“Bloodborne Pathogens”
Danita Mullings
TOSHA believes the information in this
presentation to be accurate and delivers
this presentation as a community service.
As such, it is an academic presentation
which cannot apply to every specific fact
or situation; nor is it a substitute for any
provisions of 29 CFR Part 1910 and/or
Part 1926 of the Occupational Safety and
Health Standards as adopted by the
Tennessee Department of Labor and
Workforce Development or of the
Occupational Safety and Health Rules of
the Tennessee Department of Labor and
Workforce Development.
Hepatitis and HIV
Hepatitis
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Viruses which attacks the liver
Liver performs many functions vital to
life
– Blood reservoir, blood filter,
carbohydrate, fat, protein metabolism,
storage of vitamins, iron, etc.
Hepatitis A
Caused by infection with Hepatitis A virus
NOT BLOODBORNE
Virus is found in the stool of infected persons
HAV is usually spread from person to person
by putting something in the mouth (even
though it may look clean) that has been
contaminated with the stool of a person with
hepatitis A
Occurs in epidemics both nationwide and in
communities
Hepatitis A--Symptoms
Jaundice
Fatigue
Abdominal pain
Loss of appetite
Nausea
Diarrhea
Fever
Hepatitis A Prevention
Good personal hygiene and proper
sanitation can help prevent hepatitis A
Always wash your hands with soap and
water after using the bathroom,
changing a diaper, and before
preparing and eating food
Vaccine is available
Hepatitis B
Caused by infection with Hepatitis B virus
IS BLOODBORNE
Occurs when blood or body fluids from an infected
person enters the body of a person who is not
immune
HBV is spread through
– having sex with an infected person without using a condom
(the efficacy of latex condoms in preventing infection with
HBV is unknown, but their proper use may reduce
transmission)
– by sharing drugs, needles, or "works" when "shooting" drugs
– from an infected mother to her baby during birth
– through needlesticks, sharps exposures, blood splashes on
the job,
Can cause lifelong infection, cirrhosis (scarring) of
the liver, liver cancer, liver failure, and death
Hepatitis B Symptoms
Jaundice
Fatigue
Abdominal pain
Loss of appetite
Nausea, vomiting
Joint pain
Hepatitis B--Prevention
A safe and effective vaccine is available
Use latex condoms correctly and every time you
have sex. (The efficacy of latex condoms in
preventing infection with HBV is unknown, but their
proper use may reduce transmission.)
If you are pregnant, get a blood test for hepatitis B;
Infants born to HBV-infected mothers should be
given HBIG (hepatitis B immune globulin) and
vaccine within 12 hours after birth.
Never share drugs, needles, syringes, or "works“
Do not share personal care items that might have
blood on them (razors, toothbrushes)
At work, do not come into contact with another
person’s blood or body fluids
Hepatitis C
Hepatitis C is a disease of the liver caused by the Hepatitis C virus
(HCV)
IS BLOODBORNE
Occurs when blood or body fluids from an infected person enters
the body of a person who is not infected
HCV is spread through
– having sex with an infected person without using a condom (the
efficacy of latex condoms in preventing infection with HBV is unknown,
but their proper use may reduce transmission)
– by sharing drugs, needles, or "works" when "shooting" drugs, through
needlesticks, sharps exposures, blood splashes on the job, or
– from an infected mother to her baby during birth
– through needlesticks, sharps exposures, blood splashes on the job,
Chronic infection: 55%-85% of infected persons
Chronic liver disease: 70% of chronically infected persons
Leading indication for liver transplant
Hepatitis C--Symptoms
Jaundice
Fatigue
Dark urine
Abdominal pain
Loss of appetite
Nausea
80% of infected persons have no signs
or symptoms
Hepatitis C--Prevention
There is no vaccine to prevent hepatitis C
Do not shoot drugs and never share
needles, syringes, or "works"
Do not share personal care items that
might have blood on them (razors,
toothbrushes)
At work, do not come into contact with
another person’s blood or body fluids
Hepatitis D
Hepatitis D is a liver disease caused by the
hepatitis D virus (HDV)
It is a defective virus that needs the
hepatitis B virus to exist
Hepatitis E
Hepatitis E is a liver disease caused by the
hepatitis E virus (HEV)
NOT BLOODBORNE
It is transmitted in much the same way as
hepatitis A virus
Hepatitis E does not occur often in the United
States
Viral Hepatitis - Overview
Type of Hepatitis
A
Source of
virus
Route of
transmission
