E3821
BBP in Healthcare Facilities
Leader’s Guide
© 2008 ERI Safety Videos
INTRODUCTION TO THE OSHA
BLOODBORNE PATHOGENS STANDARD
Background
On December 6, 1991 the Occupational Safety and Health Administration
(OSHA) published the "Occupational Exposure to Bloodborne Pathogens"
Standard. The purpose of this regulation is to "eliminate or minimize
occupational exposure to Hepatitis B Virus (HBV), Human Immunodeficiency
Virus (HIV) and other bloodborne pathogens".
Other agencies of the Federal government have been involved with the issue
of employee exposure to medically related infectious materials for some time.
For instance, for a number of years the Department of Health and Human
Service's has published a booklet entitled, "Guidelines for Prevention of
Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to
Healthcare and Public Safety Workers".
Additionally, in 1989, the Environmental Protection Agency (EPA) published
interim final rules on the "Standards for Tracking and Management of Medical
Wastes".
The impetus behind this activity is varied. First, the publicity received in recent
years regarding the Human Immunodeficiency Virus (HIV) and AIDS has
sensitized the public and legislators alike regarding the transmission of
infectious diseases. Additionally, increased emphasis on employee safety and
health has elevated the concern regarding exposure to Hepatitis B, especially
in healthcare facilities.
OSHA initially became involved in this area in 1983, issuing a set of voluntary
guidelines designed to reduce the risk of occupational exposure to Hepatitis B
Virus.
In late 1986, the American Federation of State, County and Municipal
Employees (AFSCME) petitioned OSHA to formally take action to reduce the
risk to employees from exposure to various infectious agents. Later that same
year, the Service Employees International Union, the National Union of
Hospital and Healthcare Employees and other groups petitioned
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OSHA to create a standard to protect healthcare employees from the hazard
posed by occupational exposure to the Hepatitis B Virus. It was these actions
that prompted OSHA to begin work on the Bloodborne Pathogens Standard.
This standard represents OSHA's first regulation of occupational exposure to
biological hazards.
This standard has also been changed several times over the years, including a
recent update concerning the Exposure Control Plan that attempts to reduce
sharps-related injuries.
Major Compliance Requirements
The requirements in OSHA's Bloodborne Pathogens Standard can be grouped
into a number of major areas:
$ Creating an Exposure Control Plan - This plan describes how
the facility will comply with the Bloodborne Pathogens Standard
and protect employees from hazards presented by bloodborne
pathogens encountered in the workplace, and must be
reevaluated at least once a year.
$ Standard Precautions - A "Standard Precautions" program must
be observed throughout the facility to prevent contact with blood
and other potentially infectious materials.
$ Engineering and Work Controls - Controls must be
implemented to reduce employees' exposure to bloodborne
pathogens. These include things such as:
- Sharps containers.
- Hand washing facilities.
- Equipment decontamination.
$ Personal Protective Equipment - Employees must have access
to all types of personal protective equipment that can be used to
reduce or eliminate their exposure to bloodborne pathogens. This
equipment must be available in their work areas. Procedures for
collection, decontamination and disposal of this equipment must
also be addressed.
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$ Housekeeping - Written cleaning schedules must be created to
clean and decontaminate work areas. "Regulated Waste" must be
handled according to existing OSHA, EPA and state/local laws.
$ HIV and HBV Research Laboratories and Production
Facilities - Special requirements exist for these types of facilities.
Since most laboratories in healthcare settings are clinical and
diagnostic in nature (which are not covered under these special
requirements) this section of the standard does not apply to most
healthcare institutions.
$ Hepatitis B Vaccination - A free vaccination program must be
provided for employees who have occupational exposure to
bloodborne pathogens.
$ Post-Exposure Evaluation and Follow up - A defined process
must be put into place to provide employees with appropriate
medical consultation and treatment if they experience an
"exposure incident" involving bloodborne pathogens.
$ Labels and Signs - Biohazard warning labels are required in a
number of situations including:
B Regulated waste.
B Storage/transport containers.
B Contaminated equipment.
$ Information and Training - Employees must be provided with
information and training in areas including:
B The Bloodborne Pathogens Standard itself.
B The epidemiology and symptoms of bloodborne
diseases.
B Transmission of bloodborne diseases.
B The facility's Exposure Control Plan.
B An explanation of how to recognize tasks that may
involve exposure.
B A review of methods that will prevent or reduce
exposure (such as engineering controls, work
practices, personal protective equipment, etc.).
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B How to select and use personal protective
equipment.
B The use of biohazard labels, signs and container
"color-coding".
B Information on the Hepatitis B vaccine, including
efficacy, safety and benefits. Also, information on the
facility's free vaccination program.
B Actions to take in case of emergencies involving
bloodborne pathogens.
B An explanation of the procedures to follow if an
exposure incident occurs, including reporting and
medical follow-up.
B Information on the post-exposure evaluation and
follow-up that is provided to employees in case of an
exposure incident.
