B L O O D B O R N E PAT H O G E N S A D M I N I S T R AT I V E G U I D E

Transcription

1 B L O O D B O R N E PAT H O G E N S A D M I N I S T R AT I V E G U I D E

2 2009 Comprehensive Loss Management, Inc. This material is the property of CLMI Safety Training and may not be reproduced or distributed in any manner. When permitted, you may print a single copy of this material for your personal use.

3 Bloodborne Pathogens Instructions Instructions Welcome To The Safety Program! This is one in a series of comprehensive programs that provide unique safety solutions for companies faced with limited time, money and resources. This program is designed to provide a step-by-step, color-coded guide for individuals with limited knowledge of safety management, training or compliance. The program is written in an uncomplicated, easy-to-follow style. Clear and simple explanations of the topic are included, and the Take A Closer Look sections provide more detailed information. The program has the following sections: Introduction This section provides information on the topic and the training benefits for your company and employees. The program s goals are defined as well as how these goals can be incorporated into your safety training efforts. How To Comply This section explains the steps you can take to help employees avoid injuries and reduce related costs to your company. Written Program This section includes a sample written program along with forms that will help you customize the written program to fit your company s needs. Training OSHA compliance also requires employee training. This section provides a complete training guide and tools, including these materials: An Instructor Guide that provides objectives, discussion questions, training techniques and follow-up activities to support the trainer in conducting an effective training session. A video that provides important information to employees in an effective and interesting style. Designed to educate employees on information that may be unfamiliar to the trainer, the video takes a positive, upbeat approach that s entertaining as well as informative. An Employee Handbook that provides information for employees during training and also serves as a reference tool after training has been completed. A Learning Exercise to test employees knowledge and determine their level of understanding about the topic. A Glossary Of Terms. A PowerPoint presentation. Page i

4 Bloodborne Pathogens Instructions All of the programs in this series have been developed by Certified Safety Professionals (CSPs) with backgrounds in safety training and compliance for all types of industries. This unique package is the most effective and easy-to-use program available, guiding the program administrator step by step through the safety and compliance requirements. UNDERSTANDING THE SYMBOLS Take A Closer Look This symbol identifies material that provides a more detailed explanation of the summary information given previously. The Note This symbol identifies information that the reader should take note of or refers the reader to another section in the manual for additional information. Caution This symbol indicates important points in the program that the reader needs to understand. Video Question Slide Handbook Flipchart Helpful Hint Page ii

5 Bloodborne Pathogens Instructions Table Of Contents Page # Introduction I-1 How To Comply H-1 Explanation Of The OSHA Standard H-1 How To Develop Your Exposure Control Plan H-4 OSHA Standard 29 CFR Written Program W-1 OSHA Requirements W-1 Written Program Development W-2 Bloodborne Pathogens Written Exposure Control Plan W-4 Recordkeeping W-10 Training T-1 Instructor Guide T-1 Delivery T-6 Training Tips T-17 Learning Exercise T-20 Glossary Of Terms T-22 Slides T , 2002, 2005 Comprehensive Loss Management, Inc. Page iii

6 Bloodborne Pathogens Instructions The information contained in this program has been developed in good faith and is believed to present good safety principles. CLMI and all other participating organizations make no representations or warranties as to the completeness or accuracy thereof. Persons using this information must make their own determination as to its suitability for their purposes in support of their own safety programs. CLMI and all other participating organizations are in no way responsible for damages of any nature resulting from the use of this information. Technical expertise provided by: Richard R. Johnson, CSP James Oukrop, ARM Richard A. Pollock, CSP Page iv 1998, 2002, 2005 Comprehensive Loss Management, Inc.

7 Bloodborne Pathogens Introduction Introduction Bloodborne Pathogens Blood is the most important fluid in the human body. It carries oxygen and nutrients throughout the body, making life possible. However, blood can sometimes transmit life-threatening diseases. Today s headlines often mention diseases caused by viruses such as Hepatitis B, Hepatitis C and HIV (Human Immunodeficiency Virus), which is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). These diseases are caused by bloodborne pathogens: microorganisms that can be carried in human blood and body fluids and cause serious diseases. Because of the serious nature of bloodborne pathogens, it s important that employees understand what they are, how they are transmitted and how individuals can protect themselves. This guide will help you develop a program for controlling the transmission of bloodborne pathogens in the workplace. It s designed to present a simple, step-bystep approach that you can use to develop a program that will ensure that everyone in the workplace understands the hazard and how to avoid personal contact and potential infection. The outcomes of your bloodborne pathogens program will be as follow: To understand the hazards of bloodborne pathogens To develop a written Exposure Control Plan To ensure employees know how to avoid potential infection Page I-1

8 Bloodborne Pathogens Introduction Bloodborne pathogens is a complex topic. This guide is designed to give you a basic understanding, but you may also want to consult additional information. Some excellent resources include the following: Your health care provider Local infectious disease control centers Your insurance company s loss-control department The OSHA consultation division in your state Page I-2

