bloodborne pathogens

Transcription

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
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.
© 2009 Comprehensive Loss Management, Inc.
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
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
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 1910.1030
Written Program
W-1
OSHA Requirements
W-1
Written Program Development
W-2
Bloodborne Pathogens Written Exposure Control Plan
W-4
Recordkeeping
Training
W-10
T-1
Instructor Guide
T-1
Delivery
T-6
Training Tips
T-17
Learning Exercise
T-20
Glossary Of Terms
T-22
Slides
T-24
© 1998, 2002, 2005 Comprehensive Loss Management, Inc.
Page iii
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.
Bloodborne Pathogens – Introduction
Bloodborne Pathogens
Introduction
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
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:
•
•
•
•
Page I-2
Your health care provider
Local infectious disease control centers
Your insurance company’s loss-control department
The OSHA consultation division in your state
Bloodborne Pathogens – How To Comply
How To Comply
Explanation
Of The OSHA Standard
This section contains the
following information:
• Explanation Of The OSHA
Standard
• How To Develop Your
Exposure Control Plan
• OSHA Standard 29 CFR
1910.1030
The Occupational Safety And Health Administration
(OSHA) has established a Bloodborne Pathogens
Standard 29 CFR 1910.1030. 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
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
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
How To Develop Your
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
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
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
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
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 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
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
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
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.
2.
3.
4.
5.
Universal Precautions
Personal Protective Equipment (PPE)
Housekeeping
Engineering Controls
Work Practice Controls
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
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
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
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
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
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 1910.20, 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
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
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
Bloodborne Pathogens – Written Program
OSHA Requirements
Written Program
This section contains the
following topics:
• OSHA Requirements
• Written Program
Development
• Bloodborne Pathogens
Written Exposure
Control Plan
• Recordkeeping
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
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
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
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 1910.1030 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.
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
Page W-5
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.
• 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
HBV Pre-Exposure Program
• The Hepatitis B vaccine and vaccination series will be offered within 10 working
days of initial assignment to employees who have occupational exposure.
• The vaccine and vaccinations, as well as all medical evaluations and follow-up,
will be made available to employees during work hours at no cost.
• Vaccinations will be administered according to current recommendations of the
U.S. Public Health Service.
• Each employee who declines the vaccination will sign a declination form.
(The vaccination will still be available to the employee at a later date and at no
cost if he or she continues to have the potential for exposure in the workplace.)
HBV Postexposure Program
• Company postexposure procedures will be followed for any employee who is not
initially identified as occupationally exposed but who voluntarily or inadvertently
becomes exposed in the workplace.
• The HBV vaccine will be administered within 24 hours of any reported exposure
incident.
Exposure Incident Procedure
• The routes of exposure and how exposure occurred will be documented.
• The source individual will be identified and documented.
• If consent is given, the source individual’s blood will be tested and documented as
soon as possible to determine HIV, HBV and HCV infectivity.
• The exposed employee will be provided with the source individual’s test results
and information about applicable laws and regulations concerning source identity.
• After consent is given, the exposed employee’s blood will be tested for HIV, HBV
and HCV serological status.
• If the employee does not give consent for HIV serological testing, the baseline
blood sample will be preserved for at least 90 days.
• Recommendations by the U.S. Public Health Service will be followed.
• The health care provider who is responsible for administering the vaccine and
postexposure evaluation will be given a copy of the OSHA standard.
• After an exposure incident occurs, the health care provider will receive a
description of the exposed employee’s job duties relevant to the exposure incident,
documentation of the route of exposure and circumstances of exposure, results of
the source individual’s blood tests and all relevant employee medical records,
including vaccination status.
Page W-7
• The employee will be provided with a copy of the health care provider’s written
opinion within 15 days after the evaluation.
• The following health care provider will complete the postexposure evaluations:
Name
________________________________________________________________
Location _______________________________________________________________
Address _________________________________ Phone
_________________________
Training
• Employees will be trained annually on the requirements of the OSHA standard,
symptoms of bloodborne diseases, ways in which bloodborne pathogens are
transmitted, how to recognize tasks that might result in occupational exposure
and what measures are provided by the company’s Written Exposure Control Plan
(which will include receiving a copy of the plan).
