OSHA BBP Standard
Reason: Concern for employees who are occupationally exposed to blood and other body fluids and could acquire certain disease through exposure
Purpose: To minimize risk for employees with occupational exposure to blood and body fluids
Location: BCDP and BEOH, also at www.osha.gov
Requires: Exposure Control Plan
Blood Borne Pathogens Training
Blood Borne Pathogens Training
Overview of BBP StandardTypes of pathogensExposure Control Plan
Blood Borne Pathogens
Human immunodeficiency virus (HIV)
Hepatitis B virus (HBV)
Hepatitis C virus (HCV)
Blood Borne Pathogens
Can acquire from blood body fluids containing visible blood other potentially infectious material
(OPIM)• cerebral spinal fluid (CSF), synovial fluid,
pleural fluid, peritoneal fluid, amniotic fluid
Blood Borne PathogensFeces, nasal secretions, saliva (except in dental settings), sputum, sweat, tears, urine, and vomitus are not considered infected with blood borne pathogens unless they contain visible blood.
Blood Borne Pathogens
Occupational exposure occurs by: percutaneous injury (needlestick or cut) contact with mucous membranes contact with non-intact skin
in which there is blood, body fluids with visible blood, OPIM
Blood Borne Pathogens
HIV virus that causes AIDS incubation period 1
to 3 months person is infectious from onset of infection throughout life all persons are susceptible
Blood Borne Pathogens
HIV risk of transmission
• needlestick: 0.3%• splash/spray to mucuous
membranes: 0.09%• non-intact skin: less than
mucous membrane exposure
Blood Borne Pathogens
HBV virus that causes hepatitis B incubation period 45 to 180 days person is infectious if test for antigen
(HBsAG) is positive unvaccinated persons are susceptible
• vaccination is recommended for persons with occupational exposure
Blood Borne PathogensHBV
risk of transmission• needlestick: 22-31%
if source is HBeAG +• needlestick: 1-6%
if source is HBeAG -• direct or indirect contact with non-intact
skin or mucous membranes is an important source of occupational exposure
Blood Borne Pathogens
HCV virus that causes hepatitis C incubation period 6 to 9 weeks most persons are infectious for life all are susceptible
Blood Borne Pathogens
HCV risk of transmission
• needlestick: 1.8%• mucous
membranes: rare• non-intact skin:
very rare
DPH Exposure Control Plan
universal/standard precautions• hand hygiene
• PPE engineering controls work practice controls HBV vaccination post-exposure management training
DPH Exposure Control Plan
available to employees copies available in
BCDP and BEOH
reviewed, updated annually
use of safe medical devices included
DPH Exposure Control PlanExposure Determination
Any DPH employee who performs or may perform phlebotomies, fingersticks, administers immunizations (including smallpox vaccinations) has occupational exposure to blood borne pathogens
Universal Precautionspart of OSHA BBP standardused on ALL individualsused for ALL contact with:
blood, body fluids, OPIM mucous membranes non-intact skin
to protect against blood borne pathogens
Standard Precautions
part of CDC guidelines on infection controlused on ALL individualsblood, all body fluids, secretions,
excretions(except sweat) considered infectious (regardless of visible blood)
used to protect against all infectious agents
Standard Precautions
Hand hygieneuse of personal protective equipment
Hand Hygiene
Wash hands after touching blood, body fluids, secretions,
excretions, contaminated items, regardless if gloves are worn
immediately after removing gloves before leaving work area whenever hands are dirty or contaminated
Hand HygieneHand washing technique
turn on faucets to comfortable water temperature wet hands, apply soap, lather rub with friction for at least 15 seconds, making sure to
wash back of hands, fingers, fingertips, in between fingers
rinse with fingertips pointing downward dry hands with paper towel discard paper towel and turn off faucets with clean
paper towel
Hand HygieneWaterless alcohol gel
may use if hands are not visibly soiled
more effective against organisms convenient gentler to skin than soap, water,
paper towels takes less time than soap and water wash
Hand HygieneUse of waterless gel
press pump down completely
to dispense appropriate amount dispense into palm of one hand rub palms, backs of hands,
fingers, fingertips, between
fingers until dry, about 30 seconds make sure hands are dry before
resuming activities
PPE
gowns, gloves, surgical masks, face shields, goggles, shoe covers, aprons
used when there is a reasonable anticipation of exposure to blood, body fluids, mucous membranes, non-intact skin
provides protection for clothing, skin, eyes, mouth, nose
PPE
employer responsibilities• provide in appropriate sizes • make accessible• require use by employees• clean, launder, repair, replace as needed• provide training
PPE
Employee responsibilities: use appropriately dispose of
appropriately
PPE for DPH
Gloves non-latex wear for phlebotomies, fingersticks,
smallpox vaccinations remove between clients, wash hands select correct size have readily available at work station
PPE for DPH
Gowns protect skin, prevent soiling of clothing do not re-use disposable gowns wash hands after removing use when cleaning spills
of blood/body fluids
PPE for DPH
“Over shirts” use if desired at STD clinics
and HIV testing sites remove immediately if saturated
with blood/body fluids place in designated laundry
bags for professional cleaning
PPE for DPHLab coats
disposable lab coats used by vaccinators
at smallpox clinics remove and dispose
of before leaving
vaccination station,
wash hands
PPE for DPH
Surgical masks with eye protection/face shields cover eyes, nose, and mouth when anticipating
splash or spray to face eye glasses are not protective
PPE Removal
1) Remove gloves by grasping outside of gloved hand with other gloved hand and peel off. Hold removed glove
in gloved hand.