This information and training must be provided annually to all
employees who may have occupational exposure to bloodborne
pathogens. Also, all new employees and employees who are
transferred from one department or area to another must be given
this training if their new position will expose them to bloodborne
pathogens in new or different ways.
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INTRODUCTION TO THE PROGRAM
Structure and Organization
Information in this program is presented in a definite order so that employees
will see the relationships between the various groups of information and can
retain them more easily. The sections included in the program are:
$ The Bloodborne Pathogens Standard itself.
$ The epidemiology and symptoms of bloodborne diseases.
$ Transmission modes for bloodborne pathogens.
$ The Exposure Control Plan.
$ An explanation of how to recognize tasks that may involve
exposure.
$ A review of methods that will prevent or reduce exposure (such as
engineering controls, work practices, use of personal protective
equipment, etc.).
$ How to select and use personal protective equipment.
$ The use of biohazard labels, signs and alternative container
"color-coding".
$ Information on the Hepatitis B vaccine, including efficacy, safety
and benefits. Also, information on the facility's free vaccination
program.
$ Actions to take in case of emergencies involving bloodborne
pathogens.
$ An explanation of the procedures to follow if an exposure incident
occurs, including reporting and medical follow-up.
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$ Information on the post-exposure evaluation and follow-up that is
provided to employees in the case of an exposure incident.
These sections include examples and other references that will help
employees to relate the information to their work environments.
Objectives
This training program is designed to present information on the nature of
bloodborne diseases and help employees reduce or eliminate potential
exposure to bloodborne pathogens in their work environments. Upon
completion of the program, employees should:
$ Have an overall understanding of the OSHA Bloodborne
Pathogens Standard.
$ Understand the general concepts behind potential exposure to
bloodborne pathogens in their workplace.
$ Have a good understanding of the terms and language used in
discussing bloodborne pathogens.
$ Have a good knowledge of the methods that can be used to
reduce or eliminate potential exposure to bloodborne pathogens.
$ Recognize the effectiveness of the Hepatitis B vaccine, and know
about their facility's vaccination program.
$ Know the procedure to be followed in case an exposure incident
involving bloodborne pathogens occurs, including persons to
contact.
$ Understand the facility's post-exposure evaluation and follow-up
process and how it benefits them.
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Reviewing the Program
As with any educational program, the "presenter" should go through the entire
program at least once to become familiar with the content and make sure the
program is consistent with company policy and directives.
Additionally, because this program addresses a federal regulation, the
presenter should check to make sure that the program's contents do not
conflict with any of the regulations that the facility is subject to in this area. An
"outline" of the points in the program is included in this Presenter's Guide to
help with this task and for general reference.
As part of this review process, you should determine how you will conduct
your session. The use of materials, such as handouts, charts, etc., that may be
available to you needs to be well thought out and integrated into the overall
program presentation.
PREPARING FOR THE PRESENTATION
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Structuring the Presentation
In conducting this education session, you should proceed with a friendly and
helpful attitude. Remember that the "trainees" are looking to your experience
and knowledge to help them relate to the situations shown in the program. It is
important to let the trainees interact with you and each other during the training
session. Stimulating conversation within the group is one of the best things
you, as the presenter of the program, can do to help everyone get as much as
possible from the session. Be alert for comments that could help in this area in
future sessions and make note of them.
As the presenter, you also should:
$ Keep the session related to the topic of bloodborne pathogens.
$ Relate discussions to your company’s operations, procedures,
and responsibilities.
$ Prevent any one person or small group of employees in the
session from doing all the talking.
$ Get everyone involved. Ask questions of those who don't
participate.
$ Clarify comments by relating them to the key points in the
program.
Use the outline of the major points included in the program, as well as the
information included in the quiz, as the basis for answering any questions. If
you don't know the answer, say so. Tragic results may occur should you
provide incorrect or inaccurate information. Remember, this is a positive
program on working with bloodborne pathogens safely. Make sure your
attitude and words reflect this and that the emphasis is always
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on providing the information needed by the attendees to reduce or eliminate
exposure to bloodborne pathogens they may encounter in their jobs.
Preparing the Supplemental Information
This program has been produced to be used as the "core" source of
information concerning bloodborne pathogens and how to reduce or eliminate
exposure. As such, it addresses the "general" things that an employee needs
to know in these areas. The OSHA Bloodborne Pathogens Standard also
requires that additional, "site specific" information be provided to employees.
As part of the preparation for conducting this session, you need to accumulate
this information and list it so that you can easily present it to your "trainees".
Examples of this type of "site specific" information include:
$ The availability of your facility's Exposure Control Plan.
$ The availability of a copy of the Bloodborne Pathogens Standard.
$ The location of personal protective equipment in the employees'
work areas.
$ Specifics regarding your free Hepatitis B vaccination program.
$ How to contact the appropriate facility personnel in case of a spill,
leak, or accident involving materials that may contain bloodborne
pathogens.
Setting Up the Class and Classroom
Remember, there are a number of things that must be done to "set up" the
class as well as the classroom. These fall into several groups of activities, and
include:
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$ Scheduling and Notification
B Use the enclosed form to schedule employees into
the session.
