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Bloodborne
Pathogens
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Bloodborne
Pathogens Training
|
 Why
do I need bloodborne pathogens training?
The Occupational Safety and Health
Administration (OSHA) requires that all employees who have the
potential for exposure to bloodborne
pathogens (BBP) must be provided with certain protections
by their employer. These protections are outlined in detail within
OSHA's Bloodborne Pathogens Standard, 29
CFR 1910.1030 . The University of Kentucky must follow the requirements
set forth by OSHA to ensure the safety of its own employees. |
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What
will I learn from this program?
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| The
purpose of this online training program is to provide general awareness
regarding the precautions you should be taking if you are an employee,
student, or other individual working with blood
or other
potentially infectious materials (OPIM). Additionally, supervisors
and administrators will learn about their responsibilities to ensure
the protection of employees and students. This course is only part
of a comprehensive BBP training program. Worksite - specific training
will still need to be conducted by the PI, supervisor, or other
responsible individual(s). |
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What
are some diseases caused by bloodborne pathogens?
|
 Bloodborne
pathogens are disease causing agents present in blood or OPIM. There
are many diseases caused by bloodborne pathogens, such as herpes,
syphilis, malaria, babesiosis, brucellosis, leptospirosis, arboviral
infections, and cytomegalovirus. However, acquired immunodeficiency
syndrome (AIDS) and hepatitis are the bloodborne diseases that cause
the most concern in occupational settings. The information that
follows is essential in understanding how human immunodeficiency
virus (HIV) and various hepatitids are transmitted, and how to prevent
exposure at work. |
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How
does HIV cause AIDS?
|
 HIV
destroys a certain kind of blood cells--CD4+ T cells (helper cells)--which
are crucial to the normal function of the human immune system. In
fact, loss of these cells in people with HIV is an extremely powerful
predictor of the development of AIDS. There is a strong connection
between the amount of HIV in the blood and the decline in CD4+T
cell numbers and the development of AIDS. Reducing the amount of
virus in the body with anti-HIV drugs can slow this immune destruction. |
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How
is HIV transmitted?
|
 HIV
is spread through human body fluids, most commonly blood and semen.
It has also been transmitted less frequently by vaginal secretions
and breast milk. Although it has been isolated from saliva, tears,
and urine, these fluids have not been implicated in the transmission
of HIV. Saliva in dental procedures is considered infectious because
of the inevitable presence of blood.
HIV is not transmitted through surface contact with dried blood.
Incorrect interpretation of conclusions drawn from laboratory studies
have unnecessarily alarmed some people. To obtain data on the survival
of HIV, laboratory studies have required the use of artificially
high concentrations of laboratory-grown virus. Although these unnatural
concentrations of HIV can be kept alive for days or even weeks under
precisely controlled and limited laboratory conditions, CDC studies
have shown that drying of even these high concentrations of HIV
reduces the amount of infectious virus by 90 to 99 percent within
several hours. Since the HIV concentrations used in laboratory studies
are much higher than those actually found in blood or other specimens,
drying of HIV-infected human blood or other body fluids reduces
the theoretical risk of environmental transmission to essentially
zero. |
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What are the symptoms of AIDS?
|
 In
some individuals, a flu-like illness occurs within 1 to 6 weeks
after exposure to the virus. After a long, symptom-free (latent)
period of up to 7 to 10 years, HIV- infected individuals become
symptomatic. The symptoms include, but are not limited to:
- Enlarged
Lymph Nodes
- Malaise
- Headache
- Diarrhea
- Night
Sweats
Individuals
with AIDS develop certain types of tumors or infections caused by
"opportunistic" bacteria, fungi, viruses, and parasites
that infrequently cause infections in otherwise healthy people.
These opportunistic infections are the usual cause of death. |
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What is my risk of becoming infected with HIV at work?
|
 HIV
is not efficiently transmitted through workplace exposures. From
1980 to 1999, the Center for Disease
Control (CDC) documented 56 cases of occupationally acquired
HIV transmission. "Documented" cases are healthcare workers
who have contracted HIV through a work-related injury. All other
risk factors were ruled out and exposure on the job was documented.
