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Bloodborne Pathogens
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.
Bloodborne Pathogens
 Pathogenic micro-
organisms present
in human blood that
can lead to diseases
 Most common in US
– Human immunodeficiency virus (HIV)
– Hepatitis B (HBV)
– Hepatitis C (HCV)
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 (HAV)
 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
 Hepatitis A infection occurs in epidemics both
nationwide and in communities
 Hepatitis A is NOT bloodborne and, therefore, is
NOT covered by the bloodborne pathogen
standard
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 infection with the hepatitis A
virus
 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
 Hepatitis B is a disease of the liver caused by
infection with the hepatitis B virus (HBV)
 Infection occurs when blood or body fluids from an
infected person enters the body of a person who is
not immune
 HBV is spread through:
– 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)
– Sharing drugs, needles, or "works" when "shooting"
drugs
– Exposure to blood and body fluids on the job
– From an infected mother to her baby during birth
Hepatitis B
 HBV can cause lifelong infection, cirrhosis
(scarring) of the liver, liver cancer, liver failure,
and death
 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
 If you are pregnant, get a blood test for hepatitis B
 Never share drugs, needles, syringes, or "works“
 Do not share personal care items that might have
blood on them (razors, toothbrushes)
 Do not come into contact with another person’s blood
or body fluids at work
Hepatitis C
 Hepatitis C is a disease of the liver caused by
infection with the hepatitis C virus (HCV)
 Infection occurs when blood or body fluids from an
infected person enters the body of a person who is
not infected
 HCV is spread through
– Sharing needles or "works" when "shooting" drugs,
– Exposure to blood and body fluids on the job
– From an infected mother to her baby during birth
 55%-85% of infected persons are chronically
infected
 70% of chronically infected persons develop chronic
liver disease
Hepatitis C
 Hepatitis C infection is the leading indication for
liver transplant
 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)
 Do not come into contact with another
person’s blood or body fluids at work
Hepatitis D
 Hepatitis D is a liver disease caused by infection
with 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 infection with
the hepatitis E virus (HEV)
 It is transmitted in much the same way as hepatitis
A virus through the fecal/oral route
 Hepatitis E virus is NOT bloodborne and is
NOT covered by the bloodborne pathogen
standard
 Hepatitis E virus does not occur often in the United
States
Viral Hepatitis - Overview
Type of Hepatitis
A
Source of
virus
feces
Route of
transmission
Chronic
infection
Prevention
B
C
D
E
blood/
blood/
blood/
feces
blood-derived blood-derived blood-derived
body fluids body fluids body fluids
fecal-oral percutaneous percutaneous percutaneous fecal-oral
permucosal permucosal permucosal
no
yes
yes
yes
no
pre/postblood donor
pre/post- ensure safe
pre/postexposure
exposure
screening;
exposure
drinking
immunization immunization risk behavior immunization; water
modification risk behavior
modification
HIV
 Human immunodeficiency virus
 Infection occurs when blood or body fluids from an
infected person enters the body of a person who is
not infected
 HIV is spread through:
– Sex with an infected person without using a condom (the efficacy of
latex condoms in preventing infection with HIV is unknown, but their
proper use may reduce transmission)
– Sharing drugs, needles, or "works" when "shooting" drugs
– Exposure to blood and body fluids on the job
– From an infected mother to her baby when she is pregnant, when she
delivers the baby, or if she breast-feeds her baby
 Leads to the disease AIDS
 Destroys the immune system
HIV/AIDS Symptoms
 You cannot rely on symptoms to know whether or
not you are infected
 The only way to know if you are infected is to be
tested for HIV infection
 Many people who are infected with HIV do not have
any symptoms at all for 10 years or more
 You also cannot rely on symptoms to establish that a
person has AIDS
 The symptoms of AIDS are similar to the symptoms
of many other illnesses
 AIDS is a medical diagnosis made by a doctor
based on specific criteria established by the CDC
HIV Prevention
 Use latex condoms correctly and every time you
have sex
 Don’t share, syringes, or “works” used to inject
drugs, steroids, vitamins, etc.