B Make sure that the session is scheduled so that it fits
into your attendees' work day.
B Send out notification of the session well in advance,
to give people enough time to incorporate it into their
schedule for that day.
B If possible, post a notification on bulletin boards in
the affected employees' areas.
$ The Classroom
B Schedule the room well in advance.
B Make sure the room can accommodate the expected
number of attendees.
B Check it again on the day of the program to make
sure there is no conflict.
B Make sure the room can be darkened, and won't
create a glare on the television screen.
B Locate the light controls and test them.
B Make sure the power for the videotape or DVD player
you are using operates separately from the room
light.
B See if you can control the room temperature.
B Know where the closest restrooms are located.
B Assure that the room is free from distracting noises.
B Make sure emergency exits are marked and known
to the attendees.
$ Seating
B Make sure everyone can see the screen from their
seat.
B Make sure everyone can hear both the
videotape/DVD and you (when you speak).
B Check to see that seating is such that writing can be
done easily.
B Make sure the seating arrangement allows eye
contact between attendees, and between you and
attendees.
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$ Equipment and Materials
B Make sure the videotape or DVD player, monitor, and
all appropriate cables and extension cords are
available.
B Make sure a stand or table is available and is of
appropriate height for all attendees to easily see the
monitor.
B If you plan on using a chartpad, blackboard, or other
writing board, make sure it is available, easy to see,
and you have the proper writing instruments.
B Make sure you have 6" x 8" index cards or other
materials to be used as "name tents" for attendees.
B Make sure you have made up a sufficient number of
copies of the quiz and Employee Fact Sheet, as well
as any other handouts you are using.
$ "Final Check"
B Make sure equipment is in the room prior to the
scheduled session.
B Make sure you have the right program, (look inside
the three-ring binder!)
B Check to see that the room is set up properly.
B Check equipment prior to the presentation to assure
that it works.
B Make sure extension cords, etc. are "taped down", if
need be, to avoid tripping.
B If you are using the videotape version of the program,
run the "leader" up to the point where the program
begins.
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CONDUCTING THE SESSION
The Initial Steps
In conducting the session remember the positive nature of this presentation.
Everyone is attending in order to learn more about how to do things safely.
Initially, you need to:
$ Introduce yourself as the session leader.
$ State the title of the program, "Bloodborne Pathogens in
Healthcare Facilities" and the purpose of the session (to learn
more about the OSHA Bloodborne Pathogens Standard and how
to reduce or eliminate exposure to bloodborne pathogens the
attendees may encounter in their jobs).
$ Inform the attendees when there will be breaks (if you plan them)
the location of exits and restrooms and if water, coffee, or other
refreshments will be available.
$ Make sure all of the attendees have "signed in" on your
Scheduling and Attendance Sheet. Remember, it is very
important to document peoples' attendance at the session.
Once this housekeeping is done, it is time to move to the "meat" of the
session. First, the attendees need to be informed about the objectives of the
session (this is where you can use a flip chart or board to list the objectives,
which should be done prior to the class starting). This listing should be
preceded with some introductory remarks. Your own words are always best,
but the remarks should follow along the lines of the following:
"Today we are going to talk about the OSHA Bloodborne
Pathogens Standard, and how we can work as safely as possible
in an environment that brings us into potential contact with
bloodborne pathogens."
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"Our healthcare system is one of the best in the world. But in
providing healthcare services we are constantly coming into
contact with potentially hazardous situations. Contact with blood
and other human body substances, and other materials that may
be contaminated is one of these hazards."
"The government has passed a set of laws and regulations to
make sure that facilities where these potential exposures occur
do as much as possible to guard against infection from
bloodborne pathogens."
"To help us understand these laws and learn how to reduce or
eliminate potential exposure to bloodborne pathogens we need as
much information as possible about their hazards and how to
control them. Before we do anything else, let's take a look at what
we want to accomplish in this session."
"We realize that the first step in protecting ourselves in these
situations is to be able to recognize, as much as possible,
situations where potential exposure can exist. And we realize that
some situations in our facility can be potentially hazardous. We
have tried to limit these hazards through the use of engineering
controls, such as sharps containers, and by following good work
practices. We also know that it is important to use appropriate
personal protective equipment in many of our job duties.
Additionally, for some time we have been practicing "Standard
Precautions", which is an integral part of this OSHA regulation."
"These are the type of things the regulation addresses. And
learning more about these areas, as well as new requirements in
the regulation, is the focus of this session. In order to do that,
these are the things we would like to accomplish here today
(verbally reference the 'Objectives' list, provided in the preceding
section of this manual or indicate to the board or chart where you
have written them down)."
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Once the objectives have been provided, you are ready to show the program.
However, you need to let the attendees know that they will be taking a quiz at
the end of the session (if you are using it). It needs to be emphasized that they
are not being "graded", but that the quiz is being used to see if the session is
effectively transmitting information to them in a way they will remember.