Of the 56 confirmed cases, 48 occurred through parenterel exposure
(piercing the skin with a HIV - contaminated sharp object). Eight
occurred by splashing or splattering of blood or OPIM to the eyes,
nose, or mouth. There were 136 possible cases in the same time period.
The "possible" cases in healthcare workers have been investigated
and are without identifiable behavioral or transfusion risks. Although
each person had experienced exposure to blood or body fluids, or
laboratory solutions containing HIV, a specific work-related incident
resulting in a HIV- positive blood test was not documented.
How do these CDC statistics translate to actual risk to workers?
The probability of becoming infected following a work - related
exposure to a known HIV positive source is only about 0.4%. |
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If the probability of becoming infected with HIV at work is so
remote, then why worry?
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| AIDS
is uniformly fatal. Although combinations of drugs called antiretroviral
agents and protease inhibitors have been used to delay the onset
of AIDS in infected persons, there is still no cure. |
How will I keep from becoming infected with HIV at work?
|
 The
cornerstone of protection against bloodborne pathogens is universal
precautions. Universal precautions is the practice of treating
all human blood and certain human body fluids as if they are known
to be infectious for HIV, HBV, and other bloodborne pathogens. Strict
adherence with universal precautions is the only line of defense
against work - related infection with HIV, because there is no vaccine. |
What
is viral hepatitis?
|
 Hepatitis
is a serious disease caused by a virus that attacks the liver. There
are various strains of viral hepatitis which can cause lifelong
infection, cirrhosis (scarring) of the liver, liver cancer, liver
failure, and death. |
How
is viral hepatitis transmitted?
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Like HIV, Hepatitis B virus (HBV), hepatitis C virus (HCV), and
hepatitis D virus (HDV) are transmitted by percutaneous and mucosal
exposures to blood and OPIM. Exposure to hepatitis A or hepatitis
E is usually associated with unsanitary conditions (fecal - oral
route). HAV and HEV are not bloodborne pathogens and therefore are
not included in OSHA's Bloodborne Pathogens Standard. |
Which strain of hepatitis virus is of greatest concern in the occupational
setting, and what is my risk of becoming infected at work?
|
 HBV
is of greatest concern in the occupational setting for several reasons.
There is a relatively high risk of becoming infected following an
exposure. In fact, exposure to a known contaminated source results
in a 37 - 62% likelihood of infection. The chance of developing
clinical hepatitis following exposure is 22 - 31%. Like HIV, HBV
is most efficiently transmitted through percutaneous exposure. However,
unlike HIV, HBV can readily be transmitted through surface contact
with dried blood or OPIM. HBV infections that occur in workers with
no history of nonoccupational exposure or occupational percutaneous
injury might have resulted from direct or indirect blood or body
fluid exposures that inoculated HBV into cutaneous scratches, abrasions,
burns, other lesions, or on mucosal surfaces. HBV has been demonstrated
to survive in dried blood at room temperature on environmental surfaces
for at least 1 week. The potential for HBV transmission through
contact with environmental surfaces has been demonstrated in investigations
of HBV outbreaks among patients and staff of hemodialysis units. |
What
are the clinical symptoms of Hepatitis B?
|
 Symptoms
of hepatitis B include:
-
Headache
- Malaise
- Loss
of Appetite
- Nausea
- Fever
- Jaundice
- Dark
Urine
The
incubation period, or the time period from initial infection to
the onset of symptoms is 4 - 28 weeks. |
How will I keep from becoming infected with HBV at work?
|
 Unlike
HIV, there is a vaccine for HBV. The primary measure for prevention
of hepatitis B is immunization; hepatitis B can be prevented
using either preexposure prophylaxis (preventive treatment)
with hepatitis B vaccine or postexposure prophylaxis with
hepatitis B immune globulin (HBIG) and hepatitis B vaccine.