2) Slide fingers of
ungloved hand under
remaining glove.
Discard gloves.
PPE Removal
3) Remove any PPE from face next, handling by head bands, ear pieces, or ties. Discard.
4) Remove gown by pulling away from neck and shoulders, touching inside of gown only. Turn gown inside out. Discard.
PPE Removal
Wash hands!
Engineering Controls
Safety devices on sharps: needles, lancets must be used if available evaluated by staff
Shearing, breaking, bending, re-capping of contaminated sharps is prohibited
Do not remove needle from used tube holder after phlebotomy
Engineering Controls
Place used sharps in disposal containers immediately after use
Sharps containers puncture resistant leakproof labeled or red in color stabilized if portable
Engineering Controls
Sharps containers Replace sharps containers
when 2/3 full The users of the containers
are responsible for replacing when necessary
Work Practice Controls
Do not eat, drink, apply make-up, handle contact lenses, or smoke in areas with likely exposure to blood or OPIM testing areas areas where specimens located
Do not store food or beverages in refrigerators, freezers, coolers, shelves, cupboards where specimens are located
Work Practice ControlsDo not place hands into used sharps
containersUse a brush and dustpan or tongs or forceps
to pick up broken glass or other sharp items
Waste Disposal
Infectious waste sharps disposable items that are saturated with
blood or OPIM to the point where such material can be squeezed, poured, dripped, or flaked off the items
for DPH, most infectious waste will be sharps
Waste Disposal
Infectious waste place in red biohazard bags, seal to prevent
spillage during handling store in designated areas for collection by
waste haulers Central Health Clinic: biohazard collection
room Madison:???
Waste Disposal
Document waste disposal date removed amount where shipped by whom send completed forms to ICE
Laundry
handle with minimal agitation place dry laundry in bags at point of use laundry that is wet from blood or OPIM is
placed in plastic bags send to professional cleaners
• “over” shirts
• personal clothing visibly soiled with blood or OPIM
Labels Infectious waste: red bag with biohazard
label Sharps containers:
biohazard label blood specimens:
biohazard labeled storage
bags, storage containers refrigerators, coolers where blood or
OPIM is stored: biohazard label
Specimens
label with appropriate information wrap in material to prevent breakage place in plastic biohazard bag place paperwork in outside pouch of bag do not place specimens back into clean
collection kits store or ship appropriately
Cleaning/Disinfection
Clean first, then disinfect all equipment and environmental surfaces after contact with blood or OPIM
use EPA registered disinfectant with activity against HIV, HBV, HCV or 1:10 bleach
follow instructions on disinfectant label
Handling Blood Spills
Procedure for Cleaning Blood Spills wear PPE: gown, gloves, goggles wet cloth with the disinfectant wipe item/area with wet cloth spray disinfectant on item/area wipe with clean cloth, let air dry
Hepatitis B Vaccination
Any one with occupational exposure to blood or OPIM should be vaccinated
recommended unless:• employee has documentation of receipt of
series• antibody testing shows immunity• employee has medical contraindications
Hepatitis B Vaccination
available within 10 working days of work start date
if employee declines, must sign statement of declination
employee may request the series later
Hepatitis B Vaccination
Safety very safe vaccine US: as of 2000 more than 100 million adults
have received vaccine with few side effects serious reactions are rare mild symptoms may occur: soreness at
injection site, low-grade fever may be given during pregnancy
Hepatitis B Vaccination
Effectiveness at least 90% of adults are immune after
completing the three doses of vaccine since 1985, 90% reduction of number of
HCW infected with HBV, largely due to vaccine
Hepatitis B Vaccination
administered by deep intramuscular injection
3 doses given: 1st two doses 1 month apart, last dose is given 5 months after second dose
SLH will test antibody levels at 1-2 months after last dose to test for immunity
non-responders will be-revaccinated
Post Exposure Management
1) Clean the site percutaneous injuries:
wash with soap and water mucous membranes:
rinse copiously with water
2) Go to the nearest
Concentra clinic for evaluation.
If none in area, report to nearest ER
Post Exposure Management
3) Notify supervisor, who will notify the
ICE
4) Medical evaluation documentation of route of exposure document source person source and exposed will be tested results given to exposed person’s provider counseling