Showing the Program
At this point, you need to introduce the title of the program once again,
"Bloodborne Pathogens in Healthcare Facilities", darken the lights if
necessary, and begin the showing of the program.
If you are using the DVD version of the course you have several options as to
how you can move through the program and what employees see.
The DVD menu has three "selection bars":
$ "Play".
$ "Scene Index".
$ "Contact Info".
To just play the program from beginning to end, select "Play".
To view (or review) a specific section of the program, select "Scene Index".
You will be presented with a group of buttons, each of which corresponds to a
section of the program. You can then select the specific section that you want
to view.
If you would like information on other programs and products that are available
from MARCOM you can select "Contact Info" for information about how to
contact us.
All of our DVDs, both English and Spanish, are subtitled (similar to closed
captioning). If there are hearing impaired employees participating in your
training session, or you want people to be able to read the program narration
as well as hear it, push the "subtitle" button on your DVD
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player's remote control or the player's control panel. A print version of the
narration will then appear on the bottom of the screen as the video plays.
Conducting the Discussion
After the program has been shown, and the supplemental information given, it
is time for the group discussion on the information contained in the session.
Care must be taken to make sure that the discussion is kept to the general
topic of the bloodborne pathogens, how to reduce or eliminate exposure as
well as what to do in an exposure situation. There are several ways to conduct
these discussions. These include:
$ Calling for questions from the attendees and using these
questions as the basis for the discussion.
$ "Leading" the discussion through the points covered in the
program using statements such as:
B "One of the sections that we saw in the program was
about selection and use of personal protective
equipment. What types of personal protective
equipment do we have available that we might be
able to make better use of?"
B "We saw some interesting things about 'cleanup and
disposal of spills or leaks of materials that may
contain bloodborne pathogens'. Who can review for
us the considerations in this area that we have just
seen?"
You should use the discussion format that you are most comfortable with. The
outline of the major points addressed in the program and the questions and
answers in the master copy of the quiz should be used as a basis for this
discussion, as well as the supplemental information that you have presented in
this session.
Remember, you have allocated a limited amount of time in which this
discussion can take place. It is important to blend the attendees' questions
and areas of obvious interest with the objective of trying to touch on each
major area within the session in the discussion. By touching on each area, the
attendees are much more likely to retain the information presented in the
session.
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Concluding the Presentation
Once discussion has concluded (whether naturally or you have had to bring
the discussion to a close in order to complete the session within the time
allowed), it is time to give the quiz (if you are using it). Again, remind the
attendees that the quiz are only meant to help determine how
effective the presentation of the information is, and that they will not be
graded. Let them know that they have approximately five minutes to complete
the quiz.
At the end of the five minute period, remind the attendees to date and sign
their quizzes and then collect them. The attendees should be thanked for
attending the session and reminded of any other sessions in the educational
program that they may be attending. They can then be dismissed to return to
their normal activities.
*(An alternative to this approach is to give the quiz immediately after showing
the program, then use a review of the quiz as a basis for your group
discussion.)
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OUTLINE OF MAJOR PROGRAM POINTS
The following outline summarizes the major points of information presented in
the program. The outline can be used to review the program before conducting
a classroom session, as well as in preparing to lead a class discussion about
the program.
$ Exposure to bloodborne diseases is a serious concern in the
healthcare industry. Because of this, in 1991, OSHA created a
regulation dealing with bloodborne pathogens.
B Pathogens are the disease-causing microorganisms
found in human blood, as well as human blood
components and products.
$ Since the Centers for Disease Control's "isolation
precautions in hospitals" incorporates the concept of
standard precautions, many of you will be already
acquainted with some of the information in this program.
B For you, this will act as a "refresher" course.
B However, this program will also point out new or
different requirements that appear in the regulation.
B In addition, you will see how exposure to bloodborne
pathogens occurs so you can help protect you and
your coworkers.
$ You may want to read the regulation itself.
B Your course instructor will tell you where to find the
nearest copy.
$ While there are a number of bloodborne pathogens, those
causing Hepatitis B, Hepatitis C, and the Human
Immunodeficiency Virus pose the greatest threat.
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$ Human Immunodeficiency Virus (HIV) is the "newest" of the
bloodborne pathogens and is spreading rapidly.
B It is believed that over one million people in the U.S.
have already been infected.
B Currently, no vaccine exists to prevent infection.
B There is no known cure.
$ Symptoms experienced at the onset of HIV infection can
vary. They include:
B Weakness.
B Fever.
B Sore throat.
B Nausea.
B Headaches.
B Diarrhea.
B Other "flu-like" symptoms.
$ However, many people with the HIV virus show no apparent
symptoms for years after their initial infection.
$ Controlling the spread of HIV is very important. It is generally
believe that those who contact the HIV virus will ultimately
develop Acquired Immunodeficiency Syndrome (AIDS).
- AIDS results in a breakdown of the immune system,
canceling out the body's ability to fight off other
diseases.
$ Hepatitis is a liver disease. It usually results in an
inflammation of the liver, and frequently progresses to more
serious conditions including cirrhosis and cancer.