9 Bloodborne Pathogens How To Comply How To Comply This section contains the following information: Explanation Of The OSHA Standard How To Develop Your Exposure Control Plan OSHA Standard 29 CFR Explanation Of The OSHA Standard The Occupational Safety And Health Administration (OSHA) has established a Bloodborne Pathogens Standard 29 CFR You will find the complete standard following this section. We will go into more detail later in this guide, but in brief, OSHA requires the following: Employers must have a written Exposure Control Plan to alert employees to the risks of bloodborne illness and to train them to prevent exposure. Employers must have engineering controls, work practice controls and housekeeping procedures in place to control bloodborne pathogen hazards. Employers must provide Personal Protective Equipment (PPE) for employees who may come in contact with bloodborne pathogens as part of their work activities. Employees must have training and use equipment to protect themselves from exposure to infection. Creating a written Exposure Control Plan can help reduce the hazard of diseases transmitted by blood and other body fluids. This program should contain systematic policies, procedures and practices that help employees recognize and protect themselves from bloodborne pathogens. Your Exposure Control Plan should be designed to help employees answer the following questions: What are the hazards for bloodborne pathogens in my work area? How can I protect myself from them? Page H-1

10 Bloodborne Pathogens How To Comply Bloodborne Pathogens Definitions To help you understand bloodborne pathogens and the requirements of the OSHA standard, here are some basic definitions: Blood: Human blood, human blood components and products made from human blood. Bloodborne Pathogens: Microorganisms that are present in human blood and body fluids and can cause diseases in humans. These pathogens include Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV). Contaminated: The condition in which blood or other potentially infectious materials are present or reasonably anticipated to be present on an item or surface. Contaminated Laundry: Laundry that has been soiled with blood or other potentially infectious materials or that may contain sharps. Decontamination: The use of physical or chemical means to remove, inactivate or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use or disposal. Engineering Controls: Controls that isolate or remove the hazard of bloodborne pathogens from the workplace, including the use of sharps disposal containers and self-sheathing needles. Exposure Incident: A situation in which an employee has contact with blood or other potentially infectious materials as a result of his or her duties. This contact includes specific eye, mouth, other mucous membrane, nonintact skin or parenteral contact. Health Care Professional: A person whose legally permitted scope of practice allows him or her to independently perform the activities required for HBV vaccination and postexposure evaluation and follow-up. HBV: Hepatitis B Virus. HCV: Hepatitis C Virus. HIV: Human Immunodeficiency Virus; the virus that causes AIDS. Incubation Period: The time from initial exposure to the pathogen to when symptoms of the disease surface. Nonintact Skin: Skin that has cuts, abrasions or other openings through which bloodborne pathogens can enter the bloodstream. Occupational Exposure: Reasonably anticipated employee contact with blood or other potentially infectious materials that may result from performing an employee s duties. This contact includes specific eye, mouth, other mucous membrane, nonintact skin or parenteral contact. Page H-2

11 Bloodborne Pathogens How To Comply Bloodborne Pathogens Definitions (continued) Other Potentially Infectious Materials: 1) The following human body fluids are potentially infectious: Semen Vaginal secretions Fluid in the brain and spinal cord (cerebrospinal fluid) Fluid in the joints (synovial fluid) Fluid in the lungs (pleural fluid) Fluid surrounding the heart (pericardial fluid) Abdominal fluid (peritoneal fluid) Saliva in dental procedures Amniotic fluid All body fluids in situations where it s difficult or impossible to differentiate between body fluids Any body fluid that s visibly contaminated with blood 2) Any tissue or organ (other than intact skin) that s disconnected from a human body (living or dead) 3) HIV-containing cell, tissue or organ cultures; HIV-, HBV- or HCV-containing culture media or other solutions; and blood, organs and other tissues from experimental animals infected with HIV, HBV or HCV. Parenteral: Puncture wounds to the mucous membranes or the skin barrier caused by needle sticks, human bites, cuts or abrasions. Personal Protective Equipment (PPE): Specialized clothing and equipment worn by an employee for protection against a hazard. Regulated Waste: Liquid or semiliquid blood and other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semiliquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological or microbiological wastes containing blood or other potentially infectious materials. Sharps: Objects that can penetrate the skin, including needles, scalpels, broken glass, broken capillary tubes and exposed ends of dental wires. Source Individual: Any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to an employee. Sterilize: The use of a physical or chemical procedure to destroy all infectious organisms. Universal Precautions: An approach to infection control, in which all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, HCV or other bloodborne pathogens. Work Practice Controls: Controls that reduce the likelihood of exposure by changing the way a task is performed. You can take some simple steps to make sure that employees are protected from bloodborne infections and that you are in compliance with the OSHA standard. We will go through each of these steps in detail in the next section. Page H-3