The OSHA bloodborne pathogens standard requires that all employees
with occupational exposure, or "the reasonably anticipated
skin, eye, mucous membrane, or parenteral contact with blood
or other potentially infectious materials", must be offered
the vaccine at no cost. The vaccine is safe and effective.
There is no evidence which indicates that the hepatitis B
vaccine can cause chronic illnesses. Although the vaccine
will impart immunity in over 95% of individuals who receive
it, no vaccine is 100% effective. Thus, adhering to universal
precautions is also fundamentally important. |
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Are
there any other strains of bloodborne hepatitis that are significant
in the occupational setting?
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  There
is also a risk of infection with Hepatitis C virus (HCV) and Hepatitis
D virus (HDV) for employees who have occupational
exposure to blood or OPIM. Like HBV, HCV, and HDV can result
in acute or chronic infection. No products are available to prevent
hepatitis C, and development of a vaccine for this disease is proving
to be difficult because an effective protective antibody response
has not been demonstrated following HCV infection. Thus, the primary
strategy for hepatitis C prevention is the strict observance of
universal precautions. Because HDV infection is dependent on HBV
for replication, immunization to prevent HBV infection, through
either pre- or postexposure vaccination, can also prevent HDV infection. |
What do I need to know about OSHA's
Bloodborne Pathogens Standard?
|
 If
you are a supervisor, PI, or any other individual responsible
for
implementing the worksite BBP program, you must know the general
requirements of the standard, and see that these requirements
are
implemented in the workplace. If you are an employee or student,
you must understand and follow all workplace rules and policies
implemented to prevent exposure to BBP. To accomplish these objectives,
each workplace must have a written exposure
control plan (ECP). An ECP is a comprehensive, workplace - specific
document that outlines in detail all measures that will be taken
to eliminate or minimize employee exposure. An ECP is a manual
for
how to work safely with blood and OPIM. It is a living document.
In other words, an ECP must reflect what is actually occurring
in the workplace, from the broadest departmental policies to the
most specific work practice instructions. Supervisors must make
the workplace ECP available to employees, and review the plan as
a part of employee training. |
What
are the fundamental components of an ECP?
|
 The
5 fundamental components of an ECP are:
- Exposure
Determination
- Methods
of Compliance
- Hepatitis
B Vaccination
- Communication
of Hazards
- Post
Exposure Evaluation and Follow Up.
Next
we will discuss each of these 5 components in detail. Examples of
each component will be provided. |
1. Exposure Determination
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An
exposure determination is simply a listing of all employees with
Occupational Exposure (those who may become exposed to blood or
OPIM), and the tasks and procedures in which exposure may occur.
Below is an example of an exposure determination as it should appear
in the ECP. Please consult your workplace ECP for the actual exposure
determination.
| Employees
or Job Titles with Occupational Exposure |
Tasks
/ Duties |
| PI |
List
all tasks that may involve exposure to blood or OPIM |
| Research
Assistants |
List
all tasks that may involve exposure to blood or OPIM |
| Lab
Technicians |
List
all tasks that may involve exposure to blood or OPIM |
| First
Aid Responders |
List
all tasks that may involve exposure to blood or OPIM |
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2.
Methods of Compliance
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|
 Methods
of compliance are all protective work practices, policies, rules,
and controls, from the broadest to the most specific. Broad policies
include a statement within the ECP that all employees will follow
universal precautions, or that eating, drinking, storing food,
mouth pipetting, smoking, applying lip balm, cosmetics, or contact
lenses in the work area is prohibited.
In addition to broad policies, the ECP should also contain task
- specific descriptions of safe practices to be utilized in the
workplace. Examples of task - specific methods of compliance are:
- How/when
to wear personal protective equipment (PPE).