B Each year in the U.S., there are over 70,000 new
cases of Hepatitis B.
B It is estimated that more than 3 million people in the
U.S. are carrying the Hepatitis C virus.
B The prevalence of hepatitis is so widespread that it is
quickly becoming a larger transmission hazard than
HIV.
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$ Statistics show that healthcare workers are much more likely
to contract hepatitis than the general population.
B It is estimated that there are as many as 18,000 new
cases of hepatitis each year among healthcare
workers, which result in 200 to 300 deaths.
B While there is no cure for Hepatitis B or Hepatitis C,
a vaccine does exist that can prevent Hepatitis B
infection.
$ After exposure, it can take four weeks to six months for
hepatitis to develop.
B Early detection is extremely important, since
vaccinations begun immediately after exposure to
HBV can often prevent infection.
$ The initial symptoms of both Hepatitis B and Hepatitis C
resemble those of a mild "flu", including:
B Fatigue.
B Nausea.
B Loss of appetite.
B Possible stomach pain.
B Jaundice (a distinct yellowing of the skin).
B Darkening of the urine.
$ However, as with HIV, people infected with Hepatitis will
frequently fail to show symptoms for weeks or even months.
$ Bloodborne diseases are most often transmitted through
"parenteral" exposure.
B This is where microorganisms enter the body through
breaks in the skin or through mucous membranes.
$ These exposures most often occur through:
B Punctures from infected needles.
B Human bites.
B Skin abrasions or cuts that come into contact with
potentially infectious material.
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$
Infectious material can include:
B Blood.
B Human tissue.
B Vaginal secretions from discarded hygiene products.
B Other bodily substances with blood in them.
$ Cultures and body substances visibly contaminated with
blood must also be considered potentially infectious, as
must any body substances and materials of unknown origin.
B Materials taken from infected lab substances may
also carry bloodborne pathogens.
B Preventing parenteral exposures to these materials is
one of the major parts of the OSHA regulation.
$ The Exposure Control Plan spells out how your facility will
address the requirements of the regulation itself, and
includes:
B A determination of each employee's potential
exposure to bloodborne pathogens.
B An examination of ways to limit or eliminate
exposure.
$ The Exposure Control Plan also deals with:
B Setting up a Hepatitis B vaccination program.
B Procedures to be followed whenever an accidental
exposure occurs.
B Warning signs and labels.
B Employee training.
B Recordkeeping for exposure, vaccination and
training.
$ The plan must also incorporate the use of "Standard
Precautions".
B Treating all human blood and other body substances
as if they are known to be infectious.
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$ If you work in the healthcare industry, one of the most
critical issues the plan addresses is how to reduce the risk
of needlesticks and other sharps injuries.
B The Centers for Disease Control estimates that there
are over 500,000 injuries from contaminated sharps
each year.
B When these injuries involve infectious agents such
as hepatitis or HIV, the affected workers are at risk of
contracting bloodborne diseases.
$ One of the things OSHA has done to help combat the danger
of needlesticks is to mandate that Exposure Control Plans be
reevaluated at least once a year.
$ A major focus of these reviews is to make sure that your
group is using every means available to keep you safe,
including:
B Updated work practices.
B The use of the latest needleless technologies.
$ As a rule, the review must show that the Exposure Control
Plan:
B Reflects changes in technology that can eliminate or
reduce exposure.
B Documents investigation and implementation of new
medical devices that are designed to reduce or
eliminate exposure.
B Incorporates the opinions of frontline employees
whose interactions with patients expose them to
potentially contaminated sharps.
$ If you would like to look at your facility's plan, see your
training instructor or supervisor.
$ Labeling is the most "visible" requirement in the regulations.
B Containers carrying any potentially infectious
materials, such as blood, must be marked with a
biohazard label.
B Labels must also appear on any equipment and
materials suspected of being contaminated.
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$ The word "contaminated" indicates the presence or
anticipated presence of potentially infectious materials on an
item or surface.
$ Biohazard labels are fluorescent orange/red with the
biohazard symbol in a contrasting color.
B The word "Biohazard" is also marked on the lower
portion of the label.
B Red bags or red containers can substitute for these
labels.
$ There are several exceptions to these labeling requirements:
B Individual containers of blood do not have to be
labeled if they are placed inside another labeled
container for transport or storage.
B Facilities following Standard Precautions in handling
all specimens do not have to use this type of labeling
if the specimens are recognizable by the employees
who normally handle them.
B Labeled blood products released for transfusion or
other clinical use are also exempt if these specimens
remain in the facility.
$ Common places that you will see biohazard labels include:
B Refrigerators and freezers containing blood or other
potentially infectious materials.
B Containers used to store, transport or ship materials.
B Contaminated equipment awaiting cleaning.
B Containers of regulated waste.
B Potentially infectious materials such as blood.
B Contaminated items such as bandages, bedding and
towels.
B Contaminated sharps, including needles, scalpel
blades and broken glass.
B Containers which may have infectious material in
them.