12 Bloodborne Pathogens How To Comply How To Develop Your Exposure Control Plan Developing an Exposure Control Plan for the workplace is the best way to make sure employees understand how to protect themselves against infectious diseases that are transmitted by bloodborne pathogens. A successful bloodborne pathogens program includes these steps: STEP 1) STEP 2) STEP 3) STEP 4) STEP 5) STEP 6) Understand Bloodborne Pathogen Hazards Identify Bloodborne Pathogen Hazards In The Workplace Establish An HBV Vaccination Program For Exposed Employees Control The Hazards Establish Postexposure Follow-Up Procedures Provide Annual Employee Bloodborne Pathogens Training We will go through these steps one by one, taking a closer look at the important information you will need to know as you develop your program. Page H-4

13 Bloodborne Pathogens How To Comply STEP 1) Understand Bloodborne Pathogen Hazards The first step is to understand what bloodborne pathogens are and what hazards they present in the workplace. Bloodborne pathogens are microorganisms (viruses and bacteria) that are present in blood and body fluids and can cause diseases in humans. The three most common bloodborne pathogens are the following: Human Immunodeficiency Virus (HIV) Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) Human Immunodeficiency Virus (HIV) HIV attacks a certain type of white blood cell the T cell which is a vital part of the body s immune system. HIV infects T cells and multiplies inside them, eventually destroying the host cells. As a result, the body is left without an important line of defense against infection. A person infected with HIV is therefore susceptible to opportunistic diseases (such as certain forms of pneumonia, cancer and other ailments) that would not seriously affect someone with a healthy immune system. Once a person is HIV positive and contracts an opportunistic disease, he or she is considered to have Acquired Immune Deficiency Syndrome (AIDS). There is currently no vaccine or cure for AIDS. HIV infection may mimic a variety of other medical illnesses. Treatment varies depending on the symptoms the person experiences. The percentage of HIV-infected persons who will ultimately contract AIDS is unknown. As a result, prevention of HIV infection depends on effective screening of blood products, precautions regarding sexual practices and infection-control practices in the workplace. Page H-5

14 Bloodborne Pathogens How To Comply Hepatitis B Virus (HBV) HBV is the virus that causes Hepatitis B infection. Once HBV has been transmitted, the incubation period ranges from 45 to 180 days, with an average of 120 days. The onset of Hepatitis B occurs gradually and is discovered in the patient only after the illness has fully developed. Although most people will be asymptomatic (that is, without symptoms), possible symptoms of Hepatitis B include the following: Weight loss Malaise Nausea Vomiting Abdominal pain Jaundice (yellow skin) Skin rashes Aching joints Though less well known than HIV, HBV occurs much more commonly. Each year, an estimated 140,000 to 320,000 persons primarily young adults are infected with HBV. Currently, it s estimated that there are 1 to 1.25 million infectious HBV carriers in the United States. Of this group: 70,000 to 160,000 will show acute symptoms of the disease. 8,400 to 19,000 will require hospitalization. 140 to 320 will die from acute HBV infection. An estimated 6% to 10% of infected persons will develop chronic active Hepatitis B. The U.S. Centers For Disease Control and Prevention estimate that 5,000 to 6,000 persons die each year from Hepatitis B related liver disorders such as cirrhosis and primary liver cancer. A vaccine is available to help protect persons at risk from exposure to HBV. The vaccine currently used is produced in yeast by recombinant technology. It contains no human plasma, so there s no possibility that it can be infectious for HIV. Approximately 90% of healthy adults who receive the vaccine will develop protective antibodies against HBV infection. Page H-6

15 Bloodborne Pathogens How To Comply Hepatitis C Virus (HCV) HCV is the virus that causes Hepatitis C infection. It was first identified in 1989; previously, it may have been called Non-A, Non-B Hepatitis. HCV is spread by direct contact with the blood of an infected person. Once transmitted, the incubation period appears to be similar to that of Hepatitis B: 45 to 180 days, with an average of 45 to 75 days. Most people infected with HCV are asymptomatic. In fact, only about 25% to 30% of infected individuals show any signs of infection, and those signs may not be recognized. Possible symptoms of Hepatitis C are similar to those of Hepatitis B (see previous section). Approximately 4 million Americans are currently infected with HCV, and an estimated 28,000 to 180,000 new infections occur in the United States each year. About 15% of HCV-infected individuals clear the virus, and about 85% go on to develop chronic Hepatitis C. Chronic liver disease may develop in 70% of the individuals with chronic Hepatitis C, resulting in 8,000 to 10,000 deaths each year. Infection with HCV is the most common reason people have liver transplants in the United States. Alcohol use significantly affects individuals infected with HCV. The risk of HCV infection varies, based on exposure to blood or blood products. Infection rates vary from 50% to 90% among intravenous (IV) drug users to 4% among individuals who have experienced a needle stick. Individuals who had blood transfusions prior to July 1992 may also have an increased chance of being infected with Hepatitis C. However, thanks to new, more sensitive tests, the risk from blood transfusion is now just 1 out of every 100,000 units. Hepatitis C is usually transmitted by direct blood to blood contact. The most common causes of new infection are high-risk drug use, which may account for 60% of new cases, and high-risk sexual activity, which may account for 20% of new cases. At this point, the risks of occupational exposure are unclear. Only one approved treatment is currently available for Hepatitis C, and it s effective in only 15% to 25% of infected individuals. Moreover, the treatment is uncomfortable, has some risks and is expensive. There is no vaccine for HCV. The only effective way to avoid HCV infection is to avoid contact with the blood of infected individuals. Page H-7

