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Content Reviewed 03/06/2008 |
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Healthcare Wide Hazards
Bloodborne Pathogens
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Click on the area for more specific information.
Common safety and health topics:
Bloodborne Pathogens Standard
As mandated by the Needlestick Safety and Prevention
Act, OSHA revised the Bloodborne Pathogens
Standard [29 CFR 1910.1030],
effective April 18, 2001.
Definitions for bloodborne pathogens, other potentially infectious materials (OPIM), and occupational exposure are found in
29
CFR 1910.1030(b).
Potential Hazard
-
Employee exposure to blood and OPIM [29 CFR 1910.1030(b)]
due to ineffective Exposure Control Plan (ECP).
Possible Solutions
-
Identify employees who have occupational exposure to blood or OPIM [29 CFR
1910.1030(b)], and then establish and implement a written Exposure Control
Plan (ECP), designed to eliminate or minimize employee exposure [29 CFR
1910.1030(c)(1)].
-
Exposure Control Plan requirements include:
- Documenting an annual review and update of the written plan that
reflects changes in technology for safer medical devices [29 CFR 1910.1030(c)(1)(iv)(A)].
Employers must also document consideration and implementation of the safer medical devices
annually [29 CFR 1910.1030(c)(1)(iv)(B)].
- Employer must get input for the devices from those responsible
for direct patient care [29 CFR 1910.1030(c)(1)(v)].
This input must also be documented.
-
Employer should ensure that the Exposure Control Plan (ECP) is accessible to all employees [29 CFR
1910.1030(c)(1)(iii)]. They should also review and update it at least yearly [29 CFR 1910.1030(c)(1)(iv)].
- Employer should ensure that employees with occupational exposure to bloodborne
pathogens receive appropriate training, at no cost to employee, and
during working hours [29 CFR 1910.1030(g)(2)(i)
and 29 CFR 1910.1030(g)(2)(vii)].
For additional information, see Healthcare Wide Hazards -
Needlesticks/Sharps
Injuries.
Additional Information
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Potential Hazard
- No post-exposure follow-up made available after a needlestick/sharps
injury to help document injury or offer medically indicated post-exposure
prophylaxis.
Possible Solutions
- Employer should ensure that a Post-Exposure Evaluation and Follow-up is in place to handle needlestick/sharps injuries.
- Employer should provide a confidential medical evaluation and follow-up to the exposed
employee, immediately following the report of an exposure incident [29 CFR 1910.1030(f)(3)].
It is recommended that the follow-up include identifying injury patterns
and accident analysis to determine if other training, procedures, or safer
needle devices should be used to prevent future accidents.
- Post-exposure evaluation and follow-up should include:
- Maintain a log of injuries from
contaminated sharps [29 CFR 1910.1030(h)(5)].
- The
National
Institute for Occupational Safety and Health (NIOSH) recommends
that if an employee experiences a needlestick/sharps injury or is exposed to blood or other body fluid during the course of work
that the following steps be taken immediately:
- Wash needlestick and cuts with soap and water.
- Flush splashes to the nose, mouth, or skin with water.
- Irrigate eyes with clean water, saline, or sterile irrigates.
- Report the incident to your supervisor.
- Seek medical treatment immediately.
- Questions about appropriate medical treatment for occupational exposures to blood
is available 24 hours from
the Clinicians'
Post Exposure Prophylaxis Hotline (PEPline) (1-888-448-4911).
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Recordkeeping for Bloodborne Pathogens
Potential Hazard
- Lack of information to adequately implement a bloodborne pathogens program
or address bloodborne pathogen hazards.
Possible Solutions
- Employer should establish and maintain both medical and training records [29
CFR 1910.1030(h)(1) and 29 CFR
1910.1020].
- If an exposure incident occurs, employer should add reports to the medical
record to document the incident, including testing results following the
incident, follow-up procedures, and the written opinion of the health care
professional.
-
Medical Records must be preserved and maintained for each employee with
an occupational exposure to bloodborne pathogens [29 CFR 1910.1030(h)(1)]
and for at least the duration of employment plus 30 years. They must be
kept confidential (not disclosed without written permission of
employee, except by law) and separate from other personnel records and must also include:
- The employee's name and social security number, hepatitis B vaccination status, including the dates of vaccination and medical
records related to the employee's ability to receive vaccinations.