Page W-8
Attachments
Recordkeeping
A – Exposure Determination Form I
B – Exposure Determination Form II
C – Exposure Incident Checklist
D – Exposure Incident Report
E – Exposed Employee Medical Release Form
F – Source Individual Medical Release/Refusal Form
G – Sample Form Letter To Health Care Provider
H – Bloodborne Pathogens Program Evaluation Record
I – Bloodborne Pathogens Equipment List
J – Hepatitis B Vaccination Declination Statement
K – Bloodborne Pathogens Training Record
Page W-9
Recordkeeping
Exposure Determination Recordkeeping
To ensure that an employer is in compliance with the OSHA requirement for
exposure determination, Exposure Determination Form I and Form II must be
completed and maintained with the written program.
Exposure Incident Recordkeeping
These records must be kept for all individual employees who are involved in
exposure incidents. These records must be kept in employees’ individual files
for the length of their employment plus 30 years and must be kept confidential.
These forms include the following:
• Additional Recordkeeping: These forms document equipment selection and
evaluation information as well as annual evaluation of the program.
• Training Recordkeeping: Training records must be kept on file for a minimum
of 3 years.
Forms Provided
A – Exposure Determination Form I
B – Exposure Determination Form II
C – Exposure Incident Checklist
D – Exposure Incident Report
E – Exposed Employee Medical Release Form
F – Source Individual Medical Release/Refusal Form
G – Sample Form Letter To Health Care Provider
H – Bloodborne Pathogens Program Evaluation Record
I – Bloodborne Pathogens Equipment List
J – Hepatitis B Vaccination Declination Statement
K – Bloodborne Pathogens Training Record
Page W-10
Bloodborne Pathogens – Training
Instructor Guide
Training
This section contains
the following topics:
•
•
•
•
•
•
Instructor Guide
Delivery
Training Tips
Learning Exercise
Glossary Of Terms
Slides
If you have never put on a training session before, there are some helpful hints at the
end of this section.
Putting On The Training Program
Training is an important way to make sure
that all employees understand the hazards
of bloodborne pathogens in your workplace.
All employees who may come in contact
with blood or other bodily fluids in their
jobs should be trained in how to protect
themselves from bloodborne pathogens.
Your bloodborne pathogens training will
be more effective if you can motivate
employees to protect themselves from
bloodborne hazards. To do this, you need to present the training as an important
and useful part of their jobs.
The benefits of bloodborne pathogens training include the following:
• Being able to recognize potentially dangerous situations where bloodborne hazard
exposure exists
• Knowing how to protect oneself and others from exposure to bloodborne
pathogens
• Creating a safer, healthier workplace
Everyone learns in a different way. Some of your employees may learn quickly from
the video and Employee Handbook; others may need more time and attention. Take
time to answer all questions and clarify the information, as needed.
Be sure to keep accurate records of all bloodborne pathogens training. For each
participant, identify the date of training, the instructor and the information covered.
You will find a Bloodborne Pathogens Training Record, which can be used for this
purpose, in the “Written Program” section.
Page T-1
Training Materials
This Instructor Guide is intended to be used with the following materials:
“Bloodborne Pathogens” Video
Designed for all employees in the workplace, the video covers:
•
•
•
•
•
•
•
Types of bloodborne diseases
How bloodborne pathogen infection occurs
How to be protected from bloodborne pathogens
Work practices that prevent infection
What to do if you are exposed
Vaccine information
Employee Handbook
Designed for participants in bloodborne pathogens training, this handbook covers:
•
•
•
•
•
•
•
Work practices that prevent infection
What to do if you are exposed
Vaccine information
“How To Comply” Section Of The Bloodborne Pathogens Safety Program
Designed for the designated safety director or person responsible for the bloodborne
pathogens program, this guide covers:
• The OSHA Bloodborne Pathogens Standard 29 CFR 1910.1030
• Steps for establishing an Exposure Control Plan
• Bloodborne pathogens information
Slides
Designed for use in the bloodborne pathogens training program, a Microsoft
PowerPoint slide presentation is provided on the enclosed CD.
