line SupervisorComplete and submit Cabinet

Accident Report.Complete Workers’

Compensation First Report of Injury.

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First Line SupervisorEnter appropriate information

into OSHA 300 Log.File and retain reports in

employee’s medical files.

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First Line SupervisorProvide to the physician: 1)

copy of the BBP Plan and 2) description of the affected

employee’s duties as they relate to the occupational exposure.

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First Line SupervisorObtain physician’s written

opinion within 15 working days of the completion of the evaluation.

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First Line SupervisorReport the incident to the Kentucky Department for Public Health, Division of Epidemiology and Health

Planning.

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First Line SupervisorAll employees who are involved in any situation where there was the presence of blood or OPIM, regardless of whether

a specific exposure incident occurred, must be offered the full Hepatitis B

vaccination series as soon as possible, but no later than 24 hours after the

incident.

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Time LineIf an exposure incident occurs, all other post exposure follow-up procedures according to the BBP Standard must be initiated

immediately.

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Time LineEmployer must ensure that the

medical provider is familiar with and follows the

recommendations for post exposure follow-up.

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Bloodborne and Body Fluid Cleanup

These procedures are based on OSHA standard 29 CFR 1910.1030

for all employees who have come in contact with infected blood, blood

products and/or body fluids at work.

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Bloodborne and Body Fluid Cleanup

Occurs most often when performing first aid or coming

into contact with someone who has been injured on the job.

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Clean-Up Procedures When Blood or Body Fluids are

Present

Put on disposable gloves and appropriate personal

protective equipment.

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PresentRemove any broken glass or sharp objects from the area

using mechanical means: forceps, needle nose pliers, and/or broom and dust pan.

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PresentNever Remove Sharps, Broken

Glass, Etc. By Hand.

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Clean-Up Procedures When Blood or Body Fluids are Present

Contain the area by covering with paper towels and carefully pouring appropriate disinfectant solution around and on the area.

EXAMPLE-1:10 mixture of household bleach and water.

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PresentTake care not to splash

disinfectant solution or create aerosols while pouring.

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Present

Remove the paper towels and repeat the process until all visual material is removed.

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Present

Re-wet the cleaned area with disinfectant and air dry until all visual material is removed.

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PresentBlood contaminated items used for first aid and care of lacerations, nose bleeds, etc. shall be contained in a plastic lined container, closed, and disposed of with the daily trash in a large, heavy duty plastic bag of sufficient strength to preclude bursting and tearing during handling, storage or transport.

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First Aid Site Clean-Up Procedures When Blood or Body Fluids are

PresentItems such as gauze,

bandages, band-aids, and/or cotton balls are not required to have special hazard labels,

only double bagging.

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First Aid Site Clean-Up Procedures When Blood or Body

Fluids are PresentIf the first aid supplies are saturated to the point where liquid can be squeezed

in considerable amount, the supplies must be soaked in a disinfectant

solution to decontaminate them.

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First Aid Site Clean-Up Procedures When Blood or Body

Fluids are Present

They may be double bagged and included with the

normal waste disposal.

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Remove all personal protective equipment, dispose, and

immediately wash hands and other contaminated body parts.

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Place any soiled linen in a laundry bag. Soiled linen should be handled carefully as if it were contaminated.

Pre-soak linen with disinfectant cleaning solution and launder with

soap and water.

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Linen and clothing contaminated with blood or body fluids must be handled

with gloves.

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Thank You For Your ParticipationFor additional assistance contact:

Richard T. OwenEducation Cabinet Safety

Coordinator601 East Main Street

Frankfort, Kentucky 40601502-564-7346

Documents

1 Kentucky Education and Workforce Development Cabinet Occupational Health and Safety Program Bloodborne Pathogen Exposure