Bloodborne Pathogen Initial Training Module

BACKGROUND

On December 6, 1991 the Occupational Safety and Health Administration (OSHA) published the "Occupational Exposure to Bloodborne Pathogen Standard" (29 CFR 1910-1030).

The purpose of this regulation is to eliminate or minimize occupational exposure to Bloodborne Pathogens, particularly the Hepatitis B Virus (HBV) and the Human Immunodeficiency Virus (HIV) which is the causative agent of AIDS.

One part of the compliance with this standard deals with employee training and awareness.

Individuals who are occupationally at risk to exposure to "Bloodborne Pathogens" fall under this standard and must be properly trained. Below are listed the job classifications in our facility where all employees in these job classifications may come into contact with human blood or other potentially infectious materials which may result in possible exposure to BBP.

Nurse Supervisor

Nurse I and II

Police Officer

Police Sergeant

Police Lieutenant

Police Chief

Director EOHS

Environmental Scientists I and II

Trainer

Lifeguard

Below are listed the job classifications where some employees with these job classifications may come into contact with human blood or other potentially infectious materials which may result in possible exposure to BBP.

Dispatcher

Professor

Associate Professor

Assistant Professor

Instructor

Graduate Assistant

Student Assistant

Janitorial Worker

Housekeeping Manager II

Laundry Worker

Recreational Facility Manager I and III

Other Potentially Infectious Material---Includes

-Human body fluids such as:

Semen

Amniotic fluid

Pleural fluid

Synovial fluid

Vaginal secretions

Cerebrospinal fluid

Saliva in dental procedures

Note--saliva, urine, feces, vomit are not included in the standard unless they are visibly contaminated with blood.

-Body Fluids that cannot be readily identified.

Bloodborne pathogen---Microorganisms (germs) present in blood or other body fluids that can cause disease.

Contaminated---having potentially infectious materials on an item or a surface.

Exposure Incident---A specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employees duties.

Universal Precautions---a concept that all potentially infectious material be handled as if they contain bloodborne pathogens and that proper work practice controls and engineering controls be used to prevent further contamination and exposure.

Work Practice Controls---Safer ways to perform tasks. Example: Nurses not recapping used needles. Washing hands after cleaning up spills. Not eating, smoking, or drinking in areas where potentially infectious materials are located.

Engineering Controls---Using equipment to minimize contamination and exposures. Example: Using a dustpan or tongs to pick up broken glass.

-Mouth via swallowing

-Lungs via inhalation

-Bloodstream via broken skin

-Blood and tissues via other mucous membranes (eyes)

Personal Protective Equipment (PPE) are engineering controls that are used to protect an individual's Portals of Entry.

-Gloves

-Masks

-Protective Clothing

-Protective Eyewear

The two most common bloodborne pathogens are:

Hepatitis B Virus (HBV)

Human Immunodeficiency Virus (HIV)

Hepatitis B Virus

-this is the causative agent of the disease called hepatitis

-hepatitis is a disease characterized by the inflammation of the liver.

-Frequently leads to cirrhosis and liver cancer

-Hepatitis B is the most prevalent form of Hepatitis

-Hepatitis B infects approximately 300,000 people yearly

-Currently there are over 1 million chronic carriers in the United States

SYMPTOMS

-Fatigue -Diarrhea

-Stomach pain -Itching skin

-Loss of appetite -Mild fever

-Nausea -Aching muscles and joints

-Jaundice -Dark urine or light feces

-"Flu-like"

Individuals with Hepatitis B may not show symptoms for some time (6 weeks to 6 months after exposure) and can become chronic carriers of the disease.

The Hepatitis B Virus can live on surfaces at room temperature for up to 7 days.

Hepatitis B is easier to contract than HIV because it can live on surfaces longer and it does not take as much blood to cause infection to occur.

If properly diagnosed and treated, recovery and prognosis are good.

Hepatitis B vaccine is given by injection. Three doses, given on three different dates, are needed for full protection. Exactly when these three doses are given can vary. Your doctor or nurse will tell you when the three shots should be given.

The Hepatitis B vaccine prevents Hepatitis B in 85%-95% of people who get all three shots. Studies have shown that in these people protection lasts at least ten years.

Booster doses are not recommended at this time.

You have the right to decline the vaccine.

If you decline to take the vaccine you will be asked to sign a declination form similar to the one seen here.