Page T-2
Using This Instructor Guide
This Instructor Guide provides the following symbols to help you conduct
the session:
This symbol indicates that you should use the flipchart.
This symbol indicates that you should ask a question.
This symbol indicates that you should show a slide.
This symbol indicates that you should show the video.
This symbol indicates that you should refer to the Employee Handbook.
This symbol indicates that you should read the note for the instructor.
Page T-3
Program Preparation
The best way to ensure that you will conduct a successful training session is to be
fully prepared. Here are some important preparation steps:
1. Identify the location of the room in which you will conduct the training. Ideally,
the room should be quiet, well ventilated and well lit.
2. Schedule the session, and send out notices to managers and participants.
3. Assemble the following materials (some will be optional, depending on your
presentation plans):
• TV and VCR or DVD player
• Video/DVD
• Computer, projector and screen
• Markers and flipchart or whiteboard
• Copies of your Written Exposure Control Plan for participants
• Samples of Personal Protective Equipment (PPE) to be used in your workplace
• A sample accident situation for participants to practice proper exposure
control procedures
• Employee Handbooks
• Copies of the Learning Exercise (found at the end of this guide)
4. Review all program materials thoroughly. Make notes of examples or discussion
questions that pertain to your situation. Anticipate questions that participants
are likely to ask.
5. Read through the Learning Exercise. You may want to add additional questions
to verify that participants understand the unique risk factors and procedures in
your company.
6. Consider how you want to present the Learning Exercise. The purpose of
the exercise is to check for understanding. It can be used as part of a group
discussion, completed in small groups or filled out by individuals. It is not
recommended that the exercise be used as a test.
7. Practice presenting the classroom session.
8. OPTIONAL: Hand out the Employee Handbook prior to the program to give
participants time to read it before the session.
Page T-4
Program Presentation
The following information is provided to help you present an effective training
session. You may choose to present the program following a different format, but
keep in mind that these instructions are designed to achieve certain objectives.
It may be helpful to write key terms and their definitions on flipcharts before the
session begins. You will find a Glossary Of Terms later in this Instructor Guide.
Writing participants’ responses to questions on a whiteboard or flipchart is also
helpful, so participants can see as well as hear important information.
Encourage employees to take an active role in their learning. This will help keep the
session interesting, increase participants’ ability to retain and use the information
presented and allow you to check their understanding.
Learning Objectives
Upon completion of the program, participants will be able to:
•
•
•
•
•
Understand what bloodborne pathogen hazards exist in the workplace.
Take Universal Precautions in the workplace.
Be able to use Personal Protective Equipment (PPE).
Know how to dispose of regulated waste properly.
Understand your company’s Written Exposure Control Plan.
Final Preparation
1. Prepare all materials and test all equipment at least 1 hour before the session.
This will allow time for any last-minute maintenance of the equipment.
2. Cue up the program so it’s at the start point.
3. Have the words “Protect Yourself From Bloodborne Pathogens” displayed on a
flipchart or slide. This will focus participants on the topic to be discussed.
4. Display the session agenda on a flipchart or slide. This will help participants
follow along.
Page T-5
Delivery
Welcome & Introduction
Welcome participants to the training session.
Introduce the topic “Bloodborne Pathogens.”
Show Slide #1, “Agenda” (or write the agenda on a flipchart).
Describe the agenda for the session:
•
•
•
•
•
•
•
•
Introduction
Discussion Of Bloodborne Pathogens
Discussion Of Workplace Specifics
Hands-On Demonstration And Practice
Employee Handbook
Learning Exercise
Close
Post the agenda so participants can follow along during the session.