Below is an example of a PPE / task specification table as it
should appear in the ECP. Please consult your workplace ECP
for actual PPE / task specifications. All contaminated
PPE must be discarded before leaving the work area. If the contaminated
PPE is not disposable, then it must be placed in a contaminated
laundry receptacle.
| PPE |
Task(s) |
| Gloves,
Lab Coat |
All
laboratory activities. Always wear gloves while in work
areas |
| Splash
Goggles / Facial Shield |
pipetting,
vortex mixing of unsealed containers, and decanting liquids |
| Utility
Gloves, Apron |
Cleaning
spills of blood or OPIM; Cleaning contaminated broken
glass or other contaminated
sharps. |
| Gloves,
Microshield |
Providing
first aid / CPR. |
- How
to dispose of small amounts of regulated
waste and remove gloves:
 |
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| 1.
Before removing disposable gloves, gather any contaminated
materials used in providing first aid and/or clean up and
hold them in one hand. |
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| 2.
Strip off the glove containing the contaminated materials
from the wrist, turning it inside out so the "clean"
side is on the outside. |
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| 3.
Place that glove in the other hand and strip off the glove
on that hand, turning it inside out. |
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4.
Dispose of the gloves/material in a regulated waste container.
5. Wash hands with soap and water |
- How
to dispose of larger amounts of regulated waste:
- Before
removing disposable gloves, gather all contaminated materials
together and put them in a biohazard (red) bag. These bags
should be labeled with the universal biohazard symbol.
- Make
sure the bag is intact and that there is no danger of leaking.
If the bag is torn or punctured or is contaminated on the
outside, place the bag inside a second biohazard bag.
 Strip
off disposable gloves from the wrist, turning them inside
out so that the "clean" side is on the outside.
Drop them into the red bag along with the other contaminated
materials. Close the bag by handling only the clean outside
surfaces. DO NOT throw the biohazard bag into the regular
trash.- Wash
hands with soap and water.
- Inform
your supervisor so he/she can make arrangements to properly
dispose of the biohazard bag.
- How
to wash hands properly
| Proper
handwashing is one of the most important infection control
measures for employees working with blood or OPIM. Handwashing
facilities must be available within the facility to
all employees with occupational exposure. |
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| The
following is an example of a uniform hand washing procedure
that should be outlined within the ECP: |
| 1.
Wet both hands and wrists. Lather with soap and warm water.
|
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| 2.
Spread the lather to the back of the hands and wrists. Clean
the finger tips and between the fingers. Washing time should
be at least 15 seconds. |
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| 3.
Rinse hands and wrists well to remove all soap. |
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| For
additional information about handwashing and hand antisepsis
in health-care settings, and specific recommendations regarding
hand-hygiene practices, see the CDC
Guideline for Hand Hygiene in Healthcare Settings. |
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For
routine cleaning, use an apply an EPA
registered tuberculocidal disinfectant or an EPA registered
disinfectant that is labeled as effective against HIV and
HBV. Spray the disinfectant onto contaminated surfaces and
allow ten minutes before wiping. A 0.5% solution of sodium
hypochlorite in water is effective. When using any commercial
sterilant, be sure to read the directions on the label for
additional use instructions. The ECP should have a schedule
for routine cleaning of potentially contaminated surfaces
or equipment in the workplace. |
- How
to clean spills or contaminated surfaces:
| 1.
The appropriate PPE must always be used when cleaning potentially
contaminated surfaces. The first step is to contain the
spill. For small spills, gauze or paper towels should be
placed over the blood or OPIM for containment and absorption. |
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| 2.
Next, apply a disinfectant. This can be a 0.5% solution
of sodium hypochlorite in water, or other commercially available
EPA
registered tuberculocidal sterilants. |
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| 3.
Use paper towels or a dust pan and broom to remove the materials. |
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| 4.
Dispose of the contaminated materials in a properly labeled,
closable regulated waste container. When cleaning larger amounts
of blood or OPIM, work slowly and carefully to avoid splashing.
If the contaminated area involves a volume of blood or OPIM
that cannot be safely handled by employees, call UK Environmental
Management at 323-6280 |
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| 5.
Once contaminated materials are removed from the surface,
reapply the sterilant and allow ten minutes before wiping
again |
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3.