I understand that due to my occupational exposure to blood or other potentially infectious materials, I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me.

_____________________

Signature

HBIG usually given to individuals who have received an exposure and have not had the Hepatitis B vaccine. It is usually then given with the Hepatitis B vaccine. It gives protection for the first 1-3 months; then the vaccine takes over and gives long lasting protection.

The most common side effect of hepatitis B vaccine is soreness where the shot is given.

Hepatitis immune globulin has sometimes been associated with swelling or hives. Also a low grade fever and joint aches are possible

The vaccine is offered to employees who have contact with blood and other infectious material.

How much does it cost?

The vaccine is free to you. All you have to do is consent to take it.

What is the vaccine?

A series of three shots, usually offered over a six month period. You must take all three of these shots to help your body develop the immunity necessary to protect you.

The shots are usually given in the arm for better absorption.

Are all people who take the vaccine protected from HBV?

No. Some people may not get protection, so there is no 100% guarantee you will get immunity. The chances, however, are very high, around 85-95%

Are there special considerations concerning the vaccine?

Yes. People who are sensitive to yeast or components of the vaccine should not take the vaccine (most people can take it).

Taking the vaccine may need to be delayed if you have a bad infection (cold, flu, etc.).

Before making a decision as to whether you can or cannot take the vaccine you should discuss it with your family physician.

Do I need to decide on whether or not to take the vaccine?

Yes, you must make a decision to take the vaccine or not, and sign the correct form (consent form or denial form).

It is not clear how long the vaccine is effective. However, all indications are protection lasts at least seven years.

Note: You cannot get AIDS from the shot.

Life threatening bloodborne pathogen.

A viral infection which attacks the immune system and causes the disease call Acquired Immune Deficiency Syndrome (AIDS).

Not as infectious as hepatitis B virus because there are not as may virus particles present in body fluids.

The HIV virus is more fragile than the HBV virus and can be easily destroyed on environmental surfaces.

-Swollen lymph glands -yeast infections

-recurrent fever -other opportunistic

-night sweats infections such as

-rapid weight loss Kaposi Sarcoma

-constant fatigue Pneumocystis

-diarrhea and decreased appetite pneumonia

Your employer is responsible for developing an exposure control plan for your workplace. A copy of this exposure plan is available from your Safety Officer.

UNIVERSAL PRECAUTIONS

All blood or other potentially infectious materials will be considered infectious regardless of the status of the source individual.

The following procedures will be used when dealing with all potentially infectious materials.

-Wash hands after contact with persons and immediately after contact with blood or other body fluids.

-Gloves are to be worn when handling all potentially infectious materials.

-Needles and sharps must be immediately discarded in rigid impervious containers. Needles are not to be cut, recapped or manipulated after use.

A sharp may be defined as any potential contaminated item that has the ability to puncture the skin. This incudes glass that may be contaminated with blood or other body fluids.

-Mouthpieces, disposable resuscitative face masks, and ambubags should be used in place of mouth-to-mouth resuscitation when possible.

-Gowns should be worn when the possibility of clothes contamination exists.

-Face protection is used when performing tasks that are likely to subject employees to aerosols, splashes, or sprays.

ENGINEERING CONTROLS

Engineering controls will be used to eliminate or minimize exposure to employees. These controls will consists of, but are not limited to:

Sharps disposal containers

Plastic bags for containing potentially infected waste

Dust pan and brooms for picking up potentially contaminated materials.

WORK PRACTICE CONTROLS

Work practice controls include but are not limited to:

Proper handwashing

Labeling of infectious waste containers and storage areas

Disinfecting areas contaminated with body fluids

i.e. floors, table tops, etc.

NOTE: A suitable disinfectant will be provided for your use. The disinfectant used should be known to be effective against the HBV and the HIV virus and must be EPA registered. A 10% solution of household bleach can be used routinely or in an emergency to clean up spill of potentially infectious materials.

All procedures must be conducted in a way that will minimize splashing, spraying or spattering.

All personal protective equipment will be provided by the employer at no expense to the employees. Personal protective equipment will be chosen based on anticipated exposure to blood or other potentially infectious materials.

Gloves will be worn in any situation where it can be reasonably anticipated that there may be hand contact with blood or other potentially infectious material.

Masks and\or eye protection will be worn any time there is a risk of splashing or aerosol formation.

