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Preventing Exposures to Preventing Exposures to Blood Borne PathogensBlood Borne Pathogens

Updated 10/06

All Staff

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What is exposure control?What is exposure control?

Exposure control is an approach to eliminate employee contact to a potential health hazard.

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Elements of an exposure Elements of an exposure control plancontrol plan

• Exposure determination• Methods of compliance:

– universal precautions – work practices – engineering controls– use of personal protective equipment

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Elements of an exposure Elements of an exposure control plancontrol plan

• Hepatitis B vaccination program • Procedure for evaluation of exposure incidents • Post-exposure evaluation and follow-up• Inclusion of evaluation of safer engineering

devices

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Where is your exposure Where is your exposure control plan located?control plan located?

• A copy of your exposure control plan should be maintained by your

employer.• It should be reviewed and updated

annually.• You should have access to the plan

for review.

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Why is an exposure control Why is an exposure control plan important ?plan important ?

Identifies employees at risk for exposure to bloodborne pathogens

Provides for the education of employees regarding the bloodborne pathogen risk and how to avoid this risk

Provides a mechanism to educate employees about the uses and limitations of engineering controls, work practices and personal protective equipment

Provides a plan for post-exposure follow-up

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What is an occupational What is an occupational exposure?exposure?

An “occupational exposure is a reasonably anticipated skin, eye, mucous membrane, non-intact skin or parenteral contact with blood and other potentially infectious materials that may result from the performance of an employee’s duties.”

OSHA

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How can exposures be How can exposures be prevented?prevented?

1) Your employer should identify job categories at risk for exposure.

2) Consistent use of universal precautions for all clients.

3) Use of personal protective equipment.

4) Use of engineering controls .

5) Use of safe work practices.

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Prevention is the key!Prevention is the key!

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How are bloodborne pathogens How are bloodborne pathogens transmitted?transmitted?

Hepatitis B and C and HIV are transmitted in a Hepatitis B and C and HIV are transmitted in a

healthcarehealthcare setting: setting:

by needle stick injuries contact with blood or body fluids through

cuts, scrapes and breaks in the skin splashes to the eye, nose and mouth area

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What are the symptoms of What are the symptoms of Hepatitis B and C?Hepatitis B and C?

Hepatitis attacks the liver and may cause serious liver disease.

Sometimes jaundice occurs with these infections.

Hepatitis can feel like a flu-like illness for months.

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Do people with hepatitis Do people with hepatitis always have symptoms?always have symptoms?

Some people never have symptoms. Others are considered in a chronic carrier

state - no symptoms but can pass the disease to others

HBV can lead to cirrhosis, liver cancer and death.

Hepatitis C may lead to cirrhosis of the liver.

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How many cases of How many cases of Hepatitis B occur each year?Hepatitis B occur each year?

Approximately 140,000 - 320,000 cases occur each year.

20,000 people go on to be chronic carriers 850 people will develop chronic liver

problems 140-320 people will die from active

Hepatitis B each year

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How many cases of How many cases of Hepatitis C occur each year?Hepatitis C occur each year?

35, 000 - 180,000 Americans become infected with HCV per year

HCV is associated with 8,000 - 10,000 deaths each year (chronic liver disease

> 85% of people who become infected with HCV will go on to develop chronic infection

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HIVHIV

The number of people with HIV and AIDS continues to increase.

Total number of people living with HIV/AIDS is 40 million as of 2003

Approximately 5 million people were newly infected with HIV in 2003

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What are the symptoms of What are the symptoms of HIV?HIV?

HIV attacks the body’s immune system Many people are infected but do not know

they have been infected. Early symptoms of AIDS may include

fever, loss of appetite, weight loss, chronic fatigue and skin rashes.