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$ There are a number of ways that you can recognize activities
that might involve exposure to bloodborne pathogens.
B The most obvious is to look for biohazard signs and
labels.
B If you are not sure what materials need labeling, ask
your supervisor.
$ You should also be aware of all of the tasks that you perform
which deal with:
B Blood.
B Other body substances.
B Tissues where blood could be present.
$ Your employer has compiled lists of job classifications and
activities that may present risk of exposure.
B These lists can be found in your facility's Exposure
Control Plan.
$ There are many ways that you and your employer can work
to reduce exposure to bloodborne pathogens. These include
the use of:
B "Standard precautions."
B Engineering controls.
B Work practice controls.
B Personal protective equipment (PPE).
B Good housekeeping practices.
$ "Engineering controls" refer to equipment or machinery that
minimize exposure. Your facility uses many of these, such
as:
B Puncture resistant "sharps" containers.
B Self-ventilating laboratory hoods.
B Sharps with engineered injury protections such as
self-sheathing needles.
$ "Work practice controls" reduce the potential for exposure
by focusing on the safest ways to perform tasks.
B You are probably familiar with many of the practices
on OSHA's list.
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$ Hand washing is one of the most important.
B If you have been involved in an exposure situation,
OSHA requires that you wash your hands
immediately after removing gloves and PPE.
B Remember to wipe the spigot with your towel when
turning it off, to avoid recontamination.
$ You must wash your hands immediately. After contact with
blood or other potentially infectious material, as well as rinse
other areas with generous amounts of water:
B Eyes.
B Nose.
B Other mucous membranes.
$ Other work practices are also addressed by OSHA:
B Minimize splashing, spraying or creation of droplets
when dealing with potentially infectious samples.
B No mouth pipetting or suctioning is permitted.
$ During handling or storage, specimens must be placed in
appropriately labeled, leak-proof containers.
B Appropriately labeled, secondary containers must be
used if the outside surface of the primary container is
contaminated.
B If there is a danger that the specimen could puncture
the primary container, the secondary container must
be puncture-resistant as well as leak-proof.
$ OSHA considers housekeeping practices to be very
important to the control of exposure situations.
B Written cleaning schedules that specify methods of
decontamination must be maintained to keep all
areas clean and sanitary.
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$ Equipment and surfaces must be cleaned and
decontaminated after contact with blood or other potentially
infectious materials.
B If they are obviously contaminated, work surfaces
must be cleaned immediately with disinfectant.
B Otherwise, this should be done at the end of each
work shift.
B Protective coverings on equipment... such as plastic
or coated absorbents... must also be replaced when
decontaminated.
$ There are several work practice control requirements that
apply to contaminated needles and sharps:
B They must not be bent.
B They can not be recapped or removed unless there is
no feasible alternative.
B If they have to be recapped or removed, you must
use a one-handed technique or a mechanical device.
$ Broken glass is not to be picked up by hand, but by using:
B A brush and dustpan.
B Tongs.
B Other tools.
$ Contaminated sharps must be discarded as soon as possible
into appropriately labeled containers that are:
B Closeable.
B Puncture-resistant.
B Leak-proof.
$ These containers should be easily assessable and must be:
B Left upright.
B Replaced routinely.
B Never overfilled.
B Closed when handled.
B Subject to the same secondary container
requirements as specimens.
9
$ Rules also govern the handling of other regulated waste in
your facility.
B It must be placed in appropriately labeled, closeable
and leak-proof containers.
B Containers must be closed and secured during
handling.
$ The secondary containment rules that apply to specimen
handling also apply to regulated waste.
B This waste must be disposed of in accordance with
existing federal and state regulations.
$ Another part of the regulation concerns contaminated
laundry.
B It should be handled as little as possible and always
bagged appropriately.
B It must never be sorted or rinsed at its originating
location.
$ Labeled or color-coded bags are required to transport
laundry.
B Bags must be leak-proof if the laundry is wet.
B All laundry must be handled with gloves and other
appropriate PPE.
$ Never eat, drink or smoke in work areas where exposure may
occur.
B Never apply cosmetics, lip balm or contact lenses in
these areas.
B Food and drink should never be stored in laboratory
refrigerators or freezers.
$ The last type of workplace control the regulation addresses
concerns equipment.
B Before any piece of equipment is serviced or shipped
it must be inspected for contamination with body
substances.
10
$ Any required disinfection should be completed as soon as
possible.
B If the equipment can not be totally decontaminated, it
must remain labeled as a biohazard.
B All employees or service personnel who may come in
contact with the equipment must be notified of the
location and type of contamination.
$ The use of PPE is another important part of the Bloodborne
Pathogens Regulation.
B It must be worn whenever there is a chance of
exposure to blood or other potentially infectious
material.
B Gloves are mandatory in these situations.
$ Disposable gloves should be replaced as soon as possible
after becoming contaminated.
B Never attempt to decontaminate and reuse them.
B Replace disposables immediately when they are torn
or otherwise damaged.
B Removing rings before putting on gloves will help
keep them from tearing.