16 Bloodborne Pathogens How To Comply How Bloodborne Pathogens Are Spread Bloodborne pathogens are spread through the exchange of blood and other body fluids, including the following: Semen Vaginal secretions Fluid in the brain and spinal cord (cerebrospinal fluid) Fluid in the joints (synovial fluid) Fluid in the lungs (pleural fluid) Fluid surrounding the heart (pericardial fluid) Abdominal fluid (peritoneal fluid) Saliva in dental procedures Amniotic fluid All body fluids in situations where it s difficult or impossible to differentiate between body fluids Any body fluid that s visibly contaminated with blood Any tissue or organ (other than intact skin) that s disconnected from a human body (living or dead) HIV-containing cell, tissue or organ cultures; HIV-, HBV- or HCV-containing culture media or other solutions; and blood, organs and other tissues from experimental animals infected with HIV, HBV or HCV Bloodborne pathogens can also be transmitted through materials that have become contaminated with blood or body fluids. Bloodborne pathogens are not transmitted by casual contact, such as touching or sharing equipment or facilities. The two most common ways that people become infected by bloodborne pathogens are through sexual transmission and IV drug use. However, any contact with infected blood or body fluids carries the risk of potential infection. Although HIV tends to have higher visibility in the media, there s a greater risk of infection from HBV, since it s relatively easy to contract. For example, according to the U.S. Centers For Disease Control and Prevention, the chance of a person becoming infected with HIV as the result of being cut with a contaminated sharp object is less than 0.3%. The chance of becoming infected with HBV is much higher. In each milliliter of blood from a person infected with HBV, there are approximately 1 billion (10 9 1) viral particles. A dose of only 1,000 particles is enough to acquire the disease. Drops of blood too small to see can be transmitted into the body through the eyes, nose or mouth or through undetected cuts in the skin. Page H-8

17 Bloodborne Pathogens How To Comply As a result, it s important to be aware of the risks for HBV infection during potential exposure situations. While irrational fears about workplace exposure to HIV, HBV and HCV should be prevented, these diseases should not be treated lightly. Employees should fully understand the infection risks, how bloodborne pathogens are transmitted and how to protect themselves. STEP 2) Identify Bloodborne Pathogen Hazards In The Workplace The next step in creating your Exposure Control Plan is to identify those job classifications or tasks in the workplace where employees may be exposed to bloodborne pathogens. Employees who are designated First Aid responders or who are assigned to clean up spills of blood or other body fluids may come in contact with bloodborne pathogens. It s important for these employees and any concerned co-workers to understand the hazards of bloodborne pathogens, how they are transmitted and how individuals can protect themselves. To determine exposure, begin by reviewing all job classifications within the workplace, and then classify them in two groups: 1. Job classifications in which all employees have occupational exposure, such as First Aid responders who face potential exposure when performing CPR, mouth-to-mouth resuscitation or other medical procedures. For this group, it isn t necessary to list specific work tasks. 2. Job classifications in which some employees have occupational exposure, such as maintenance workers or janitors who might be exposed when cleaning up after an accident and/or during the disposal of blood, body fluids and materials contaminated by these fluids. For this group of job classifications, you must list specific tasks and procedures that may cause occupational exposure. Page H-9

18 Bloodborne Pathogens How To Comply Once you have classified jobs into these two groups, you should keep the list on file and update it as necessary. This list can be used to educate employees on the types of hazards associated with specific jobs or job tasks. Outside medical/dental clinics, hospitals and paramedical organizations, very few people contract HIV, HBV or HCV on the job. But because the result of any of these infections can be fatal, employees should always protect themselves from potential exposure. STEP 3) Establish An HBV Vaccination Program For Exposed Employees OSHA regulations require employers to offer the HBV vaccine free of charge to employees in job classifications where everyone has occupational exposure to blood or other body fluids. The vaccine must be offered within 10 working days of initial assignment to the job. These job classifications include designated First Aid responders and plant nurses. Any employee who chooses not to accept the vaccine must be asked to sign a statement indicating this decision. However, in the future, if that employee decides to get the vaccine and is still occupationally exposed to bloodborne pathogens, he or she may still be vaccinated free of charge. In addition to being used as a pre-exposure vaccination, the HBV vaccine is also effective when given within 24 hours after exposure. The key to taking effective postexposure action is to have a plan in place to deal with exposures in the workplace. This is covered in more detail in Step 5. Records of HBV vaccinations and refusal statements should be kept on file. Page H-10