 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
 Don’t share razors or toothbrushes because of the
possibility of contact with blood
 Do not come into contact with another person’s
blood or body fluids at work
You Cannot “Catch” 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 open-mouthed or
"French" kissing with an infected person because of
possible blood contact)
Other Bloodborne Diseases









Syphilis
Malaria
Brucellosis
Babeosis
Leptospirosis
Arborviral Infections
Relapsing Fever
Creutzfeld-Jacobs Disease--Mad-cow
Viral Hemorrahgic Fever--Ebola
The Bloodborne Pathogen Standard
29 CFR 1910.1030
 1.
 2.








Written Exposure Control Program
Engineering Controls (safer medical devices) and work
practice controls
3. Personal Protective Equipment
4. Housekeeping
5. Hepatitis-B vaccine and antibody test
6. Confidential follow-up and evaluation of circumstances in
event of a needlestick or other exposure incident
7. Labeling
8. Initial and Annual training.
9. Sharps Injury Log
10. Recordkeeping
Scope of the Standard
 Covers all employees with reasonable
anticipation of exposure to potentially
infectious materials (bloodborne pathogens)
 Applies to general industry situations only
 Does not apply to the construction industry
 5.6 million workers in health care and
public safety occupations are covered
Potentially Infectious Materials- Any visibly
 Blood (human) contaminated body
fluid
 Semen
 Vaginal secretions  Any body fluid where
 Cerebrospinal fluid differentiation is
difficult
 Pleural fluid
 Any unfixed tissue or
 Pericardial fluid
organ
 Peritoneal fluid
 Aqueous and vitreous
 Amniotic fluid
humors in the eyes
 Saliva in dental proc.
Modes of Transmission
 Stick or Cut
 Splash to mucous membranes of the eyes,
nose, mouth
 Non-intact skin exposure
Universal Precautions
 Must be observed
 All blood and body fluids are treated as if
known to be infected with HIV, HBV,
HCV, etc.
 Key to Prevention of Infection
– Do not come into contact with
another person's blood or body
fluids
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
– Each employee should know the procedure to
follow to obtain a copy
Exposure Control Plan
 Safer Medical Devices
– The Exposure Control Plan must be updated every
12 months to reflect evaluation, consideration, and
selection of appropriate devices
– Document in the plan the devises evaluated and
those currently used
– Front line employees must be involved in the
selection of devices and their involvement must be
documented
Handwashing
 The single most important aspect of
infection control
 Wash hands when contaminated with
blood or body fluids and after removing
personal protective equipment
 Use antiseptic hand cleaner clean
paper/cloth towels or antiseptic
towelettes when "in the field"
 Wash hands with soap and water asap
Needles/Sharp Objects
 Use sharps with sharps injury prevention or needleless






systems for all procedures involving sharps
Place in puncture resistant, labeled, leak-proof 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
Do not overfill sharps containers
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
employees
 Must be accessible to the employees
 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
 Gloves
– patient care and utility
 Mucous membrane
– splash
 gowns
 Non-intact skin
– spill or splash
goggles/faceshields
 masks
 pocket masks
 shoe covers
 glasses/
Decontamination
 Written decontamination schedule must be part
of the exposure control plan
 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
Regulated Waste
 Sharps containers
– Needles
– Blades
– Broken glass
 Red bags
– Liquid or semi-liquid blood or
OPIM
– Items caked with dried blood or
OPIM
– Items that could release blood or
OPIM
– Pathological waste
– Microbiological waste
Hepatitis B Vaccination
 The employer must offer the HBV vaccination to
exposed employees after they have received training
and within 10 working days of job assignment
– At no cost to the employee
– Provided by PLHCP (see next slide)
– 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
What is a PLHCP?