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Training Records must be established and maintained for all exposed employees for 3
years, from the date the training occurred. They must include [29 CFR 1910.1030(h)(2)]:
- The names and job titles of all persons attending the training
sessions, the dates, and content of the training sessions, and the names
and qualifications of all trainers.
- Whenever an employer is ceasing to do business and there is no
successor employer to receive and maintain the records subject to this
standard, the employer must notify affected current employees of their
rights of access to records at least three (3) months prior to the
cessation of the employer's business. [29
CFR 1910.1020(h)(2)]
- Employer must make both medical and training records available
upon request to: [29 CFR
1910.1030(h)(3)(ii)]
- Director of NIOSH.
- Assistant Secretary of Labor for the Occupational Safety and Health.
- Employees or employee representatives (someone having written consent of the employee).
- Employer must maintain a log of injuries from contaminated sharps [29
CFR 1910.1030(h)(5)] for
each injury including:
NOTE: If an employer is not required to maintain injury/illness log under 1904, then this does not apply [29 CFR 1910.1030(h)(5)(ii)].
Additional Information
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Potential Hazard
-
Exposure to blood and OPIM from needlestick injuries due to:
Possible Solutions
For additional information, see Healthcare Wide Hazards -
Needlesticks/Sharps
Injuries.
Additional Information
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Other Sharps
"Contaminated Sharps" means any contaminated object that can penetrate the skin including, but not limited to, needles,
scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires
[29 CFR
1910.1030(b)].
Potential Hazard
- Exposure to blood and OPIM through other sharps:
Possible Solutions
- Implement engineering and work practice controls to help prevent exposures.
For additional information, see Healthcare Wide Hazards -
Needlesticks/Sharps
Injuries.
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Universal Precautions
An approach to infection control which treats all human blood and other potentially infectious materials as if
they were known to be infectious for HIV, HBV or other bloodborne pathogens [29 CFR
1910.1030(b)].
Potential Hazard
-
Exposure to bloodborne pathogens due to lack of universal precautions.
Possible Solutions
- Employer should implement universal precautions
[29 CFR 1910.1030(d)(1)].
- Treat all blood and other potentially infectious materials with appropriate precautions.
- Use gloves, masks, and gowns if blood or OPIM exposure is anticipated.
- Use engineering and work practice controls to limit exposure.
There are other concepts in infection control that are acceptable alternatives to universal precautions, such as Body Substance
Isolation (BSI) and Standard Precautions [OSHA CPL
02-02-069 (CPL 2-2.69)]. These methods define all body fluids and substances as infectious and incorporate not only the fluid and materials covered by the
Bloodborne Pathogens Standard, but expand coverage to include all body fluids and substances.
For additional information, see Healthcare Wide Hazards -
Universal Precautions.
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Personal Protective Equipment (PPE)
Potential Hazard
- Exposure to blood and OPIM due to an ineffective Personal Protective Equipment (PPE) program.
Possible Solutions
- Appropriate use of Personal Protective Equipment (PPE). PPE is required by the
Bloodborne Pathogens Standard (if exposure to blood and OPIM is anticipated and where occupational exposure remains, after institution
of engineering and work practice controls) [29 CFR 1910.1030(d)(2)(i)].
- Wear gloves when hand contact with blood, mucous membranes, OPIM, or non-intact skin is
anticipated, and when performing vascular access procedures, or
when handling contaminated items or surfaces [29 CFR 1910.1030(d)(3)(ix)].
- Employer must ensure that employees wash hands and any other skin with soap and water or flush mucous membranes with water as soon
as feasible after contact with blood or other potentially infectious materials (OPIM)
[29 CFR 1910.1030(d)(2)(vi)].
- Employers must provide readily accessible hand washing facilities [29
CFR 1910.1030(d)(2)(iii)].
- Dispose of PPE. Protective clothing must be removed before
leaving the work area [29 CFR 1910.1030(d)(3)(vii)],
and disposed of in an appropriately designated area or container for storage, washing, decontamination or disposal
[29 CFR 1910.1030(d)(3)(viii)].
