Table of Contents INTRODUCTION ................................................................................................................ 2 BLOODBORNE DISEASES ............................................................................................... 2 HBV ................................................................................................................................ 2 HIV.................................................................................................................................. 3 W ORKPLACE TRANSMISSION............................................................................................. 3 MEANS OF TRANSMISSION ................................................................................................ 3 CONTAMINATED SURFACES .......................................................................................... 4 EXPOSURE CONTROL PLAN .......................................................................................... 4 WORK PRACTICE CONTROLS ........................................................................................ 4 AVOIDING NEEDLE-STICKS ................................................................................................ 5 HAND-WASHING................................................................................................................ 5 PERSONAL HYGIENE ......................................................................................................... 5 PERSONAL PROTECTIVE EQUIPMENT ......................................................................... 6 GENERAL RULES FOR PPE ............................................................................................... 6 RESUSCITATION DEVICES ................................................................................................. 7 GLOVES ........................................................................................................................... 7 HOUSEKEEPING ............................................................................................................... 8 HBV VACCINATION .......................................................................................................... 8 ADDITIONAL INFORMATION ........................................................................................... 9 QUIZ ................................................................................................................................. 10 Page 1 Bloodborne Pathogens Bloodborne Pathogens Introduction There once was a time when you could come to the rescue of a co-worker without much thought given to your own safety. Unfortunately, today that is no longer the case due to bloodborne pathogens. When most people think of bloodborne pathogens, or diseases transmitted through contact with blood or other body fluids, HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency syndrome) are the diseases that most readily comes to mind. However, there is another disease that is just as deadly, called HBV or hepatitis B virus. In fact, you’re more likely to be infected with HBV in the workplace than with HIV or AIDS. The Occupational Health and Safety Administration (OSHA) has developed and implemented a standard designed to protect you from bloodborne pathogens called 29 CFR 1910.1030. It details how you and your employer can reduce your risk of contracting a bloodborne disease while on the job. You are covered under this standard if it is reasonably anticipated that you could be exposed to bloodborne pathogens while performing your job. Bloodborne Diseases While on the job, you could be exposed to any number of bloodborne diseases, including non-A hepatitis, non-B hepatitis, delta hepatitis, syphilis, and malaria, among other diseases. However, the two most significant are HBV and HIV. HBV Hepatitis B virus attacks the liver, one of the body's organs that detoxifies the blood. HBV can be very damaging, leading to cirrhosis in the advanced stages and almost certain death. Unlike HIV or AIDS, hepatitis B virus can be cured if caught in time. There is even a vaccine to prevent infection with HBV, which may result in one or more of the following: Flu-like symptoms that become so severe that hospitalization is required. No symptoms at all, thus making you unaware that you are infected. Blood, saliva, and other body fluids may be infectious. Body fluids DO NOT include sweat or tears. It is possible to spread the virus to sexual partners, family members, and unborn infants. Page 2 Bloodborne Pathogens HIV The human immunodeficiency virus attacks the body’s immune system, leaving it vulnerable to any number of diseases that normally would not be dangerous or deadly to human beings. Once a person becomes susceptible to these illnesses and diseases, they have what is known as AIDS, or Acquired Immune Deficiency Syndrome. There currently is no cure or vaccine for HIV or AIDS. Infection with HIV results in one or more of the following: May carry the virus without developing symptoms for several years. Will eventually develop AIDS. May suffer from flu-like symptoms, fever, diarrhea and fatigue. May develop AIDS-related illnesses including problems, cancer and other opportunistic infections. neurological HIV is transmitted primarily through sexual contact, but may also be transmitted through contact with blood and some body fluids. HIV is NOT transmitted by touching or working around people who carry the disease. Workplace Transmission In the workplace, bloodborne pathogens can be transmitted in a multitude of ways. HBV, HIV, and other pathogens may be present in: Body fluids such as saliva, semen, vaginal secretions, cerebrospinal fluid, amniotic fluid, blood, and other body fluids. Body fluids DO NOT include sweat and tears. Unfixed tissue or organs other than intact skin from living or dead humans. Means of Transmission There are a number a ways that bloodborne pathogens can be transmitted in the workplace. Some of the most common include: Accidental injury with a sharp object contaminated with infectious material. This would include needles, broken glass, nails, and sharp metal edges. Indirect transmission, such as