 PLHCP = Physician or Other Licensed
Health Care Professional
 In Tennessee, licensing boards have
determined a PLHCP is a:
– Physician
– Physician’s Assistant
– Advanced Practice Nurse
HBV Vaccination
 Must be offered to all exposed employees
 Exposed employees may decline to take the
shots, but must sign a declination statement
 Highly recommended and safe
 Few contraindications
 Three-shot series—titer 1-2 months after
last shot
 No booster currently recommended
Health Care Professional’s
Written Opinion for Hepatitis B
Vaccination
 A PLHCP must determine if the shots are
appropriate for each employee
 The PLHCP must provide to the employer a
Health Care Professional’s Written Opinion for
each employee who takes the shots
– A copy must be provided to the employee within 15
days of completion of the evaluation
 Employee 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 to the employee
 Begin ASAP after exposure incident
 Report exposure incidents to your
supervisor or designated personnel
immediately
Post-Exposure Follow-up
 The employer must:
– Investigate the incident
– ID source individual, obtain consent, and test
his/her blood to determine HBV, HCV, and
HIV infectivity ASAP, if possible
– Give the results of source individual's test to the
exposed employee
– Obtain and test exposed employee's blood for
HBV, HCV, and HIV serological status
Post-Exposure Follow-up
 Provide post-exposure prophylaxis to the exposed
employee as indicated by the CDC
– “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
– “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
 Provide counseling to the exposed employee
 Provide evaluation of illness reported by the employee
Health Care Professional’s Written
Opinion for Post-Exposure Follow-Up
 The post–exposure follow-up must be provided by
or under the supervision of a PLHCP
 The PLHCP must provide to the employer a
Health Care Professional’s Written Opinion for
each employee who has a post-exposure follow-up
– The employee must 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
 On refrigerators,
freezers, and other
containers with
contaminated items
 Can substitute red
containers
Training
 For all employees listed in the Exposure
Determination
 At no cost to employees
 During working hours
 At the time of initial assignment
 Annually--within 12 months of last training date
 Must be an opportunity for interactive questions
and answers
 Train employees on adopted safer needle devices
before implementation
How TOSHA Evaluates
Employee Training
 Recall
– Employees must be able to answer simple
questions about bloodborne pathogens, the
bloodborne pathogen standard, and other
material as specified in 29 CFR 1910.1030,
paragraph (g)(2)(vii).
Recall Questions
 Five Easy Questions
– What is universal precautions?
– What do you do when there is a blood spill?
• Personal protection
• Clean-up and disposal procedures
• Disinfection (hazard communication applies)
– What do you do with contaminated sharps and
laundry?
– Have you been offered the HBV vaccination free
of charge?
– Where is the Exposure Control Plan?
Additional Training
 Copy of the BBP standard, 29 CFR 1910.1030,
must be accessible to employees
 Epidemiology, symptoms, and modes of
transmission of bloodborne diseases
 Engineering and work practice controls in practice
 Explanation of methods of recognizing tasks that
may involve exposure to blood and/or body fluids
 Information on types, use, location, removal,
handling, decontamination, and disposal of personal
protective equipment (ppe)
Additional Training
 Basis of selection of PPE
 Information on hepatitis B vaccine
 Explanation of the labeling system
 Actions to take and persons to contact in a
bloodborne emergency
 Procedure to follow if exposure incident
occurs
 Opportunity for interactive Q & A
Records
 Medical records
– Name and social security number
– Hepatitis B vaccination status
– Dates of hepatitis B vaccination
– 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
Records
Sharps Injury Log
– Per the Tennessee Sharps Injury
Prevention law
– Employer must keep a log of all sharps
injuries with
• Type and brand of device involved in the
incident
• Department or work area where the incident
occurred
• Explanation of how the incident occurred
Call TOSHA
 Memphis Office
 Jackson Office
 Nashville Office
 Knoxville Office
 Kingsport Office
 Chattanooga
 Consultative Services
901-543-7259
731-423-5641
615-741-2793
1-800-249-8510
865-594-6180
423-224-2042
423-634-6424
1-800-325-9901
Web Resources
 Federal OSHA
• www.osha.gov
 TOSHA
• www.tennessee.gov/labor-wfd/tosha
 Centers for Disease Control
• www.cdc.gov
 National Institute of Occupational Safety and
Health
• www.cdc.gov/niosh
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