$ Utility gloves... usually rubber or vinyl... are heavier and can
be reused after decontamination.
B However, they must be discarded if they are cracked,
peeling or damaged.
$ You must change gloves and wash your hands after each
exposure.
B If you are sensitive to latex, talk to your supervisor.
B Non-latex PPE will be made available to workers
with documented latex allergies.
11
$ Masks and eye protection should be worn whenever there is
a chance that fluids may splash or splatter.
B Standard safety glasses protect the eyes from direct
exposure from the front.
B Side shields provide added coverage.
B Safety goggles fit snugly and provide complete eye
protection.
$ Face shields protect not only the eyes, but the rest of your
face as well.
B However, you may also need to wear goggles or
safety glasses if there is a threat that splashing or
spraying could occur up under the shield.
$ Pocket and other face masks are designed to protect the
mouth and lip area.
B They should be worn whenever eye protection is
used.
$ Lab coats and other protective clothing provide protection
for much of the body.
B They should be selected based on the degree and
circumstance of anticipated exposure.
B They must effectively prevent the pass-through of
fluids and materials.
B Gowns with total frontal coverage do the best job of
protecting street clothes from contamination.
$ Surgical caps and hoods should be worn whenever "gross"
contamination is anticipated, such as during:
B Autopsies.
B Orthopedic surgery.
$ Shoe covers should also be worn in these situations, as well
as when cleaning up spills of significant size.
$ Your facility has PPE available for you in your work area.
B If you are unsure of its location, ask your supervisor.
12
$ Be aware of your facility's procedures for handling PPE once
it has been worn.
B Know the location of collection and disposal points
and use them.
B You must take off your PPE before leaving the work
area.
$ Good work practices and the use of PPE can substantially
reduce the risk of exposure.
$ Vaccination, however, can be the first line of defense against
infection. While there is no vaccine for HIV or Hepatitis C, a
vaccine for Hepatitis B has been available for some time.
B The vaccine is administered in three injections, given
several months apart.
B Hepatitis B vaccines are safe. There is no possibility
of infection through the vaccine itself.
B Over the years, vaccination has proven to be very
effective in preventing Hepatitis B infection.
$ Your employer has set up a free Hepatitis B vaccination
program for all employees who are at risk of exposure.
B Your training instructor can give you more
information.
B If you are at risk, it is important that you be
vaccinated.
B It is so important that OSHA requires you to sign a
form if you decline the vaccination.
$ If you are accidentally exposed to Hepatitis B infected blood
and have not been vaccinated, your employer will offer you
an accelerated vaccination series at no cost.
B This "after the fact" vaccination will not always
prevent the disease.
B However, many forms of Hepatitis B are slow to
develop.
B Given in time, a vaccination may prevent the
infection.
13
$ As careful as we may be, needlesticks, blood leakage and
spills can occur.
B You need to know what to do in case of such an
emergency.
$ First, if you come into contact with any potentially
contaminated material, you should wash the affected area
with soap and water as quickly as possible.
$ If the incident involves a spill or leakage, you should soak up
the material or contain it using absorbent barriers.
$ Then immediately take the following steps:
B The area should be cleaned with your facility's
approved disinfecting solution, such as diluted
bleach.
B Once the spill or leak has been cleaned, any
contaminated materials should be disposed of in an
approved waste disposal container.
B Discard any contaminated PPE.
B Reusable equipment should be recycled for
decontamination.
$ A number of people will need to be notified about the
incident, including:
B Your supervisor.
B Your environmental services department.
B The infection control group.
$ You may also need to complete an "Incident Report."
$ If the injury was caused by a contaminated sharp, your
facility will record it in a special "Sharps Injury Log."
B This log is specifically set up to keep track of
percutaneous injuries from contaminated sharps.
14
$ Every entry into the log must include the following
information:
B The type and brand of device involved in the incident.
B The department or work area where the accident
took place.
B An explanation of what happened.
$ Immediately following the exposure, your employer will give
you a written description summarizing:
B The routes of exposure that you experienced.
B The circumstances under which the exposure
occurred.
$ If possible, the identity of the individual from whom the
potentially infectious material originated will be established.
B Your employer will also try to determine if the source
individual's blood is infected with Hepatitis B,
Hepatitis C or HIV.
$ An appointment will be arranged for you with a healthcare
professional to review the medical ramifications of what took
place. Your employer will provide the healthcare professional
with information such as:
B The type of work you were doing when the incident
occurred.
B The result of the source individual's blood test.
B Any of your medical records which are relevant to
possible treatment.
$ With your permission, your blood will also be tested to
determine if an infection has occurred.
B Your situation will then be evaluated and discussed
with you.
B If appropriate, medical treatment may then be
recommended.
B If Hepatitis B vaccination is called for, it will be
provided by your employer at no cost to you.
15
$ The healthcare professional is also required to verify four
things with your employer:
B That you have been informed of the results of their
evaluation.
B That they have discussed any medical condition
resulting from the exposure which would require
follow up with you.