touching a contaminated surface or object and transferring the infectious material to open cuts, nicks and skin abrasions, as well as the mucous membranes of the mouth, eyes or nose. Page 3 Bloodborne Pathogens Contaminated Surfaces Keep in mind, just because there is no visible blood or other body fluids on a surface where there has been a spill does not mean that a bloodborne pathogen is not lingering, waiting for a host. HBV is an extremely hardy virus, able to survive on a dry surface at room temperatures for at least a week. It is able to do this by forming a cyst, or a cocoon-like shell that maintains a moist environment within the shell allowing the virus to survive. This cyst, when picked up by a host, deteriorates when it comes into contact with fluid, releasing the virus into the host body. Because of this potential, it is important that the area is cleaned and disinfected with a strong disinfectant, such as bleach, as soon as possible after an accident. Exposure Control Plan As stated before, due to the seriousness of bloodborne diseases in the workplace, OSHA has developed a standard to help employers minimize the risks to their employees. Under the standard, 29 CFR 1910.1030, your employer needs to have a written exposure control plan. A copy of this plan should be available to you at your request. This plan will cover the following: Identification of employees covered by the standard. Specific measures you and your facility must take to minimize your risk of exposure. Procedures to follow if there is an exposure incident. A written program can only identify the problems and list the procedures needed to safely address those problems. It is up to you to follow procedures. You are ultimately responsible for you own safety, not your supervisor or your company. Familiarizing yourself with the written program and knowing what to do BEFORE an incident occurs are two steps towards taking responsibility for your own safety. Work Practice Controls There are specific procedures to follow in order to reduce your exposure to bloodborne pathogens or infectious materials. The following are general procedures, intended to be informative. Consult your company’s written program to know the specific procedures to be used. Page 4 Bloodborne Pathogens Avoiding Needle-sticks Do not bend, recap, shear or break contaminated needles and other sharps. Remember that all used needles should be considered contaminated. Recap or remove contaminated needles from disposable syringes only when medically necessary. To recap needles, use a mechanical device, such as forceps, or a one-handed technique. Place disposable and reusable contaminated sharps in an appropriate puncture-resistant, leak-proof container immediately after use. Report any sharps containers that are mounted too high or otherwise not easily accessible. Hand-washing If infectious material gets on your hands, the sooner you wash it off, the less chance you have of becoming infected. The following work practices will help reduce your risk: Every time you remove your gloves you must wash your hands with a non-abrasive soap and running water as soon as possible. Wash or flush skin or mucous membranes as soon as possible if there is a direct contact with blood or other body fluids. Where hand-washing facilities are not available, such as an emergency medical van, your employer will provide an antiseptic hand cleanser or antiseptic towelettes. Use these as a temporary measure only. You must still wash your hands with soap and water as soon as you can. Personal Hygiene Additional self-protective controls should be followed; most of which would appear to be common sense. These would include: When working around blood or other potentially infectious materials, minimize splashing, spraying, and splattering as much as possible. Do not eat, drink, smoke, or apply cosmetics or lip balms, or handle contact lenses where you may be exposed to blood or other potentially infectious materials. Page 5 Bloodborne Pathogens Avoid petroleum-based lubricants that may eat through latex gloves. Applying hand cream is OK if you thoroughly wash your hands first. Don’t keep food and drinks in refrigerators, freezers, and cabinets or on shelves, countertops or bench-tops where blood or other potentially infectious materials may be present. Personal Protective Equipment Under normal work conditions, personal protective equipment (PPE) must not allow potentially infectious materials to contact your clothing, skin or mucous membranes. The type of PPE used for a given task depends on the degree of exposure you anticipate. Such equipment would include gloves, masks, gowns, protective eyewear, resuscitation bags or other ventilation equipment. If your job requires you to be exposed to potential bloodborne pathogen containing material, your employer will: Provide appropriate protective equipment at no cost to you. Clean, launder, repair, replace or dispose of PPE at no cost to you. General Rules for PPE Certain rules have been developed to insure that your protective equipment does its job. Both you and your employer must follow these guidelines. You must be trained in the proper use of the equipment. The equipment must be appropriate for the task. You must use appropriate equipment each time you perform a task. Your equipment must be free of physical flaws that could compromise safety. Your gloves must fit properly. If, when wearing equipment, blood or other potentially infectious materials penetrate it, remove it as soon as feasible. Before leaving the work area, remove all protective equipment and place it in a designated area or container for washing, decontamination or disposal. Page 6 Bloodborne Pathogens There is an exception to these rules. If you believe the use of PPE would prevent proper delivery of medical attention, or jeopardize your safety or that of a co-worker’s, you may temporarily and briefly abandon its use in an emergency. After the incident, your employer must investigate the circumstances to determine if such a situation could be prevented in the future. The use of PPE is required under all other circumstances. Resuscitation Devices Mechanical emergency respiratory