Hepatitis B Vaccination
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This
component of the ECP should describe the steps the employer must
take to ensure the successful completion of the hepatitis B vaccination
series for all employees with occupational exposure. For example,
the following general information should be included:
 The
vaccine is given in three stages:
- The
initial injection
- A
second injection one month later
- A
third injection 6 months after the first injection
All
three injections are necessary to ensure immunity. There is no evidence
that the vaccine has ever caused Hepatitis B, and the incidence
of side effects is low.
Some possible side effects are:
- Tenderness
and redness at the site of the injection
- Low
grade fever
- Rash,
nausea, joint pain, and mild fatigue have been reported on rare
occasions
Persistent
side effects that do not go away after 48 hours should be reported
to your doctor. The HBV vaccine must be provided at no cost to employees.
You may refuse the vaccine. If you choose to do so, then you must
sign the appropriate declination form.
Additionally, specific instructions about how to receive the vaccine
should be included. The following example is an acceptable procedure
for obtaining the hepatitis B vaccination series for UK employees,
and can be used in any UK worksite - specific ECP:
Receiving the HBV Vaccination
Each University department must ensure that the hepatitis B vaccine
is administered at no cost to its employees. If you have occupational
exposure to bloodborne pathogens, ask your supervisor or PI for
instructions on receiving the hepatitis B vaccine.
Post-Exposure
Evaluation and Follow-up: An exposure incident is a specific
eye, mouth, other mucous membrane, non-intact skin, or parenteral
(e.g. needle stick) contact with blood or OPIM that results from
the performance of an employee's duties.
If
this happens, you have the right to medical evaluation and treatment.
These post-exposure services will be furnished to you at no cost
to you, in accordance with the Bloodborne Pathogens Standard.
If you have any direct exposure to human blood or OPIM, immediately
wash the affected body part with soap and water, and notify your
PI or supervisor, who will then contact Worker's Care at
1-800-440-6285 and direct you to the appropriate medical treatment
at University Health Services. UHS will assess your exposure and
offer you the appropriate post exposure medical treatment and
counseling. Prompt medical attention may reduce the risk of serious
health consequences after an exposure incident. The PI will complete
the exposure incident evaluation form
and use the information to determine appropriate controls or protective
measures to prevent a recurrence of the exposure incident.
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4.
Communication of Hazards
|
 This
part of the ECP describes labeling and training requirements. The
biohazard legend (see right) must be placed on all containers of
blood or OPIM. The container for storage, transport, or shipping
shall bear this label and be closed prior to being stored, transported,
or shipped. When a facility utilizes Universal Precautions in the
handling of all specimens, the labeling/color-coding of specimens
is not necessary provided containers are recognizable as containing
specimens. This exemption only applies while such specimens/containers
remain within the facility. Labeling or color-coding is required
when such specimens/containers leave the facility.
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| OSHA's
Bloodborne Pathogen Standard requires that you must repeat this
training program on an annual basis. |
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5. Post Exposure Evaluation and Follow - Up
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| An exposure
incident is a specific eye, mouth, other mucous membrane, non-intact
skin, or
parenteral (e.g. needle stick) contact with blood
or OPIM that results from the performance of an employee’s duties.
If an exposure incident occurs, it is essential to ensure the proper
medical evaluation and follow up for the exposed individual. The
ECP should have a listing of procedures to be followed, and a responsible
person listed to ensure implementation of the procedures. The following
example is a viable post – exposure follow up procedure for UK
employees, and can be used in a UK worksite - specific ECP: |
• Immediately
wash the exposed skin with soap and water and flush the other areas
with water.
• Notify your supervisor immediately after washing.
•
Your supervisor should call UK Workers’ Care at 1-800-440-6285. They
will schedule an appointment at the hospital for a post-exposure
examination.
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| » Special
thanks to Kathleen M. Rose, UK Campus Recreation, and UC Berkeley
Office of Environment, Health & Safety for their contributions
to this program. |
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Last
Updated 12.01.2005
Send Comments to D. Caskey
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