Gowns, shoe covers, and other protective clothing will be worn whenever there is the danger of contamination of clothing.

When in doubt wear all protective clothing provided.

Department Chairpersons, Department Directors, Immediate Supervisors and Faculty are responsible for exposure control in their respective areas. They will work directly with the Exposure Control Officer (University Safety Officer) and employees to ensure that the proper exposure control procedures are followed. Although students are not covered by the exposure control plan, it will be the responsibility of individual faculty to inform students of any hazards associated with the use of blood, blood products, or any other infectious materials that may be used in the teaching environment.

Knowing what tasks they perform that have a potential for occupational exposure.

Attending training sessions and following Universal Precautions and Work Practice Controls.

Developing good personal hygiene habits.

Cleaning and decontamination of appropriate areas will be conducted by the person who has been using or processing the potentially infectious body fluid.

All equipment and surfaces are cleaned and decontaminated:

After contact with blood or potentially infectious materials.

After the completion of medical or research procedures.

Immediately or as soon a feasible when surfaces are overtly contaminated.

After any spill of blood or infectious material.

At the end of the work shift or procedure.

All personal protective equipment shall be cleaned, laundered and/or disposed of at no cost to the employee. All repairs and replacements will be made by the employer at no cost to the employee.

DON'T TAKE CONTAMINATED CLOTHING HOME!!!

All waste of infectious or potentially infectious material should be properly disposed of in accordance with The Ohio Infectious Waste Regulations. Sharps must be placed in a puncture-proof container bearing the international biohazard symbol. Non-sharp infectious waste should be placed in leak-proof bags (double-bagged) bearing the international biohazard symbol.

Whenever an employee has become exposed to blood or any other potentially infectious material this is referred to as an EXPOSURE INCIDENT.

An exposure incident means that blood or some other potentially infectious material has penetrated a portal of entry and that the possibility of infection exists.

The mere fact that blood gets on your gloves or perhaps even on your hands may not constitute an exposure incident.

An example of an exposure incident would be getting stuck with a contaminated needle or some other object that is contaminated and has punctured the skin. Another example would be the splashing of blood or some other potentially infectious material into the eyes or onto the face. Each incident needs to be individually assessed to determine whether or not an exposure has occurred. WHEN IN DOUBT, TREAT IT AS AN EXPOSURE INCIDENT!!!

When a employee incurs an exposure incident it should be reported to the Safety Officer immediately.

All employees who incur an exposure incident will be offered post-exposure evaluation and follow-up.

This will include:

-Documentation of route of exposure and circumstances related to the incident.

-If possible, the identification of the source individual and, if possible, the status of the source individual.

-If identified, and if consent is given, the blood of the source individual will be tested for HIV and HBV infectivity.

-Results of the testing of the source individual will be made available to the exposed individual with the exposed individual informed of all applicable laws and regulations concerning disclosure of identity and infectivity of the source individual.

-The exposed employee will be offered the option of having their blood collected for testing of their HIV/HBV serological status.

-The blood will be preserved for up to 90 days to allow the employee to decide if the blood should be tested.

-If the employee decides prior to that time that his/her will or will not be tested appropriate action will be taken and the blood will be discarded.

-If you are not sure that you want your blood tested asked that it be preserved to give you time to decide.

-The employee will be given appropriate counseling concerning precautions to take following the exposure incident.

-The employee will be given information on what potential illnesses or symptoms to be alert for.

-If any unusual illnesses or symptoms occur the employee will be instructed to report these experiences to the Safety Officer.

Accurate medical records for each employee with an occupational exposure will be kept by the Safety Officer.

These records will include:

-Name and social security number of exposed individual

-Copy of employee's Hepatitis B vaccination status including dates of inoculation

-Copies of results of all examinations

-The employer's copy of the healthcare professional's written opinion.

-A copy of all information provided by the healthcare professional.

A COPY OF YOUR FACILITY'S EXPOSURE PLAN AS WELL AS A COPY OF OSHA'S BLOODBORNE PATHOGEN STANDARD ARE AVAILABLE FOR YOUR REVIEW FROM THE UNIVERSITY SAFETY OFFICER.

After normal work hours a copy can be found at the YSU Police Department.

Individual departments covered by the plan will also be given a copy to be filed in departmental offices.

Call EOHS at Extension 3700