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Prevention ApproachesPrevention Approaches

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Contact task categories Contact task categories

Category I - Routine contact with blood and body fluids

Category II - Occasional contact with blood and body fluids

Category III - No contact with blood and body fluids

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Written Policies which:Written Policies which:

prohibit recapping, breaking or shearing needles specify safe practices when handling reusable

sharps require use of mechanical means to clean up

broken glassware disposal of contaminated sharps

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Standard PrecautionsStandard Precautions

All blood and body fluids are treated as if known to be infectious for HIV, HBV and HCV

Consistently used with all clients

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Engineering ControlsEngineering Controlscontrols that either remove the hazard or

isolate the worker from the hazard

Examples of controls are sharps disposal containers, self-sheathing needles, or biosafety cabinets.

Employees must be instructed in the use of engineering controls.

There must be regular inspection and replacement of engineering controls.

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Safe Work PracticesSafe Work Practices These practices prevent exposures.These practices prevent exposures.

HANDWASHING facilities should be close to the work area.

Handling of contaminated equipment and processing of specimens.

Identification of high risk areas by use of biohazard labeling.

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Safe Work PracticesSafe Work Practices

no eating, drinking, smoking, applying lip balm or cosmetics, or handling of contact lenses in the work areas where there is a risk of exposure.

handwashing alternatives when running water is not available

universal precautions when handling all specimens all contaminated equipment must be

decontaminated prior to servicing

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Personal Protective BarriersPersonal Protective Barriers

Must be provided at no cost to the employee nor can cost be past on to clients.

Include barriers such as fluid-resistant gloves, gowns, face shields, and masks.

Employees must be trained in the proper use and selection of PPE.

Must be easily accessible

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Hepatitis B immunizationHepatitis B immunization Educate employee on risk of BBP Free to employee Voluntary If employee declines, a declination form

must be signed. Offer within 10 days of beginning

employment Three injections over 6 months Verify sero-conversion 30 days post

immunization

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Hepatitis B immunizationHepatitis B immunization Non-converters

Re-immunize with the complete series Retest 30 days post completion of the second

series. If employee does not demonstrate immunity, consider as “non responder” and not immune to Hepatitis B.

If exposed to active HBV, administer Hepatitis B Immune globulin

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Contaminated MaterialsContaminated Materials

procedures must be followed to decontaminate the environment,equipment, laundry and work surfaces

procedure for collecting, transporting and disposal of waste

schedule for cleaning and decontamination of worksite based on location, type of surface, soil and tasks involved

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Handling Contaminated Handling Contaminated MaterialMaterial

universal precautions label with biohazard labeling or use red

bags for disposal requirements for disposal include:

close-able, labeled containers, constructed to prevent leakage during handling, storage, or transporting.

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Compliance MonitoringCompliance Monitoring

Employers are required to ensure that employees are following the practices.

Employee health/infection control programs Management monitoring Investigation of exposure circumstances

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Post exposure follow-upPost exposure follow-up

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Post exposure follow-upPost exposure follow-up

Determination as to who will be the provider Compliance with Maryland state laws and

OSHA regulations Written informed consent of employee and

source prior to HIV testing Evaluation of incident to prevent

re-occurrence

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Post Exposure Follow-upPost Exposure Follow-up

After signed informed consent of After signed informed consent of employee and source:employee and source:

employee baseline testing to include: Hepatitis B surface antibody Hepatitis C antibody HIV

source testing to include: Hepatitis B antigen Hepatitis C antibody HIV

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What should be sent What should be sent with the employee?with the employee?

Copy of the OSHA BBP regulations Description of duties and responsibilities as

related to the exposure Documentation of routes of exposure and

circumstances under which the incident occurred

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What should be sent What should be sent with the employee?with the employee?

source and employee’s blood work (should be confidential and sent directly to the outside provider)

relevant employee records regarding immunization

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Elements of healthcare Elements of healthcare professionals evaluationprofessionals evaluation

Healthcare professional’s opinion stating the employee was counseled and advised will be sent to the employer

Employee should anticipate a written opinion of the visit within 15 days. Opinion should contained detailed information.

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Related issuesRelated issues

Communicable disease Communicable disease reporting and notificationreporting and notification

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COMAR regulations require reporting of clients with communicable diseases

A call to your local health department will meet the requirements and provide an opportunity for additional information sharing e.g., staff followup;

EMS notification in circumstances were identification of a communicable disease is communicated to the office

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