Chronic
infection
Prevention
feces
fecal-oral
no
B
C
D
blood/
blood/
blood/
blood-derivedblood-derived blood-derived
body fluids body fluids body fluids
E
feces
percutaneouspercutaneous percutaneous fecal-oral
permucosal permucosal permucosal
yes
yes
yes
no
pre/postpre/post- blood donor
pre/post- ensure safe
exposure
exposure
screening;
exposure
drinking
immunization immunization risk behavior immunization;
water
modification risk behavior
modification
HIV
Human immunodeficiency virus
HIV can be passed from person to person if
someone with HIV infection has sex with or
shares drug injection needles with another
person
It also can be passed from a mother to her
baby when she is pregnant, when she delivers
the baby, or if she breast-feeds her baby
Leads to disease AIDS
Destroys the immune system
HIV Symptoms
The symptoms are similar to the
symptoms of many other illnesses
You might have HIV and still feel
perfectly healthy
The only way to know for sure if you
are infected or not is to be tested
HIV Prevention
Don’t share needles and syringes used to inject drugs,
steroids, vitamins, or for tattooing or body piercing
Don’t share equipment ("works") used to prepare drugs
to be injected
Use a latex condom to reduce the risk of STD
transmission.
Don’t share razors or toothbrushes because of the
possibility of contact with blood
If you are pregnant or think you might be soon, talk to
a doctor or your local health department about being
tested for HIV. Drug treatments are available to help
you and reduce the chance of passing HIV to your baby
if you have it
At work, do not come into contact with another
person’s blood or body fluids
You Do Not Get Hepatitis B, C, or
HIV
By working with or being around someone
who has the disease
From sweat, spit, tears, clothes, drinking
fountains, phones, toilet seats, or through
everyday things like sharing a meal
From insect bites or stings
From donating blood
From a closed-mouth kiss (but there is a
very small chance of getting it from openmouthed or "French" kissing with an infected
person because of possible blood contact)
Bloodborne Pathogens (BBPs)
Pathogenic microorganisms present
in human blood that
can lead to diseases
Human immunodeficiency virus (HIV)
Hepatitis B (HBV)
Hepatitis C (HCV)
Other Bloodborne Pathogens
Syphilis
Malaria
Brucellosis
Babeosis
Leptospirosis
Arborviral Infections
Relapsing Fever
Creutzfeld-Jacobs Disease--Mad-cow
Viral Hemorrahgic Fever--Ebola
Universal Precautions
Must be observed
All blood and body fluids are treated
as if known to be infected with HIV,
HBV, HCV, etc.
Do not come into contact with
another person's blood or body fluids
Potentially Infectious Materials-Blood
Semen
Vaginal secretions
Cerebrospinal fluid
Pleural fluid
Pericardial fluid
Peritoneal fluid
Amniotic fluid
Saliva in dental
proc.
Any visibly
contaminated
body fluid
Any body fluid
where
differentiation is
difficult
Any unfixed
tissue or organ
Aqueous and
vitreous humors
in the eyes
Other Body Fluids
These body fluids do NOT have enough
virus in them to transmit disease UNLESS
they are contaminated with blood
–
–
–
–
–
–
Urine
Feces
Tears
Sweat
Vomitus
Spit
Modes of Transmission
Non-Intact Skin
Stick or Cut
Splash to Mucous
Membranes
Exposure Control Plan
Employer's plan describing how compliance
with the standard is achieved
Describes what employees are covered
Describes tasks that are covered
Describes post-exposure follow-up procedures
Must be reviewed and updated annually
Must be accessible to employees
– Everyone should know the procedure to
follow to obtain a copy
Handwashing
The single most important aspect of infection
control
Wash hands when contaminated with blood
or body fluids and after removing gloves
Use antiseptic hand cleaner clean
paper/cloth towels or antiseptic towelettes
when "in the field"
Wash hand with soap and water asap
Needles/Sharp Objects
Use sharps with sharps injury prevention or
needleless systems
Place in puncture resistant, labeled, leakproof containers for transport, storage,
and/or disposal
Keep the container closed
Do not bend, break, recap, or remove needles
Do not pick up contaminated broken glass
directly with the hands
Do not reach by hand into containers where
contaminated sharps are placed
Eating/Drinking
Do not eat or drink in areas where
there is exposure to blood or body
fluids
Do not store food in refrigerators,
freezers, cabinets, on shelves or
countertops where blood or other
body fluids are present
Personal Protective Equipment
(PPE)
Wear PPE to prevent blood or body
fluids from getting on your clothes,
skin, underclothes, etc.