Explain that although blood is the most important fluid in the human body, it can
also sometimes transmit life-threatening diseases. Diseases such as Hepatitis B,
Hepatitis C and HIV (the virus that causes AIDS) are caused by bloodborne
pathogens. Because of their serious nature, it’s important that all of us understand
what bloodborne pathogens are, how they are transmitted and how we can protect
ourselves from them. By working together, we can avoid exposure to bloodborne
pathogens and make the workplace safer for everyone.
ASK: What are bloodborne pathogens?
Listen to responses.
Show Slide #2, “What Are Bloodborne Pathogens?”
Explain that bloodborne pathogens are microorganisms that can be carried in
human blood and body fluids and cause serious diseases.
ASK: What are some situations in our workplace where you might be exposed to
bloodborne pathogens?
Write responses on a whiteboard or flipchart.
Page T-6
Explain that we will now watch a video on bloodborne pathogens. As they watch,
ask participants to look for these topics:
•
•
•
•
•
•
•
Cleanup procedures
How to dispose of regulated waste
Show the video.
ASK: Does anyone have any questions about the video?
Respond to questions.
Discussion Of Bloodborne Pathogens
Explain that contact with body fluids can pose a hazard of exposure to
bloodborne pathogens.
ASK: What body fluids can cause infection?
Show Slide #3, “Body Fluids That Can Cause Infection.”
Explain that exposure to the following body fluids can cause infection:
•
•
•
•
•
Human blood
Semen
Vaginal secretions
Cerebrospinal fluid
Amniotic fluid
Explain that getting blood on you doesn’t necessarily mean you will become
infected. To become infected, the disease-carrying pathogen must enter your body.
ASK: What are the three ways in which this can happen?
Page T-7
Show Slide #4, “Three Ways Bloodborne Pathogens Can Enter Your Body.”
Explain that bloodborne pathogens can enter your body in these three ways :
• Through mucous membranes, such as your eyes, nose and mouth
• Through a cut or sore on your skin
• Through a wound from a contaminated object, such as a needle or broken glass
ASK: What three bloodborne diseases are most easily transmitted from
workplace exposure?
Show Slide #5, “The Three Most Common Bloodborne Diseases.”
Explain that these are the three bloodborne diseases most easily transmitted from
workplace exposure:
• HIV: Human Immunodeficiency Virus
• HBV: Hepatitis B Virus
• HCV: Hepatitis C Virus
ASK: HIV, the virus that causes AIDS, is the most well known of the bloodborne
pathogens, but from a workplace perspective, it really isn’t our biggest concern.
Why?
Show Slide #6, “HIV.”
Explain that HIV isn’t our biggest concern because your chances of becoming
infected with HIV during an emergency response are small. For instance, the chance
of contracting HIV from a needle stick or cut is approximately 0.3%, and the chance
of contracting HIV from a blood splash in your eyes or mucous membranes is less
than 0.09%.
Hepatitis B and C, on the other hand, cause a lot of concern because they are easier
to contract than HIV.
Page T-8
Show Slide #7, “Hepatitis B And C.”
Explain the following:
• Hepatitis B is relatively easy to transmit from person to person.
• HBV can cause periodic disability and even be fatal in some cases. However, there
is a vaccine that will protect you from contracting Hepatitis B.
• Hepatitis C has no vaccine. In fact, there is only one approved treatment, and it’s
risky, uncomfortable and not very successful.
• Diseases caused by HCV, such as cirrhosis and liver cancer, may show up 20 to 30
years after the initial infection.
Explain that all of these bloodborne diseases have long-term effects.
ASK: What’s the best way to protect yourself from exposure?
Show Slide #8, “Universal Precautions.”
Explain that the best way to protect yourself from exposure to bloodborne diseases
is by using Universal Precautions. This means that you assume all human blood and
body fluids are infectious. In the workplace, if someone is injured, regardless of how
well you know him or her, you should use Universal Precautions to protect yourself
before providing help.
Explain that the most common type of Universal Precaution is Personal Protective
Equipment (PPE).
