Training

1. Bloodborne
Pathogens

2. The Bloodborne Pathogen Standard:
An Overview
In 1990, the U.S. Occupational Safety and Health Administration (OSHA)
estimated that occupational exposures to bloodborne pathogens caused
more than 200 deaths and 9,000 bloodborne infections every year. To help
protect workers from this serious workplace hazard, OSHA published the
Occupational Exposure to Bloodborne Pathogens Standard on December 6,
1991. The purpose of this standard is to protect workers by limiting
occupational exposure to blood and other potentially infectious materials.
In 2000, the Needlestick Safety and Prevention Act (Public Law 106-430)
mandated that OSHA clarify and revise the Bloodborne Pathogens
Standard to address the implementation of safer needle devices. OSHA
published the revised standard, which included such new requirements as
the use of safer needle devices and maintaining a log of contaminated
needlestick injuries, in the Federal Register in January 2001. The revised
standard became effective in April 2001.
The Bloodborne Pathogen standard is located in Title 29 of the Code of
Federal Regulations (29 CFR), Part 1910.1030.

3. Bloodborne pathogens are
microorganisms that are
present in human blood and
can infect and cause disease in
people who are exposed to
blood containing the pathogen.
These microorganisms can be
transmitted through contact
with contaminated blood and
body fluids.

4. Bloodborne pathogens include, but are
not limited to:
• Human Immunodeficiency
Virus (HIV)
• Hepatitis B (HBV)
• Hepatitis C (HCV)
• Non A, Non B Hepatitis
• Syphilis
• Malaria

5. HumanImmunodeficiencyVirus (HIV)
• HIV is passed from one person to another through blood-
to-blood and sexual contact. Pregnant women infected
with HIV can also pass the virus to their baby during
pregnancy or delivery, and through breast-feeding.
• People with HIV have what is called HIV infection. Most
of these people will eventually develop AIDS as the result
of their HIV infection. By killing or damaging cells of the
body's immune system, HIV progressively destroys the
body's ability to fight infections and certain cancers.
People diagnosed with AIDS may get life-threatening
diseases called opportunistic infections, which are
caused by microbes such as viruses or bacteria that
usually do not affect healthy people.

6. HIV
• The symptoms of HIV infection range from an asymptomatic
state to severe immunodeficiency and associated
opportunistic infections, neoplasms, and other conditions.
Initial infection can be followed by an acute flu-like illness,
with such symptoms as:
fever myalgia
lymphadenopathy rash
sweats sore throat
• The risk of disease progression increases with the duration of
the infection. Most studies show that less than 5% of HIV
infected adults develop AIDS within 2 years of infection.
Without therapy, approximately 20-25% of infected adults
develop AIDS within 2 years of infection, and 50% within 10
years.

7. Hepatitis
Acute viral hepatitis is a common, sometimes serious infection
of the liver leading to inflammation and necrosis. There are at
least five distinct viral agents that cause acute viral hepatitis:
• HAV (Hepatitis A)
• HBV (Hepatitis B)
• HDV (delta)
• HCV (Hepatitis C)
• HEV (an enterally transmitted non A, non B hepatitis agent)

8. Hepatitis B Virus (HBV)
• An estimated 1.25 million Americans are chronically infected with the Hepatitis B
virus, and about 20-30% of those infected acquired the infection during childhood. A
Hepatitis B vaccine has been available since 1982, and routine Hepatitis B
vaccinations have greatly reduced the rate of disease among children and
adolescents.
• About one-third of persons infected with HBV have no signs or symptoms.
Symptoms can include:
Jaundice Fatigue
Abdominal pain Loss of appetite
Nausea, vomiting Joint pain
• Transmission of the Hepatitis B virus (HBV) occurs when an infected person's blood
or body fluids enters the body of a person who is not immune.
• The Bloodborne Pathogen standard requires employers to make the hepatitis B
vaccine and vaccination series available to all employees that have occupational
exposure to HBV. Employees who decline the vaccination must sign a statement
indicating that they understand they are at continued risk for acquiring hepatitis B.