19 Bloodborne Pathogens How To Comply STEP 4) Control The Hazards In the workplace, some employees may come in contact with human blood or body fluids as part of their jobs. Potential exposure to bloodborne pathogens may result from performing CPR, mouth-to-mouth resuscitation or First Aid procedures. Also at risk of exposure are employees who clean up after an accident and/or who are responsible for disposing of blood, body fluids or materials that are contaminated by these fluids. An important element of your Exposure Control Plan is to make sure that control procedures are in place to prevent employee infection and to provide the appropriate protective equipment to employees who may be exposed to bloodborne pathogens. Avoiding infection begins with ensuring that employees have a clear understanding of the hazards of bloodborne pathogens and the preventive measures they can take to protect themselves from exposure. There are five main elements of protection against exposure to bloodborne pathogens: 1. Universal Precautions 2. Personal Protective Equipment (PPE) 3. Housekeeping 4. Engineering Controls 5. Work Practice Controls Universal Precautions A critical element in protecting employees from bloodborne pathogens is the use of Universal Precautions: that is, treating all blood and body fluids as if they are known to be infected with bloodborne pathogens. For example, employees who come upon an accident scene should assume that all fluids present are infectious. Even though an accident scene may contain many different fluids, taking Universal Precautions means that employees should avoid any unnecessary contact or inappropriate actions that could cause infection. Page H-11

20 Bloodborne Pathogens How To Comply Personal Protective Equipment (PPE) Using Personal Protective Equipment (PPE) is extremely important in preventing employee exposure to bloodborne pathogens. Special clothing and equipment must be worn to prevent potentially infectious fluids from coming into contact with the employee and his or her clothes. PPE to prevent exposure to bloodborne pathogens includes the following: Gloves Eye protection Masks Gowns or other protective clothing CPR masks Employers are required by OSHA to provide PPE to all employees who may be exposed to bloodborne pathogens as part of their work activities. The employee s personal hygiene is another important part of exposure prevention. Whenever a potential exposure has occurred, the employee should thoroughly wash his or her hands and any other exposed skin with water and an antiseptic soap. If water isn t available, the employee should use a waterless disinfectant hand cleaner. The employee should vigorously scrub all exposed areas. The abrasive action of the scrubbing will remove contaminants from the skin. Page H-12

21 Bloodborne Pathogens How To Comply Personal Protective Equipment (PPE) Gloves During First Aid response situations where blood or other body fluids are present, the first line of defense is gloves. For the majority of minor cut and laceration situations, gloves may be the only PPE needed. Wearing them can prevent contaminants from entering the bloodstream through cuts or other openings in the skin. The following kinds of gloves should be available with First Aid equipment: Single-use latex gloves should be provided to help protect the skin and hands from direct contact with blood or other body fluids. Leather or other protective gloves should be worn over latex gloves in situations where latex gloves could be punctured, cut or torn. Gloves made from other materials should be available for use by people who are allergic to latex. Eye Protection In severe accident situations, arterial bleeding may cause blood or other body fluids to splash into an employee s face. In these situations, eye protection (such as safety glasses or goggles) can prevent contaminants from entering the employee s mucous membranes through the eyes. Masks Again, to prevent splashing blood or other body fluids from entering an employee s mucous membranes through his or her nose or mouth, a mask should be worn in responding to emergency situations. Gowns Or Other Protective Clothing If an emergency situation involves large quantities of blood or other body fluids, a gown or other protective clothing will keep these fluids from coming into contact with the employee s skin and work clothes. CPR Masks In situations where CPR or mouth-to-mouth resuscitation must be performed, special devices called CPR masks should be used. These devices must be equipped with one-way valves that prevent blood or other body fluids from entering the rescuer s mouth and nose. Using Personal Protective Equipment (PPE) Working with gloves and other PPE can be difficult, so it s important that employees practice using this equipment during training. Doing so will help ensure that employees are comfortable with PPE during an actual emergency. All contaminated PPE should be removed immediately following an emergency response. When removing gloves and other equipment, employees should turn each item inside out so as to contain any contaminants. Used PPE should be placed in appropriately designated containers when being stored, washed, decontaminated or discarded. Gloves should be properly disposed of after use or when they become contaminated, torn or punctured. Any contaminated clothing should be washed thoroughly in an appropriate disinfectant solution. If the employer provides uniforms for employees, the employer must have the uniforms properly cleaned. If an employee s street clothes become contaminated, they must be laundered separately in an appropriate disinfectant solution. See your safety equipment supplier for more information on selecting the right Personal Protective Equipment (PPE) for your situation. Page H-13