ASK: Why is PPE used?
Show Slide #9, “Personal Protective Equipment (PPE).”
Explain that Personal Protective Equipment is used to
keep potentially infectious fluids off you and your clothes.
Page T-9
ASK: What are some examples of Personal Protective Equipment?
Look for the following responses:
• Gloves should be available with First Aid equipment and include the following:
– Single-use latex gloves to protect your skin and hands from direct contact with
blood or body fluids
– Leather or other protective gloves for use over latex gloves in situations where
latex gloves could be cut or punctured
– Gloves made from other materials for use by people who are allergic to latex
• Eye protection to prevent blood from splashing in your eyes
• Masks to cover your nose and mouth
• Gowns or other protective clothing to keep blood and body fluids off your skin and
work clothes
• CPR masks that have a one-way valve to prevent blood and other fluids from
entering the rescuer’s nose and mouth
ASK: What’s the proper way to remove Personal Protective Equipment?
Show Slide #10, “Removing Personal Protective Equipment (PPE).”
• When removing gloves and other equipment, turn the items inside out so that
they contain any contaminants, and then place them in designated containers to
be stored, washed, decontaminated or discarded.
• Latex gloves are one-time use only, so dispose of them properly after they’ve been
used or become contaminated, torn or punctured.
• Contaminated clothing should be washed thoroughly in an appropriate
disinfectant solution. If we have provided you with a uniform, we will take the
responsibility to have it properly cleaned. If your street clothes become
contaminated, make sure they are laundered separately in an appropriate
disinfectant solution.
• Wash your hands and any other exposed skin after removing clothing or
equipment or if you’ve been exposed to blood or body fluids. Use soap and water
and vigorously scrub all areas. The abrasive action of the scrubbing will remove
contaminants from the skin.
• If water isn’t available, use a waterless disinfectant hand cleaner.
ASK: In some situations, you may have to clean the area where an accident
occurred to prevent the spread of bloodborne pathogens. What are the proper
procedures for doing so?
Page T-10
Show Slide #11, “Cleanup Procedures.”
• Start by wearing Personal Protective Equipment.
• Use an appropriate disinfectant (such as 1 part bleach to 10 parts water) to clean
all work and environmental surfaces, equipment and anything that has been
contaminated with potentially infectious materials.
• Bleach may damage some surfaces, so an EPA-registered hard surface
disinfectant may be used instead.
• If there is contaminated broken glass, always use tongs, forceps or a brush and
dust pan to pick it up. Never use your hands, even if you’re wearing gloves.
ASK: What’s regulated waste, and how should it be disposed of ?
Show Slide #12, “Regulated Waste Disposal.”
Explain that regulated waste is liquid or semiliquid blood and other potentially
infectious material along with other contaminated items.
Regulated waste should be disposed of by placing it in a closeable biohazard or
red-colored container. The biohazard label will warn others that the material may
be hazardous.
We will discuss the specific regulated waste procedures for our company later, but if
you have any questions, always check with your supervisor.
ASK: What is an Exposure Control Plan?
Show Slide #13, “Exposure Control Plan.”
Explain that if there is a possibility of employee exposure to bloodborne pathogens,
the employer is required to have a Written Exposure Control Plan. This plan
contains the information and procedures to protect employees from exposure to
and transmission of bloodborne pathogens in the workplace.
Page T-11
In addition, employers are required to do the following:
• Provide information and training in bloodborne pathogens exposure control to all
employees who may have exposure on the job.
• Make a Hepatitis B vaccination available to any employee who may be exposed to
bloodborne pathogens or who is designated to respond to employee injuries.
• When there is an exposure incident, provide a postexposure evaluation and
follow-up, including:
– A written accident report
– Appropriate testing and consulting with the employee
• Keep separate, confidential medical records for all employees with risks of
exposure on the job.
We will discuss our company’s Exposure Control Plan in a moment.