9. Hepatitis C Virus (HCV)
• The Hepatitis C virus (HCV) is a major cause of acute hepatitis and
chronic liver disease, including cirrhosis and liver cancer. According
to estimates from the Centers for Disease Control and Prevention,
an estimated 3.9 million Americans (1.8%) have been infected with
HCV, and 2.7 million are chronically infected. The number of new
infections per year has declined from an average of 240,000 in the
1980s to about 30,000 in 2003. Illegal injection drug use is the
primary cause of infection. Approximately 80% of the persons
infected with Hepatitis C have no signs or symptoms. Those that
have symptoms and signs may exhibit the following:
Jaundice Fatigue
Dark Urine Abdominal Pain
Loss of Appetite Nausea
• Chronic infections occur in 75-85% of infected persons, and chronic
liver disease occurs in 70% of infected persons. There is no vaccine
for Hepatitis C.

10. Transmission of Bloodborne Pathogens
• Bloodborne pathogens are transmitted when contaminated
blood or body fluids enter the body of another person. In the
workplace setting, transmission is most likely to occur
through:
• An accidental puncture by a sharp object, such as a needle,
broken glass, or other "sharps", contaminated with the
pathogen.
• Contact between broken or damaged skin and infected body
fluids
• Contact between mucous membranes and infected body
fluids.

11. Transmission of Bloodborne Pathogens
• Unbroken skin forms an impervious barrier against
bloodborne pathogens. However, infected blood or body fluids
can enter your system percutaneously through:
Open sores Cuts
Abrasions Acne
• Any sort of damaged or broken skin such as sunburn or
blisters
• Bloodborne pathogens can also be transmitted through the
mucous membranes of the eyes, nose, or mouth. For example,
a splash of contaminated blood to your eye, nose, or mouth
could result in transmission.

12. There are also many ways that bloodborne
pathogens are not transmitted. For example,
bloodborne pathogens are not transmitted by:
• touching an infected person
• coughing or sneezing
• using the same equipment, materials, toilets,
water fountains or showers as an infected
person.
• It is important that you know which ways are
viable means of transmission for the bloodborne
pathogens in your workplace, and which are not.

13. Exposure Control Plan
The Bloodborne Pathogen Standard requires that
employers develop an Exposure Control Plan and make it
accessible to all employees.
• The Exposure Control Plan is a written plan that identifies
the tasks and procedures, as well as job classifications,
where occupational exposure to blood occurs--without
regard to personal protective clothing and equipment.
• The plan also establishes the schedule by which the
employer will implement other provisions of the
standard, and specifies the procedure for evaluating
circumstances surrounding exposure incidents.

14. Exposure Control Plan
Employers must update their Exposure Control
Plan to include:
• changes in technology that reduce/eliminate
exposure
• annual documentation of consideration and
implementation of safer medical devices
• solicitation of input from non-managerial
employees

15. Methods of Compliance
The Bloodborne Pathogen Standard specifies
methods that are to be used to minimize the
transmission of bloodborne pathogens in the work
place. These methods include:
• Universal Precautions
• Engineering and Work Practice Controls
• Personal Protective Equipment (PPE)
• Appropriate Housekeeping Measures
• We'll take a more detailed look at each of these
methods in the next few pages.

16. Universal Precautions
• The Bloodborne Pathogen Standard requires that
employers implement a standardized approach
to infection control called Universal Precautions.
• The concept of Universal Precautions is that all
blood and potentially infectious materials must
be treated as if they are known to contain HIV,
HBV, or other bloodborne pathogens.

17. Body Substance Isolation
Body Substance Isolation is an alternative
infection control method in which all body fluids
and substances are defined as infectious.
Workplaces that use BSI as an alternative to
Universal Precautions extend the coverage of the
Bloodborne Pathogen standard to include all body
substances. Such workplaces must also comply
with the other provisions of the standard.