22 Bloodborne Pathogens How To Comply Housekeeping The third area that can help employees prevent exposure to bloodborne pathogens is housekeeping. Housekeeping includes these tasks: Cleaning and decontaminating all infected surfaces Disposing of blood and body fluids properly Housekeeping Cleaning And Decontaminating All Infected Surfaces Cleaning and decontaminating surfaces is important to eliminate the potential spread of bloodborne pathogens. All work surfaces, along with any equipment that has been contaminated with potentially infectious materials, must be cleaned with an appropriate disinfectant, such as 1 part bleach to 10 parts water. To disinfect items onsite, soak them in the bleach and water solution overnight; then drain the solution and dispose of the items in the trash. Bleach and water solutions should be mixed as needed, since they lose their effectiveness after 24 hours. Note that bleach may damage some surfaces, so an EPA-registered hard surface disinfectant may be used instead. Personal Protective Equipment (PPE) must be worn during cleanup operations to prevent contact with infectious substances. If employees must clean up contaminated broken glass, they should use tongs, forceps or a brush and dust pan. Employees should never use their hands, even if they re wearing gloves. Disposing Of Blood And Body Fluids Properly Regulated waste includes liquid or semiliquid blood and other potentially infectious material along with other contaminated items. Such waste must be placed in closeable, biohazard or red-colored containers or plastic bags. The biohazard label warns employees of the hazards of the waste material. All waste products must be discarded according to federal, state and local regulations. Contact your local health department for details on regulations in your area. Helpful Hint: If you don t want to handle medical waste onsite, you may contract with a medical waste disposal company. Your designated medical treatment facility may be willing to accept small amounts of waste for disposal for a nominal fee. Some companies send bagged waste with ambulances in emergencies. Page H-14

23 Bloodborne Pathogens How To Comply Engineering Controls The use of engineering controls can help you reduce employee exposure to bloodborne diseases by either removing the hazard or isolating employees from exposure. However, there are generally more opportunities for using engineering controls in health care organizations than in other types of organizations. Some examples of engineering controls include the following: Using self-sheathing needles Providing special containers for contaminated sharp instruments Using disposable airway equipment and resuscitation bags Work Practice Controls Keeping the workplace safe from bloodborne pathogen exposure requires the use of work practice controls, which alter how tasks are performed in order to prevent infection. When establishing work practice controls for your workplace, make sure that all employees understand the proper procedures for dealing with emergencies, how to protect themselves from infection and how to clean up blood, body fluids and other contaminated materials. Your work practice controls should include these measures: Proper handling and disposal of needles and sharps; used bandages and gauze; linens and all other items that come in contact with blood or other potentially infectious materials Following procedures to minimize spattering, generating droplets, splashing and spraying of blood or other body fluids Safe Work Practices The following work practices can help employees avoid exposure to bloodborne pathogens: Always take Universal Precautions: that is, treat all blood and body fluids as if they are infectious. When responding to an emergency medical situation, protect yourself before providing help to the victims, regardless of how well you know these individuals. Always wear appropriate Personal Protective Equipment (PPE). When performing CPR, always use a CPR mask equipped with a one-way valve to prevent contact with potentially infectious blood and body fluids. Contain all spills immediately, and then clean up and disinfect the area. Handle all trash as if it contains sharp and/or infectious items. Never eat or smoke in the work area. Germs can get on hands, food and smoking materials and enter the mouth. Page H-15

24 Bloodborne Pathogens How To Comply STEP 5) Establish Postexposure Follow-Up Procedures Despite protection efforts, there s always the possibility that employees will be exposed to blood or body fluids during an emergency response. Given that, you must establish procedures for follow-up after an exposure incident has occurred in the workplace. Don t wait for the exposure to happen before planning your response. An exposure incident is a situation where an employee has contact with blood or other potentially infectious materials as a result of his or her duties. This contact includes specific eye, mouth, other mucous membrane, nonintact skin or parenteral contact. All exposure incidents must be reported to the employer, and the reports must be treated with the strictest of confidence. In case of an exposure incident, the employer must have designated an emergency room, employee health clinic or other medical care facility as the place employees should go when exposed to bloodborne pathogens. If an exposure incident occurs, the employer is required to provide a postexposure evaluation and follow-up, which includes these elements: Preparing a written accident report and evaluation of the circumstances of the exposure incident Providing appropriate testing and consulting to the employee, including consultation with a physician or other health care professional regarding the risk of HIV, HBV or HCV infection and any other follow-up treatment necessary While developing your program, you will be collecting information such as health histories, inoculation records and exposure incident reports that are considered to be medical records. According to OSHA Standard 29 CFR , medical records must be kept confidential and may be released to the employee upon request or to a third party who has written permission from the employee. In May 1998, the Centers For Disease Control issued recommendations for employees who may have been exposed to HIV-containing blood. These recommendations call for the rapid evaluation by a physician and possible prophylaxis with the same medications given to HIV-positive patients. Treatment should start as soon as possible following exposure, ideally within 1 2 hours. Page H-16