devices and pocket masks are types of PPE designed to isolate you from contact with a victim’s saliva during resuscitation. Avoid unprotected mouth-to-mouth resuscitation. The person may expel saliva, blood, or other body fluids during resuscitation. Gloves Gloves are the most widely used forms of personal protective equipment. They act as a primary barrier between your hands and bloodborne pathogens. Latex or vinyl gloves are used most frequently. Heavy-duty utility gloves should be used for housekeeping duties. There are certain guidelines governing the use of gloves, and they include the following: You must wear gloves when you anticipate hand contact with blood, potentially infectious materials, mucous membranes or noncontact skin. If you are allergic to latex or vinyl gloves, your employer will provide hypoallergenic gloves, glove liners, powder-less gloves or another alternative. Since gloves can be torn or punctured by sharps, bandage any cuts before being gloved. Replace disposable single-use gloves, such as examination gloves, as soon as possible if contaminated, torn, punctured or damaged in any way. Never wash or decontaminate for reuse. Utility gloves may be decontaminated and reused unless they are cracked, peeling, torn, punctured, or no longer provide barrier protection. Taking gloves off would at appear to be a relatively easy thing to do. However, there is a safe procedure for glove removal that must be followed. It is designed to limit the potential for exposure from soiled gloves and is as follows: Page 7 Bloodborne Pathogens 1. With both hands gloved, peel one glove off from top to bottom and hold it in the gloved hand. 2. With the exposed hand, peel the second glove from the inside, tucking the first glove inside the second. 3. Dispose of the entire bundle promptly. 4. Remove gloves when they become contaminated, damaged or before leaving the work area. 5. Wash your hands thoroughly. Housekeeping In your facility’s Exposure Control Plan, specific housekeeping procedures should be addressed. Here are some general rules: Clean and decontaminate at the end of each work shift. Clean all equipment and environmental working surfaces as soon as possible after contact with potentially infectious materials. Do not pick up broken glass that may be contaminated with gloved or bare hands. Use tongs or a brush and a dustpan. Place contaminated sharps and infectious wastes in designated sharps containers. The containers should be labeled or colorcoded leak-proof containers that are sealed and easily accessible to those who use them. Do not allow containers to over-fill. Handle contaminated laundry as little as possible and with minimal agitation. Place soiled laundry in labeled or color-coded leak-proof bags or containers without sorting or rinsing. Container labels for potentially infectious materials must have a readily visible biohazard warning sign or symbol. Such a label should also be used to designate contaminated equipment. HBV Vaccination As a designated first responder, should you be exposed to blood or other infectious materials, your employer will make the hepatitis B vaccination available to you at no cost. Administration of the vaccination should begin within 24 hours of exposure. A complete series of vaccinations includes three injections over a six-month period. Such a vaccination is highly effective in preventing the development and carrying of the hepatitis B virus for nine years or longer. Page 8 Bloodborne Pathogens You should not be vaccinated if: You have already received the complete hepatitis B vaccination series. Antibody testing reveals you are immune. There are other specific medical reasons. Additional Information If you are exposed, report the incident immediately to your supervisor. If you consent, your employer will provide you with a confidential medical evaluation, including blood tests, any available postexposure preventive treatment and follow-up counseling. Your employer will provide you with a free training program during working hours before you assume a job with occupational exposure and annually thereafter. Page 9 Bloodborne Pathogens Quiz Name _________________________ Circle the appropriate response to the following: 1) True False The hepatitis B virus is easily cured. 2) True False HIV and HBV may be present in body fluids other than blood. 3) True False A broken windshield is considered a potentially contaminated sharp. 4) True False You can find your employer’s Exposure Control Plan at the local library. 5) True False When recapping needles, it is important to use two hands. Circle the letter that most correctly answers the question or statement. 6) Which of the following is not a potential route of entry into the body for bloodborne pathogens. a) facial acne b) cold sore c) skin absorption d) hangnail 7) If you are exposed to blood or other body fluids without proper PPE, you should report the incident to your supervisor: a) immediately b) sometime within 4 hours c) just before you leave work d) wait to see if you develop symptoms 8) The only time that you do not have to wear PPE is: a) when it is uncomfortable b) when it is not fashionable to do so c) if the victim tells you that they do not have a bloodborne pathogen d) if use of the equipment will prevent proper medical attention or is a safety hazard Page 10 Bloodborne Pathogens 9) A rule governing the use of PPE would be: a) it must be appropriate for the task b) it must be color coordinated c) it must comfortable to wear at all times d) it must be reusable 10) What is not true about HBV vaccinations? a) must be made available at no cost if you have been exposed to blood or other body fluids b) is a series of three injections c) only good for 1 year d) must be administered within 24 hours of exposure 11) Describe the five steps for safely removing gloves. 12) List three means of transmission for bloodborne pathogens. 13) What bloodborne pathogen can exist on a dry surface for at least a week? 14) Name the two most significant bloodborne diseases in the workplace. 15) What are the five major tactics used to reduce your risk of exposure? 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