Discussion Of Workplace Specifics
Discuss each of the following as it applies specifically to your workplace:
• Your company’s Exposure Control Plan:
– Where it’s located
– Whom to contact with questions
• Your company’s specific bloodborne pathogens protection procedures
• The Personal Protective Equipment (PPE) used in your workplace, including:
– What types of equipment are used
– How to use each type
– Where equipment is stored
– How to remove equipment
– How to decontaminate reusable equipment
– How to dispose of single-use equipment properly
• Specific information and emergency procedures regarding accidental exposure to
blood or other body fluids, including:
– What an exposure incident is
– Whom to contact in your organization if an exposure occurs
– Your postexposure evaluation and follow-up procedures
• Your specific procedures for disposal of regulated waste, including the types of
signs, labels and color coding used in your workplace to denote infectious
materials, wastes and equipment
• Your company’s HBV vaccination program, including:
– An explanation of why the HBV vaccine is needed
– Who is eligible for the vaccine
– The vaccine’s safety, effectiveness and method of administration
– The benefits of vaccination
– That there is no cost to employees
– Pre-exposure versus postexposure vaccination
Page T-12
Hands-On Demonstration And Practice
The following demonstrations may be used to reinforce the information presented
in the training session. Because of the challenges of working with gloves and other
protective equipment, it’s especially important to practice using the equipment prior
to an actual emergency response.
Demonstrate the proper use of the Personal Protective Equipment (PPE) in your
workplace, and have participants practice putting on and taking off each piece
of equipment.
Demonstrate the proper procedures for disposing of regulated waste, and have
participants practice proper disposal procedures.
Demonstrate how to avoid exposure to bloodborne pathogens by presenting an
accident scenario; have participants act out various roles, as follows:
1. Set up an accident or situation that would be common for your workplace, or
have the class select one based on past accidents they have encountered.
2. Select one or two accident victims and one or two responders.
3. Send everyone but the victims out of the room.
4. Explain to the victims their roles in the accident scenario that has been selected.
Have them play out their roles as believably as possibly, using props to enhance
realism.
5. Instruct the class to return to the room.
6. Instruct the responders to assess the situation and take action.
7. Instruct nonparticipants to watch and prepare to critique the responders.
8. Make sure the responders use Universal Precautions and appropriate Personal
Protective Equipment.
9. Observe that responders take care to limit
contamination of themselves and the
surrounding area.
10. Practice cleanup procedures following the
accident. Ensure that infectious waste
and debris is placed in proper containers
and then labeled and sealed.
11. Discuss what was done well and what
could be improved in the accident
scenario.
12. Repeat the process using a different
accident and different victims and
responders.
Page T-13
Employee Handbook
Hand out copies of the Employee Handbook, or refer employees to handbooks you
provided for reading before the session.
Explain that the handbook contains further information about the hazards of
bloodborne pathogens. Point out specific information in the handbook related to
your company’s operations.
Learning Exercise
Hand out the Learning Exercise (found at the end of this “Training” section).
Explain that this is an exercise, not a test.
Provide answers to the Learning Exercise after all participants have completed it.
Have participants self-grade their exercises and turn them in. Keep the exercises in
a file for future reference.
Participants who answered less than 80% of the questions correctly may not have
comprehended the training. Additional one-on-one training may be necessary.
Answers To Learning Exercise
1. Bloodborne pathogens are microorganisms that can be carried in human blood
or body fluids and cause serious diseases.
True.
2. It’s easier to become infected with HIV than with HBV.
False. Although HIV tends to have higher visibility in the media, there is a
greater risk of infection from HBV, since it’s relatively easy to catch. 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.
3. There is a vaccine that can prevent infection from Hepatitis B and C.
False. There is a vaccine for Hepatitis B but not for Hepatitis C.
4. Using Universal Precautions means wearing Personal Protective Equipment
(PPE) everywhere in the workplace.
False. Using Universal Precautions means treating all blood and body fluids as
if they are known to be infected with bloodborne pathogens.
5. For you to become infected, the disease-carrying pathogen must enter your body.
True.