25 Bloodborne Pathogens How To Comply Exposure Incidents At the time of an exposure incident, the exposed employee must be directed to a health care professional. The employer must provide the health care professional who is treating the employee with the following information: A copy of the OSHA Bloodborne Pathogens Standard A description of the employee s job duties as they relate to the exposure incident A report of the specific exposure incident (accident report), including the route of exposure Relevant employee medical records, including Hepatitis B vaccination status The medical evaluation and follow-up must do the following, at a minimum: Document the routes of exposure and how exposure occurred. Identify and document the source individual, if possible and not prohibited by law in your state. Obtain consent and test the source individual s blood as soon as possible to determine if infection has occurred, and then document the source s blood test results. (If the source is known to be infected with HBV, HCV or HIV, existing blood tests can be used for the medical evaluation.) Provide the exposed employee with the test results and information about applicable disclosure laws and regulations concerning the source s identity and infection status. Obtain consent and then collect and test the exposed employee s blood as soon as possible after the exposure incident. (If the exposed employee consents to baseline blood collection but not to HIV serologic testing, his or her blood sample must be preserved for at least 90 days. If within 90 days of the exposure incident, the employee agrees to have the baseline sample tested, such testing must be conducted as soon as is feasible.) Following the postexposure evaluation, the health care professional must provide a written opinion to the employer. This opinion is limited to a statement that the employee has been informed of the results of the evaluation and told of the need for further evaluation or treatment, if any. Any other findings are confidential. The employer must provide a copy of the written opinion to the employee within 15 days of the evaluation. Confidential medical records must be kept for all employees who are at risk of being exposed to bloodborne pathogens on the job. What To Do In Case Of Exposure Should an exposure incident occur, an employee should take the following steps: 1. Flush the area on your body that was exposed with warm water, and then wash it with soap and water. Vigorously scrub all areas. 2. If you have an open wound, squeeze it gently to make it bleed, and then wash it with soap and water. 3. Notify your supervisor, who will initiate the company s postexposure procedures. 4. Go to the emergency room, employee health clinic or other location designated by the company for treatment following an exposure incident. 5. You will be counseled by a physician regarding the risk of HIV, HBV or HCV infection and any follow-up treatment needed. 6. If you have not had the HBV vaccination, you should get it within 24 hours of the exposure incident. Plan ahead! Some employees may be voluntarily or inadvertently exposed to bloodborne pathogens. If they have not already received the vaccine, they must do so within 24 hours after being exposed. It s important that you determine the procedures for dealing with this type of incident before it happens. Page H-17

26 Bloodborne Pathogens How To Comply STEP 6) Provide Annual Employee Bloodborne Pathogens Training Conducting training on the hazards of bloodborne pathogens and protection procedures is another important step in reducing the risk of employee exposure. Your training should cover the following points: The OSHA Bloodborne Pathogens Standard Information on bloodborne pathogens and infection symptoms How bloodborne pathogens are transmitted What measures are provided by the company s Exposure Control Plan and how to obtain a copy of it How to recognize tasks that might result in occupational exposure How employees can protect themselves from exposure How to use Personal Protective Equipment (PPE) How to dispose of contaminated waste What to do in case of exposure Information on HBV vaccination Postexposure evaluation and follow-up Keep track of all bloodborne pathogens training by completing a Bloodborne Pathogens Training Record, and keep this record on file for a minimum of 3 years. A form for recording training can be found in the Written Program section. Bloodborne pathogens training must be conducted annually. Training is covered in more detail in the Training section. Page H-18

27 Bloodborne Pathogens Written Program Written Program This section contains the following topics: OSHA Requirements Written Program Development Bloodborne Pathogens Written Exposure Control Plan Recordkeeping OSHA Requirements OSHA requires that a written Exposure Control Plan be completed by all employers who have employees that may be exposed to bloodborne pathogens as part of their work activities. The Exposure Control Plan is an excellent way to make sure that employees are aware of bloodborne pathogen hazards in the workplace and use the proper procedures and protective equipment to prevent infection. The written Exposure Control Plan must include the following elements: Identification of bloodborne pathogen hazards in the workplace and of employees who may be exposed to those hazards HBV vaccination Personal Protective Equipment (PPE) selection Engineering and work practice controls Postexposure follow-up procedures Annual employee training To be effective, a written Exposure Control Plan needs to clearly identify the following: Key personnel who have responsibility for each segment of the program How bloodborne pathogen hazards will be identified What engineering and work practice controls will be used to control bloodborne pathogen hazards What Personal Protective Equipment (PPE) will be made available How postexposure follow-up will be performed How training will be performed What procedures should be followed to evaluate and update the program How records will be kept Page W-1

28 Bloodborne Pathogens Written Program Written Program Development Developing a written program is important for several reasons, including the following: Ensures consistent implementation of all elements of the safety program Clearly defines and presents expected outcomes, methods and individual behaviors Establishes a basis for succession of the program through personnel changes Establishes a basis for training new employees Provides documentation for regulatory agencies and clearly presents the program s elements and the logic behind its development process Saves time by documenting the best methods, resources, vendors and equipment needed to ensure safe processes Gives employees the recipe for implementing the program The written program identifies these elements: Who is responsible for tasks within the program What steps are needed for safe production What equipment is used, how it s used, where it s purchased, who s responsible for the purchasing process, where it s stored and how it s issued to employees The following sample written program, also referred to as a Written Exposure Control Plan, can help you develop a plan for your organization. It s designed to take you section by section through the complete process. Here s a closer look at each section: Purpose: This section describes what the program is expected to accomplish and the employees, departments, operations and facilities to which the program applies. This may include both nonemployees and contractors. Definitions: This section defines terms found in the written program. Responsibilities: This section identifies who is responsible for specific tasks within the program to ensure its success. Every program will have a variety of tasks or action items assigned to people in your organization. When the expectations of the program are clearly spelled out, each individual s accountability within it will be clearly established. Page W-2