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Potential Hazard
-
Exposure to latex in products like latex gloves and developing latex sensitivity or a latex allergy.
Possible Solutions
-
Employers must provide appropriate gloves when exposure to blood or other potentially infectious materials (OPIM) exists
[29 CFR
1910.1030].
- Alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided
[29 CFR 1910.1030(d)(iii)].
For additional information, see Healthcare Wide Hazards -
Latex Allergy.
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Hepatitis is an inflammation of the liver that can
lead to liver damage and death. The annual number of occupational
infections has decreased 95% since hepatitis
B vaccine became available in 1982, from more than 10,000 in 1983 to less
than 400 in 2001. Hepatitis B vaccine immunizations and compliance with
other provisions of OSHA's Bloodborne Pathogens Standard may reduce
infections.
Potential Hazard
-
Exposure to a potentially fatal bloodborne illnesses such as Hepatitis B Virus (HBV).
- Hepatitis is much more transmissible than HIV.
- Risk of infection from a single needlestick is 6%-30%.
- 50% of the people with HBV infection are unaware that they have
the virus.
- The CDC states that HBV can survive for at least one week in dried blood on environmental surfaces or contaminated needles and instruments.
For additional information, see
Contaminated Work Environments.
Possible Solutions
- Employer should implement an effective exposure control plan [29 CFR 1910.1030(c)(1)] to prevent exposure.
-
Employer must offer all employees who have occupational exposure to
blood or OPIM, under the supervisions of a licensed physician the
hepatitis B vaccination [29 CFR 1910.1030(f)(2)]:
- Employer should offer testing for antibody to hepatitis B surface antigen one to
two months after the completion of the three-dose vaccination series.
- Employees who do not respond to the primary vaccination series must be offered a second three-dose vaccine series and retesting.
Non-responders must be offered medical evaluation [29 CFR 1910.1030(f)(1)(ii)(D)].
- Employee must be offered a timely post-exposure follow-up with
hepatitis B immune globulin and initiation of hepatitis B vaccine [29
CFR 1910.1030(f)(1)(ii)(D)].
- A healthcare professional's written opinion is required after an exposure incident [29 CFR 1910.1030(f)(5)(ii)].
- Employer should make immediately available a confidential medical evaluation and
follow-up [29 CFR 1910.1030(f)(3)], following a report of an exposure incident.
- Employer must
maintain a log of injuries
from contaminated sharps
[29 CFR
1910.1030(h)].
Additional Information
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Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens Standard. OSHA
Directive CPL 02-02-069 [CPL 2-2.69], (2001, November
27).
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A Comprehensive Immunization Strategy to Eliminate Transmission of
Hepatitis B Virus Infection in the United States. Centers for Disease
Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR)
55(RR16);1-25, (2006, December 8).
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Immunization of Health Care workers. Centers for Disease Control and
Prevention (CDC), Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the
Hospital Infection Control Practices Advisory Committee (HICPAC) 46(RR-18);1-42, (1997, December 26).
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Bloodborne Pathogens in Healthcare Settings. Centers for
Disease Control and Prevention (CDC), Division of Healthcare Quality Promotion, (2001).
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Updated U.S. Public Health Service Guidelines for the Management of
Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis.
Centers for Disease Control and Prevention (CDC) Morbidity and Mortality
Weekly Report (MMRW) 50(RR11);1-42, (2001, June 29). Also available as a
334 KB PDF, 67 pages.
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Viral Hepatitis. Centers for Disease Control and Prevention (CDC),
National Center for HIV, STD, & TB Prevention.
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HIV infection has been reported following occupational exposures to HIV-infected blood through needlesticks or cuts; splashes in the
eyes, nose, or mouth; and skin contact. Most often, however, infection occurs from needlestick injury or cuts. Currently, no vaccine currently exists to prevent HIV infection, and no treatment exists to cure it.
Potential Hazard
-
Exposure to potentially fatal bloodborne illnesses such as Human Immunodeficiency Virus (HIV).
- Risk of HIV infection after needlestick is 1 in 3,000 or 0.3%.
- The CDC documented 55 cases and 136 possible cases of occupational HIV transmission to
US healthcare workers between 1985 and
1999.