Page T-14
6. Wearing single-use latex gloves provides complete protection for your hands.
False. In situations where latex gloves could be punctured, cut or torn, leather
or other protective gloves should be worn over the latex gloves to further prevent
contact with blood or other body fluids.
7. When removing contaminated clothing, you should fold it carefully so the
exposed area is visible to others.
False. When removing gloves or other equipment, turn each item inside out so
that you contain the contaminants.
8. If your hands or other skin is exposed to blood or other body fluids, you should
wash them with soap and water, vigorously scrubbing all areas.
True.
9. You can pick up contaminated broken glass with your hands as long as you are
wearing gloves.
False. You should always use tongs, forceps or a brush and dust pan to pick up
contaminated broken glass. Never use your hands, even if you are wearing gloves.
10. The Exposure Control Plan contains information and procedures to protect
employees from exposure and transmission of bloodborne pathogens in the
workplace.
True.
Close
Review the following key points of the session:
•
•
•
•
•
•
•
Definition of bloodborne pathogens
Three ways of becoming infected
HIV, HBV, HCV
Cleanup and disposal procedures
Discuss any follow-up activities you have planned.
Thank participants for their attention, and remind them that it’s their
responsibility to do these things:
•
•
•
•
•
Understand what bloodborne pathogen hazards exist in your workplace
Take Universal Precautions in the workplace
Be able to use Personal Protective Equipment (PPE)
Know how to dispose of regulated waste properly
Understand your company’s Written Exposure Control Plan
Page T-15
End the session.
Following the session, make sure that the Bloodborne Pathogens Training Record
is brought up to date, noting the participants’ names, job titles, type of training and
date of training as well as the instructor’s name.
Follow-Up
The following are suggestions for possible follow-up activities:
1. Set up a meeting several weeks after training to discuss what was learned
and how it applies to participants’ jobs.
2. Have each participant fill out a survey to assess the effectiveness of the
training.
Page T-16
Training Tips
Conducting A Successful Training Session
When conducting a training session, your goal is to communicate the information
and have participants understand and apply it to their jobs. In order to help you
achieve this goal, here are some suggestions for conducting a successful training
session:
• Recognize and allow for differences in participants’ backgrounds, needs and
learning abilities.
• Make sure participants understand the training objectives.
• Allow participants to take an active role in their learning.
• To provide opportunities for interaction and to avoid lecturing, use guiding
comments, such as these:
– “That’s a good point.”
– “What do the rest of you think?”
– “Can you tell me more?”
– “Who has a different point of view?”
• Relate the information in the training session to real-life experiences. Use
examples from your workplace to help participants connect the information to
their activities.
• Proceed from simple concepts to more complex.
• Review and summarize at the end of the session using the session objectives.
• Set a schedule, and monitor it throughout the session. Discussions and practice
may make the session longer, depending on the number of participants.
Page T-17
Using Questions
One of the most effective training tools you can use is a question. Use questions for
these purposes:
•
•
•
•
•
•
•
Kick off a discussion.
Start the group thinking about a topic.
Determine participants’ knowledge of a topic.
Collect data from participants.
Get all participants involved.
Change the direction of the discussion.
Identify conclusions and summarize a discussion.
The following types of questions can be used to direct and stimulate group
discussions:
• Overhead: This type of question is typically used after any introductory remarks
and is directed to the entire group. Its purpose is to provoke discussion and elicit
responses from as many members as possible.
• Direct: This type of question is the opposite of the overhead question. It’s aimed at
a specific individual, such as someone who appears timid or inattentive, to draw
him or her into the discussion. This type of question can also be used to bring a
rambling discussion back to the point or to draw out special information from a
particular group member.
• Reverse: This type of question allows you to avoid giving a personal opinion in
response to a group member’s question. For example, if a participant asks you a
question to which you don’t want to give your opinion, you can turn the question
around by asking:
– “What does that term mean to you?”
– “How does that make you feel?”
– “What would you do?”
Reverse questions elicit background and promote group discussion.