29 Bloodborne Pathogens Written Program Program Activities: This section describes the specific management directives (practices) that establish organization, responsibility, authority and standards and that are necessary to implement the bloodborne pathogens program. Practices must be specific and factual, not procedural. They provide guidance on how particular matters should be handled. Attachments: This section includes forms and reports that document important program information. If you fill in the blanks in the sample written program with the names and titles of people in your organization and complete the forms that follow, you will have met the requirements of a written program, as mandated by the OSHA standard. Read the information in this sample written program and verify that it accurately represents your bloodborne pathogens program. Attach all forms to your written program. You must decide how HBV vaccines will be provided to employees. The written program has documentation for pre-exposure vaccination practices. You must choose one method and inform employees of it. Delete the method that you do not use from the written program. Page W-3

30 Bloodborne Pathogens Written Program Bloodborne Pathogens Written Exposure Control Plan Purpose The purpose of this plan is to establish a program and procedures for employee protection from bloodborne pathogens at. Company Name This plan supports compliance with Occupational Safety And Health Administration 29 CFR on bloodborne pathogens. This plan applies to all company employees. Definitions Bloodborne Pathogens: Microorganisms that are present in human blood and body fluids and can cause diseases in humans. These pathogens include Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV). Exposure Incident: A situation in which an employee has contact with blood or other potentially infectious materials as a result of his or her duties. This contact includes specific eye, mouth, other mucous membrane, nonintact skin or parenteral contact. Nonintact Skin: Skin that has cuts, abrasions or other openings through which bloodborne pathogens can enter the bloodstream. Occupational Exposure: Reasonably anticipated employee contact with blood or other potentially infectious materials that may result from performing an employee s duties. This contact includes specific eye, mouth, other mucous membrane, nonintact skin or parenteral contact. Source Individual: Any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to an employee. Universal Precautions: An approach to infection control, in which all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, HCV and other bloodborne pathogens. Page W-4 May be reproduced by original purchaser. 1998, 2002, 2005 Comprehensive Loss Management, Inc.

31 Bloodborne Pathogens Written Program Responsibilities The Program Administrator: Name & Title This person is responsible for these tasks: Issuing and administering this plan and making sure that it satisfies the requirements of all applicable federal, state and local bloodborne pathogens regulations Identifying which employees are likely to be exposed to bloodborne pathogens Developing procedures for postexposure incidents Maintaining medical records of exposure incidents, training records and hepatitis vaccinations Completing exposure incident reports and notifying affected individuals Evaluating and updating the program annually Training employees annually First Aid Providers: Names & Titles These people are responsible for these tasks: Using Universal Precautions in all situations that involve exposure to blood and other body fluids Informing the program administrator of all exposure incidents May be reproduced by original purchaser. 1998, 2002, 2005 Comprehensive Loss Management, Inc. Page W-5

32 Bloodborne Pathogens Written Program Program Activities Determination Of Exposure A list will be made of all job classifications that have the potential for exposure to bloodborne pathogens. Specific tasks and procedures will be listed when only some employees in a job classification have the potential to be occupationally exposed. Personal Protective Equipment (PPE) Employees will be provided with PPE at no cost. PPE will be removed before leaving the work area or after a garment becomes contaminated. Used PPE will be placed in designated containers. Gloves will be worn when the employee may have contact with blood or other potentially infectious materials. Gloves will be replaced if torn, punctured or contaminated. Utility gloves will be decontaminated for reuse if they are not torn or cracked. Decontaminated disposable gloves will never be reused. Appropriate face and eye protection will be worn when splashes, sprays, spatters or droplets of blood or other potentially infectious materials pose a hazard to the eyes, nose or mouth. Appropriate protective body covering will be worn when occupational exposure is anticipated. Housekeeping All equipment and work surfaces that have been contaminated with blood or other potentially infectious materials will be cleaned and decontaminated with an appropriate disinfectant. Tongs, forceps or a brush and a dust pan will always be used to pick up contaminated broken glass. All infectious waste will be placed in red-colored plastic bags for disposal. Contaminated sharps will be discarded in containers that are closeable and puncture resistant. The containers will then be discarded into red-colored plastic bags. All regulated waste will be discarded according to federal, state and local regulations. Labeling All infectious waste containers will be labeled with a biohazard symbol and the word biohazard. Page W-6 May be reproduced by original purchaser. 1998, 2002, 2005 Comprehensive Loss Management, Inc.