18. Engineering and Work Practice Controls
Engineering Controls Work Practice Controls
Controls that isolate or remove the
bloodborne pathogens hazard from the
workplace.
Controls that reduce the likelihood of
exposure by altering the manner in which
a task is performed.
Examples: sharps disposal containers, self-
sheathing needles, safer medical devices,
such as sharps with engineered sharps
injury protections and needleless systems
Example: Prohibiting recapping of needles
by a two-handed technique.
Employers must select and implement appropriate engineering and work practice
controls in situations where occupational exposures to blood or other potentially
infectious materials may occur.
The objective of engineering controls and work practice controls is the same: to
reduce or minimize employee exposure to bloodborne pathogens. The difference
between the two types of controls is that one isolates or removes the hazard from the
workplace, while the other reduces the risk of exposure by altering how tasks are
performed. Definitions and examples of each type of control are:

19. Exposure Determination
To select the proper engineering and work practice controls to
implement in the workplace, the employer must make an
exposure determination. This determination must contain:
• A list of all job classifications in which all employees in those
job classifications have occupational exposure;
• A list of job classifications in which some employees have
occupational exposure, and
• A list of all tasks and procedures or groups of closely related
task and procedures in which occupational exposure occurs
and that are performed by employees in job classifications
listed in accordance with the provisions of paragraph
(c)(2)(i)(B) of this standard.
• This exposure determination shall be made without regard to
the use of personal protective equipment.

20. Needlestick Safety
Two commonly used engineering controls are
Needleless Systems: devices that do not use a needle for:
• Collection of bodily fluids
• Administration of medication/fluids
• Any other procedure with potential percutaneous exposure to
a contaminated sharp
Sharps with Engineered Sharps Injury Protections (SESIP)
• Non-needle sharp or a needle with a built-in safety feature or
mechanism that effectively reduces the risk of an exposure
incident.

21. Work Practice Controls
Hand washing is one of the
simplest and most effective
practices used to prevent
the transmission of
bloodborne pathogens.
Hand washing keeps you
from transferring
contamination from your
hands to other areas of
your body, or to other
surfaces you may contact
later.

22. Hand washing tips
• Thoroughly wash hands or other exposed skin with soap and water as soon as
possible following an occupational exposure to blood or other potentially
infectious materials.
• Wash your hands with soap and water every time you remove your gloves. If
your gloves are intact and you have had no occupational exposure to blood or
other potentially infectious materials, antiseptic hand cleaners may be used
as an appropriate hand washing practice. However, washing with soap and
running water every time you remove your gloves is the recommended
practice.
• Use soft, antibacterial soap, if possible. Avoid harsh, abrasive soaps, as these
may open fragile scabs or other sores.
• If skin or mucous membranes come in direct contact with blood, wash or
flush the area with water as soon as possible.
• Where handwashing facilities are not available, use antiseptic hand cleansers
or antiseptic towelettes. However, these should be used as a temporary
measure only. You must still wash your hands with soap and running water as
soon as you can.

23. Personal Hygiene
Personal hygiene involves using good judgment when working in
areas with the potential for exposure. Examples of good
personal hygiene practices include:
• Minimizing splashing, spraying, spattering and generation of
droplets when attending to an injured person.
• Refraining from eating, drinking, smoking, applying cosmetics
or lip balms, or handling contact lenses where there is a
reasonable likelihood of occupational exposure.
• Keeping food or drink away from refrigerators, freezers,
shelves cabinets or on countertops or bench tops where blood
or other potentially infectious materials are present.
• Refraining from mouth pipetting/suctioning of blood or other
potentially infectious materials.