• Follow-Up: This type of question is designed to expand the discussion or lead the
group forward toward the session’s objectives.
Page T-18
Handling A Difficult Group
Occasionally, you’ll get a group that’s difficult to handle. Here are a few ideas
on how to work with this type of group and help them understand and apply
the information:
• If your group is quiet or unresponsive, allow time for participants to “warm up.”
In this case, ask nonthreatening questions that are easy to answer.
• If your group won’t stop discussing, commend participants for their high level of
participation and then tell them that it’s time to move on.
• If you have a group of “fighters,” encourage those participants who strongly
disagree on an issue to think of ways to resolve the disagreement.
Handling Difficult Participants
To keep the session productive and on target, here are a few methods for dealing
with some types of difficult participants:
• An overly helpful participant who jumps in with a response to every question may
prevent others from becoming involved. Make a special effort to engage other
participants in the exercise or discussion.
• A participant who won’t be budged from his or her opinion can be asked to accept
the group consensus for the moment and then assured that you will be glad to
discuss his or her point of view later.
• A participant who points out the worst in every idea but seldom offers an
alternative can be acknowledged politely but passed over for other opinions.
• An overly talkative participant can be put back on track by restating the relevant
points or by pointing out (with a smile) that he or she is a bit “off the subject.”
• A reserved participant can be drawn out by asking him or her a direct question
and then following the response with a sincere compliment.
• A daydreamer can be brought back to attention by asking him or her an easy
question or restating earlier remarks and asking for his or her opinion.
Page T-19
Learning Exercise
Directions: Answer each of the following questions “True” or “False” by circling the
appropriate letter.
T
F
1. Bloodborne pathogens are microorganisms that can be carried
in human blood or body fluids and cause serious diseases.
T
F
2. It’s easier to become infected with HIV than with HBV.
T
F
3. There is a vaccine that can prevent infection from Hepatitis B
and C.
T
F
4. Using Universal Precautions means wearing Personal
Protective Equipment (PPE) everywhere in the workplace.
T
F
5. For you to become infected, the disease-carrying pathogen must
enter your body.
T
F
6. Wearing single-use latex gloves provides complete protection for
your hands.
T
F
7. When removing contaminated clothing, you should fold it
carefully so the exposed area is visible to others.
T
F
8. If your hands or other skin is exposed to blood or other body
fluids, you should wash them with soap and water, vigorously
scrubbing all areas.
T
F
9. You can pick up contaminated broken glass with your hands as
long as you are wearing gloves.
T
F
10. The Exposure Control Plan contains information and
procedures to protect employees from exposure and
transmission of bloodborne pathogens in the workplace.
Name:
Date:
Employee Identification #:
Company:
Trainer’s Name:
Page T-20
Answers To Learning Exercise
1. True.
2. False. Although HIV tends to have higher visibility in the media, there is a
greater risk of infection from HBV, since it’s relatively easy to catch. 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.
3. False. There is a vaccine for Hepatitis B but not for Hepatitis C.
4. False. Using Universal Precautions means treating all blood and body fluids
as if they are known to be infected with bloodborne pathogens.
5. True.
6. False. In situations where latex gloves could be punctured, cut or torn, leather
or other protective gloves should be worn over the latex gloves to further
prevent contact with blood or other body fluids.
7. False. When removing gloves or other equipment, turn each item inside
out so that you contain the contaminants.
8. True.
9. False. You should always use tongs, forceps or a brush and dust pan to
pick up contaminated broken glass. Never use your hands, even if you are
wearing gloves.
10. True.
Page T-21
Glossary Of Terms
Blood: Human blood, human blood components and products made from
human blood.
Bloodborne Pathogens: Microorganisms that are present in human blood 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.
Page T-22
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.
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
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.
Page T-23
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 and other bloodborne pathogens.
Work Practice Controls: Controls that reduce the likelihood of exposure by
changing the way a task is performed.
Slides
A Microsoft PowerPoint slide program is provided for the training session.
Page T-24

bloodborne pathogens

Transcription

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