Must be provided at no cost to the
employee
Employer must enforce the use
Must be removed prior to leaving the
work area and placed in designated
area
PPE
Parental exposure
– stick or cut
Mucous membrane
– splash
Non-intact skin
– spill or splash
Decontamination
Clean and decontaminate all equipment and
environmental and working surfaces after
contact with blood and/or body fluids
Decontaminate with appropriate
disinfectant
– EPA registered tuberculocidal disinfectant
– EPA registered disinfectant with label stating it
is effective against HIV and HBV
– Household bleach, diluted 1:10-1:100, made
fresh daily
Contaminated Laundry
Remove contaminated clothing when it
becomes contaminated
Place immediately in bag or container that
is labeled
Prevent leakage
Hepatitis B Vaccination
Your employer must offer you the HBV
vaccination after you have received
training and within 10 working days of
job assignment
– At no cost
– Provided by PLHCP
– According to US Public Health Service
most current recommendations
“Immunization of Health Care Workers:
Recommendations of ACIP and HICPAC,”
MMWR, Vol. 46, No. RR-18
HBV Vaccination
Sign a declination statement if do not want to
take the shots
Highly recommended
Few contraindications
Three-shot series
No booster currently recommended
Each employee should be given a health care
professional’s written opinion as to whether it
is safe for YOU to take the shots and whether
or not you did
Can decline now, take the shots later
Post-Exposure Follow-up
After exposure incident
– Stick or cut
– Splash
– Non-intact skin exposure
At no cost
Begin ASAP after exposure incident
Report exposure incident to your
supervisor or designated personnel
immediately
Post-Exposure Follow-up
Investigation of the incident
ID source individual, obtain consent,
and test their blood to determine
HBV, HCV, and HIV infectivity ASAP
Results of source individual's test
given to exposed person
Obtain and test exposed person's
blood for HBV, HCV, and HIV
serological status
Post-Exposure Follow-up
Post-exposure prophylaxis as indicated by CDC
Counseling
Evaluation of reported illnesses
According to U.S. Public Health Service Guidelines
– HIV--“Updated U.S. Public Health Service Guidelines
for the Management of Occupational Exposures to
HIV and Recommendations for Postexposure
Prophylaxis,” September 30, 2005, Vol 54, RR-09
– HBV, HCV--“Updated U.S. Public Health Service
Guidelines for the Management of Occupational
Exposures to HBV, HCV, and HIV and
Recommendations for Postexposure Prophylaxis”
June 29, 2001, Vol 50, No. RR-11
Written Opinion
Employee will be provided a copy of
the Health Care Professional's
Written Opinion for Post-Exposure
Follow-up within 15 days of
completion of the evaluation
Labels
Containers with
contaminated
items
Can substitute
red
Training
Before exposure
Annually
At no cost
Records
Medical records
– Name and social security number
– HBV vaccination status
– Results of exposure incident follow-up
– Health care professional's written
opinions
– Info provided to health care professional
– Confidential
Records
Training
–Dates
–Contents
–Names and qualifications of
trainers
–Names and titles of persons
attending
What’s Wrong Here?
Resources
www.osha.gov
www.tennessee.gov/labor-wfd/tosha
www.cdc.gov
www.cdc.gov/niosh
Memphis Office
901-543-7259
Jackson Office
731-423-5641
Nashville Office
615-741-2793
1-800-249-8510
Knoxville Office
865-594-6180
Kingsport Office
423-224-2042
Chattanooga
423-634-6424
Consultative Services
1-800-325-9901