Possible Solutions
- Employer should implement an effective exposure control plan [29 CFR 1910.1030(c)(1)] to prevent exposure.
- Employer must, under certain circumstances, provide post-exposure prophylaxis for HIV to healthcare workers who have an exposure incident [29 CFR 1910.1030(b)].
- Limited data suggests that such prophylaxis may considerably reduce the chance of becoming infected with HIV. However, the drugs
used for prophylaxis have many adverse side effects.
- Employer must offer employees who have an incident a confidential medical evaluation and follow-up
[29 CFR 1910.1030(f)(3)].
- Employer must
maintain a log of injuries
from contaminated sharps
[29 CFR
1910.1030(h)].
Additional Information
-
Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens Standard. OSHA
Directive
CPL 02-02-069 [CPL 2-2.69], (2001, November
27).
-
Updated U.S. Public Health Service Guidelines for the Management of
Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis.
Centers for Disease Control and Prevention (CDC) Morbidity and Mortality
Weekly Report (MMRW) 50(RR11);1-42, (2001, June 29). Also available as a
334 KB PDF, 67 pages.
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Updated U.S. Public Health Service Guidelines for the Management of
Occupational Exposures to HIV and Recommendations for Postexposure
Prophylaxis. Centers for Disease Control and Prevention (CDC),
Morbidity and Mortality Weekly Report (MMWR) 54(RR09); 1-17, (2005,
September 30). Updates US Public Health Service recommendations for the
management of the health-care personnel (HCP) who have occupational
exposure to blood and other body fluids that might contain human
immunodeficiency virus.
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HCV infection is the most common chronic bloodborne infection in the United States.
Hepatitis C infection is caused most commonly by needlestick injuries. HCV infection often occurs with no symptoms, however chronic infection can develop which may lead to active liver disease. Currently there is no vaccine available for hepatitis C.
Potential Hazard
-
Exposure to potentially fatal bloodborne illnesses such as Hepatitis C Virus (HCV), which is a major cause of chronic liver disease.
- Risk of HCV infection after needlestick is 1.8%.
Possible Solutions
- Employer should implement an effective exposure control plan [29 CFR 1910.1030(c)(1)] to prevent exposure.
- Employer must offer employees who have an incident a confidential medical evaluation and follow-up
[29 CFR 1910.1030(f)(3)].
- A healthcare professional's written opinion is required after an exposure incident [29 CFR 1910.1030(f)(5)(ii)].
- Immunoglobulin or antiviral therapy is not recommended and no effective post-exposure
prophylaxis is known at this time (CDC 1998).
Additional Information
-
Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens Standard. OSHA
Directive CPL 02-02-069 [CPL 2-2.69], (2001, November
27).
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Hepatitis C: What Clinicians and other Health Professionals Need to Know.
Centers for Disease Control and Prevention (CDC), (2001).
-
Bloodborne Pathogens in Healthcare Settings. Centers for
Disease Control and Prevention (CDC), Division of Healthcare Quality Promotion, (2001).
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Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease.
Centers for Disease Control and Prevention (CDC), Morbidity and
Mortality Weekly Report (MMWR) 47(RR19);1-39, (1998, October 16).
-
Updated U.S. Public Health Service Guidelines for the Management of
Occupational Exposures to HBV, HCV, and HIV and Recommendations for ostexposure Prophylaxis.
Centers for Disease Control and Prevention (CDC) Morbidity and Mortality
Weekly Report (MMRW) 50(RR11);1-42, (2001, June 29). Also available as a
334 KB PDF, 67 pages.
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Viral Hepatitis C.
Centers for Disease Control and Prevention (CDC), National Center for HIV, STD, & TB Prevention.
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Labeling and Signs
Potential Hazard
- Exposure to bloodborne pathogens due to improper labeling of potential hazards.
Possible Solutions
- Implement labeling and signs.
- Exception for Blood Products. Individual containers of blood, blood components or
products that are labeled as to their contents and have been released for transfusion or other clinical use need not be labeled as
hazardous [29 CFR 1910.1030(g)(1)(i)(F)].
- Individual containers of blood or OPIM need not be labeled if placed in a labeled container for storage, transport, shipment or
disposal [29
CFR 1910.1030(g)(1)(i)(G)].
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