24. Personal Protective Equipment
The type of protective equipment appropriate for your job or
research varies with the task and the degree of exposure you
anticipate. Equipment that protects you from contact with blood
or other potentially infectious materials (OPIM) may include:
• Gloves
• Eye Protection
• Masks and Face Shields
• Gowns, Aprons, and Other Protective Body Clothing
All Personal Protective Equipment can be found in Room 111 of
the Health Center.

25. Gloves
• Gloves should be made of latex, nitrile, rubber, or other water
impervious materials. If gloves are particularly thin or flimsy,
double gloving can provide an additional layer of protection. If
you have cuts or sores on your hands, cover these with a
bandage or similar protection as an additional precaution
before donning your gloves.
• Always inspect your gloves thoroughly before putting them
on. Never use gloves that are damaged, such as torn or
punctured.
• Remove contaminated gloves carefully, avoiding touching the
outside of the gloves with bare skin. Dispose of contaminated
gloves in a proper container.

26. Eye Protection
Bloodborne pathogens can be
transmitted through the mucous
membranes of the eye.
Consequently, you should use eye
protection whenever there is a
risk of splashing or vaporization of
contaminated fluid, such as while
cleaning up spills or during certain
laboratory procedures.

27. Masks and Face Shields
Masks and face shields provide additional
protection for tasks that may generate splashes,
spray, spatter, or droplets of blood or other
potentially infectious materials, and eye, nose, or
mouth contamination can be reasonably
anticipated. Masks and face shields are not a
substitute for eye protection, and must be used in
combination with suitable eye protection.
•

28. Protective Body Clothing
Appropriate protective
clothing such as, but not
limited to, gowns, aprons,
lab coats, clinic jackets, or
similar outer garments
shall be worn in
occupational exposure
situations. The type and
characteristics will depend
upon the task and degree
of exposure anticipated.

29. GeneralGuidelinesforPersonalProtectiveEquipmentUse
• Persons should be trained to use the equipment properly.
• The equipment should be appropriate for the task and should fit
properly, especially gloves.
• The equipment should be free from physical flaws that could
compromise safety.
• Persons must use appropriate protective equipment each time they
perform a task involving potentially infectious materials.
• The employer should issue PPE or make it readily accessible in the
work area.
• The employer should maintain, replace or dispose of any PPE at no
cost to employees.
• Persons should remove all PPE prior to leaving the work area.
• Persons should place removed PPE in an appropriately designated
area or container for storage, washing, decontamination or disposal.
• Persons should remove garments such as lab coats or aprons that
are penetrated by blood or other potentially infectious materials
immediately or as soon as feasible.

30. Signs, Labels & Color Coding
Signs and labels in the workplace communicate
bloodborne pathogen hazards to employees. The
warning label must include the universal
biohazard symbol and the term "biohazard" in a
color that contrasts with the fluorescent orange,
orange-red background, as illustrated to the right:
Warning labels must be affixed to containers of regulated waste,
refrigerators and freezers containing blood or other potentially
infectious material, and other containers used to store,
transport, or ship blood or other potentially infectious materials.
Red bags or red containers can be substituted for labels.
Contaminated equipment which is to be serviced or shipped
must also have a warning label and a statement regarding which
portions of the equipment remain contaminated.

31. Signs, Labels & Color Coding
Some common exceptions to the labeling requirements are:
• Containers of blood, blood components, and blood products
bearing an FDA required label that have been released for
transfusion or other clinical uses.
• Individual containers of blood or OPIM that are placed in
secondary labeled containers during storage, transport,
shipment, or disposal.
• Specimen containers, if the facility uses Universal Precautions
when handling all specimens, the containers are recognizable
as containing specimens, and the containers remain within the
facility.
• Regulated waste that has been decontaminated.

