Occupational Safety and Health Administration (OSHA) Guidelines: www.osha.gov
Blood borne pathogens are infectious microorganisms present in blood that can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), the virus that causes AIDS. Workers exposed to blood borne pathogens are at risk for serious or life-threatening illnesses.
Body Substance Isolation Body Substance Isolation (BSI) is the practice of how to handle and dispose of body fluids in a safe manner to prevent the spread of infection. It focuses on isolating all moist and potentially infectious body substances, such as blood, feces, urine, sputum, and wound drainage, from all persons. BSI includes thorough hand washing, the use of gloves and plastic aprons, and proper disposal of both body fluids and the items used. It means using gloves when handling anything warm, wet, and not yours. Plastic aprons should be worn when splashing or soiling is likely. Waste such as soiled gloves, bloody bandages, or soiled briefs and pads should be put in a plastic bag and closed. That bag can then be put in with the regular garbage and placed in the trashcan. This way the waste is in two bags. Blood spills need to be cleaned up in a special way. You can use a disinfectant made from one part bleach and ten parts water. You should wear gloves and use paper towels to clean the area. The waste (towels and gloves) should go into a plastic bag and closed. Again, that bag should be put in the regular garbage and placed in a trashcan. Following these recommendations will help to avoid the spread of infection and to keep you and your care recipient healthy.
Exposure control plan.
In general, the standard requires employers to:
- Establish an exposure control plan. This is a written plan to eliminate or minimize occupational exposures. The employer must prepare an exposure determination that contains a list of job classifications in which all workers have occupational exposure and a list of job classifications in which some workers have occupational exposure, along with a list of the tasks and procedures performed by those workers that result in their exposure.
- Employers must update the plan annually to reflect changes in tasks, procedures, and positions that affect occupational exposure, and also technological changes that eliminate or reduce occupational exposure. In addition, employers must annually document in the plan that they have considered and begun using appropriate, commercially-available effective safer medical devices designed to eliminate or minimize occupational exposure. Employers must also document that they have solicited input from frontline workers in identifying, evaluating, and selecting effective engineering and work practice controls.
- Implement the use of universal precautions (treating all human blood and OPIM as if known to be infectious for blood borne pathogens).
- Identify and use engineering controls. These are devices that isolate or remove the blood borne pathogens hazard from the workplace. They include sharps disposal containers, self-sheathing needles, and safer medical devices, such as sharps with engineered sharps-injury protection and needleless systems.
- Identify and ensure the use of work practice controls. These are practices that reduce the possibility of exposure by changing the way a task is performed, such as appropriate practices for handling and disposing of contaminated sharps, handling specimens, handling laundry, and cleaning contaminated surfaces and items.
- Provide personal protective equipment (PPE), such as gloves, gowns, eye protection, and masks. Employers must clean, repair, and replace this equipment as needed. Provision, maintenance, repair and replacement are at no cost to the worker.
- Make available hepatitis B vaccinations to all workers with occupational exposure. This vaccination must be offered after the worker has received the required blood borne pathogens training and within 10 days of initial assignment to a job with occupational exposure.
- Make available post-exposure evaluation and follow-up to any occupationally exposed worker who experiences an exposure incident. An exposure incident is a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or OPIM. This evaluation and follow-up must be at no cost to the worker and includes documenting the route(s) of exposure and the circumstance under which the exposure incident occurred; identifying and testing the source individual for HBV and HIV infectivity, if the source individual consents or the law does not require consent; collecting and testing the exposed worker’s blood, if the worker consents; offering post exposure prophylaxis; offering counseling; and evaluating reported illnesses. The healthcare professional will provide a limited written opinion to the employer and all diagnoses must remain confidential.
- Use labels and signs to communicate hazards. Warning labels must be affixed to containers of regulated waste; containers of contaminated reusable sharps; refrigerators and freezers containing blood or OPIM; other containers used to store, transport, or ship blood or OPIM; contaminated equipment that is being shipped or serviced; and bags or containers of contaminated laundry, except as provided in the standard. Facilities may use red bags or red containers instead of labels. In HIV and HBV research laboratories and production facilities, signs must be posted at all access doors when OPIM or infected animals are present in the work area or containment module.