B Whether Hepatitis B vaccination is recommended.
B Whether you have received the first part of the
vaccination series.
$ All other information that results from your medical
evaluation will remain confidential.
$ Bloodborne pathogens are dangerous.
B But by combining engineering controls, good work
practices, Hepatitis B vaccinations, and the use of PPE…
we can protect ourselves, and others, from exposure!
16
QUIZ
"BLOODBORNE PATHOGENS
IN HEALTHCARE FACILITIES"
Name:
Date:
1.
Which of the following are the two most prevalent bloodborne diseases in the United States?
Hepatitis B.
HIV.
Tuberculosis.
Mononucleosis.
2.
Approximately how many new cases of Hepatitis B occur in the United States each year?
70,000.
300,000.
3 million.
3.
True or False... Vaccines do exist that can prevent infection from Hepatitis C and HIV?
True
False
4.
What is the most important personal hygiene practice for preventing infection from bloodborne diseases?
Cleaning fingernails daily.
Hand washing.
Gargling with disinfectant.
5.
What color must be used as the "background" on biohazard warning labels?
Yellow.
Red/orange.
Black.
6.
True or False... All types of gloves can be reused after an exposure incident if they are decontaminated?
True
False
7.
True or False... Personal protective equipment can help guard against infection by bloodborne pathogens?
True
False
17
QUIZ
"BLOODBORNE PATHOGENS
IN HEALTHCARE FACILITIES"
PRESENTER'S COPY...WITH ANSWERS
1.
X
X
2.
X
3.
X
4.
X
5.
X
6.
X
7.
X
Which of the following are the two most prevalent bloodborne diseases in the United States?
Hepatitis B.
HIV.
Tuberculosis.
Mononucleosis.
Approximately how many new cases of Hepatitis B occur in the United States each year?
70,000.
300,000.
3 million.
True or False... Vaccines do exist that can prevent infection from Hepatitis C and HIV?
True
False
What is the most important personal hygiene practice for preventing infection from bloodborne diseases?
Cleaning fingernails daily.
Hand washing.
Gargling with disinfectant.
What color must be used as the "background" on biohazard warning labels?
Yellow.
Red/orange.
Black.
True or False... All types of gloves can be reused after an exposure incident if they are decontaminated?
True
False
True or False... Personal protective equipment can help guard against infection by bloodborne pathogens?
True
False
PRUEBA
18
"PATÓGENOS TRANSPORTADOS POR LA SANGRE EN INSTALACIONES DEL CUIDADO
DE SALUD"
Employee Name: ____________________________
Training Date: _____________
1.
Cuáles de las siguientes son las dos enfermedades transmitidas por la sangre más predominantes en
Estados Unidos?
Hepatitis B
VIH
Tuberculosis
Mononucleosis
2.
Aproximadamente cuántos casos nuevos de Hepatitis B ocurren anualmente en Estados Unidos?
70,000
300,000
3 millones
3.
Hay vacunas capaces de impedir la infección de Hepatitis C y VIH?
Verdadero
Falso
4.
Cuál es el procedimiento de higiene personal más importante para evitar la infección con enfermedades
transmitidas por la sangre?
Limpiarse las uñas diariamente
Lavarse las manos
Hacer gárgaras con desinfectante
5.
Qué color debe usarse de fondo para las de etiquetas de advertencia de biopeligro?
Amarillo
Rojo/Naranja
Negro
6.
Los guantes de cualquier tipo pueden reutilizarse tras un incidente de exposición, si se les descontamina.
Verdadero
Falso
7.
El Equipo de Protección Personal puede resguardar contra la infección con patógenos transmitidos por la
sangre.
Verdadero
Falso
PRUEBA
19
"PATÓGENOS TRANSPORTADOS POR LA SANGRE EN INSTALACIONES DEL CUIDADO
DE SALUD"
COPIA DEL PRESENTADOR...CON RESPUESTAS
1.
)Cuáles de las siguientes son las dos enfermedades transmitidas por la sangre más predominantes en
Estados Unidos?
X Hepatitis B
X VIH
Tuberculosis
Mononucleosis
2.
)Aproximadamente cuántos casos nuevos de Hepatitis B ocurren anualmente en Estados Unidos?
X 70,000
300,000
3 millones
3.
)Hay vacunas capaces de impedir la infección de Hepatitis C y VIH?
Verdadero
X Falso
4.
)Cuál es el procedimiento de higiene personal más importante para evitar la infección con enfermedades
transmitidas por la sangre?
Limpiarse las uñas diariamente
X Lavarse las manos
Hacer gárgaras con desinfectante
5.
)Qué color debe usarse de fondo para las de etiquetas de advertencia de biopeligro?
Amarillo
X Rojo/Naranja
Negro
6.
Los guantes de cualquier tipo pueden reutilizarse tras un incidente de exposición, si se les descontamina.
Verdadero
X Falso
7.
El Equipo de Protección Personal puede resguardar contra la infección con patógenos transmitidos por la
sangre.
X Verdadero
Falso
20