- Provide information and training to workers. Employers must ensure that their workers receive regular training that covers all elements of the standard including, but not limited to: information on blood borne pathogens and diseases, methods used to control occupational exposure, hepatitis B vaccine, and medical evaluation and post-exposure follow-up procedures. Employers must offer this training on initial assignment, at least annually thereafter, and when new or modified tasks or procedures affect a worker’s occupational exposure. Also, HIV and HBV laboratory and production facility workers must receive specialized initial training, in addition to the training provided to all workers with occupational exposure. Workers must have the opportunity to ask the trainer questions. Also, training must be presented at an educational level and in a language that workers understand.
- Maintain worker medical and training records. The employer also must maintain a sharps injury log, unless it is exempt under Part 1904 — Recording and Reporting Occupational Injuries and Illnesses, in Title 29 of the Code of Federal Regulations.
Occupational Safety and Health Administration www.osha.gov 1-800-321-6742
Be sure your facility’s Exposure Control Plan meets OSHA’s criteria.
According to the OSHA Blood borne Pathogens Standard, an Exposure Control Plan must meet certain criteria:
- It must be written specifically for each facility;
- It must be reviewed and updated at least yearly (to reflect changes such as new worker;
- Positions or technology used to reduce exposures to blood or body fluids);
- It must be readily available to all workers.
Exposure incidents and reports.
OSHA’s Blood borne Pathogens standard (29 CFR 1910.1030) requires employers to make immediate confidential medical evaluation and follow-up available for workers who have an exposure incident, such as a needle stick. An exposure incident is specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials (OPIM), as defined in the standard that results from the performance of a worker’s duties.
Reporting an Exposure Incident
Exposure incidents should be reported immediately to the employer since they can lead to infection with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), or other blood borne pathogens. When a worker reports an exposure incident right away, the report permits the employer to arrange for immediate medical evaluation of the worker. Early reporting is crucial for beginning immediate intervention to address possible infection of the worker and can also help the worker avoid spreading blood borne infections to others. Furthermore, the employer is required to perform a timely evaluation of the circumstances surrounding the exposure incident to find ways of preventing such a situation from occurring again. Reporting is also important because part of the follow-up includes identifying the source individual, unless the employer can establish that identifications infeasible or prohibited by state or local law, and determining the source’s HBV and HI infectivity status. If the status of the source individual is not already known, the employer is required to test the source’s blood as soon as feasible, provided the source individual consents. If the individual does not consent, the employer must establish that legally required consent cannot be obtained. If state or local law allows testing without the source individual’s consent, the employer must test the individual’s blood, if it is available. The results of these tests must be made available to the exposed worker and the worker must be informed of the laws and regulations about disclosing the source’s identity and infectious status.
Medical Evaluation and Follow-up
When a worker experiences an exposure incident, the employer must make immediate confidential medical evaluation and follow-up available to the worker. This evaluation and follow-up must be: made available at no cost to the worker and at reasonable time and place; performed by or under the supervision of a licensed physician or other licensed healthcare professional; and provided according to the recommendations of the U.S. Public Health Service (USPHS) current at the time the procedures take place. In addition, laboratory tests must be conducted by an accredited laboratory and also must be at no cost to the worker. Worker who participates in post-exposure evaluation and follow-up may consent to have his or her blood drawn for determination of a baseline infection status, but has the option to withhold consent for HIV testing at that time. In this instance, the employer must ensure that the worker’s blood sample is preserved for at least 90 days in case the worker changes his or her mind about HIV testing. Post-exposure prophylaxis for HIV, HBV, and HCV, when medically indicated, must be offered to the exposed worker according to the current recommendations of the U.S. Public Health Service. The post-exposure follow-up must include counseling the worker about the possible implications of the exposure and his or her infection status, including the results and interpretation of all tests and how to protect personal contacts. The follow-up must also include evaluation of reported illnesses that may be related to the exposure.
The employer must obtain and provide the worker with a copy of the evaluating healthcare. Professional’s written opinion within 15 days of completion of the evaluation. According to OSHA’s standard, the written opinion should only include: whether hepatitis B vaccination was recommended for the exposed worker; whether or not the worker received the vaccination, and that the healthcare provider informed the worker of the results of the evaluation and any medical conditions resulting from exposure to blood or OPIM which require further evaluation or treatment. Any findings other than these are not to be included in the written report.
For more information, go to OSHA’s Blood borne Pathogens and Needle stick Prevention Safety and Health Topics web page at: https://www.osha.gov/SLTC/bloodbornepathogens/index.html
Occupational Safety And Health Administration