32. Response to Emergencies Involving
Blood or Body Fluids
If you are faced with a spill of blood or body fluids, here are some key
points to keep in mind:
• Wear appropriate Personal Protective Equipment (PPE).
• Carefully cover the spill with an absorbent material, such as paper
towels, to prevent splashing.
• Decontaminate the area of the spill using an appropriate
disinfectant, such as a solution of one part bleach to ten parts water.
When pouring disinfectant over the area always pour gently and
work from the edge of the spill towards the center to prevent the
contamination from spreading out.
• Wait 10 minutes to ensure adequate decontamination, and then
carefully wipe up the spilled material. Be very alert for broken glass
or sharps in or around the spill.
• Disinfect all mops and cleaning tools after the job is done.
• Dispose of all contaminated materials appropriately.
• Wash your hands thoroughly with soap and water immediately after
the clean up is complete.

33. Spill Kit
• The Spill Kit is located in Room 111 at the Health Center.
• All items contained in this kit are for one-time use only. Once
used, they should be placed in the disposal bag provided and
disposed of properly. These items should not be worn outside
the contaminated area.
ASSUME ALL BLOOD AND BODY
FLUID SPILLS ARE CONTAMINATED
AND POTENTIALLY HAZARDOUS TO
YOUR HEALTH

34. Housekeeping and Waste Disposal
Keeping the worksite clean and sanitary is a
necessary part of controlling worker exposure to
bloodborne pathogens. Cleaning schedules and
decontamination methods depend on the type of
surface to be cleaned, the type of soil that is
present, and the particular tasks or procedures
that are being performed.

35. General housekeeping guidelines are:
• Clean and decontaminate all equipment and working surfaces
after contact with blood or other potentially infectious materials
• Contaminated work surfaces, such as counters, fume hoods, or
biosafety cabinets, should be decontaminated with an
appropriate disinfectant as follows:
• after completing procedures
• immediately or as soon as feasible if they are heavily contaminated
or if there has been a spill of blood or other potentially infectious
materials
• at the end of the work shift if the surface may have become
contaminated since the last cleaning.
• Inspect and decontaminate bins, pails, cans, and similar
receptacles intended for reuse which have a reasonable likelihood
for becoming contaminated with blood or other potentially
infectious substances on a regularly scheduled basis.
• Clean and decontaminate receptacles immediately or as soon as
feasible upon visible contamination.

36. Handling Contaminated Laundry
Soiled laundry in a non-healthcare setting is not generally covered by the
Bloodborne Pathogens Standard. However, employees handling laundry that is
soiled or contaminated with blood or other potentially infectious materials
should follow the recommendations of the standard, which include:
• Handle soiled linen as little as possible and with minimum agitations, to
prevent exposure to the handler
• Facilities that use Universal Precautions for handling all soiled laundry may
mark laundry bags or containers, containing contaminated laundry, with an
alternative label or color-code provided all employees recognize the
containers as requiring compliance with Universal Precautions. If the
contaminated laundry is sent off-site for cleaning to a facility which does not
use Universal Precautions in the handling of all soiled laundry, it must be
placed in a bag or container which is red in color or labeled with the
biohazard label.
• When sending soiled linen to an off-site facility for laundering, place and
transport the linen in specially marked, leak-proof bags.
• If laundry is washed on-site, ensure individuals performing the laundering
are trained and use universal precautions. Wash laundry in accordance with
decontamination practices recommended by the Centers for Disease
Control (CDC).

37. Waste Disposal
Regulated waste refers to:
• Any liquid or semi-liquid blood or other potentially infectious
materials
• Contaminated items that would release blood or other
potentially infectious materials in a liquid or semi-liquid 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
• Pathological and microbiological wastes containing blood or
other potentially infectious materials

38. Recordkeeping
Medical records must be kept for each employee with occupational
exposure for the duration of employment plus 30 years, must be
confidential and must include name and social security number;
hepatitis B vaccination status (including dates); results of any
examinations, medical testing and follow-up procedures; a copy of
the healthcare professional's written opinion; and a copy of
information provided to the healthcare professional.
Training records must be maintained for three years and must
include dates, contents of the training program or a summary,
trainer's name and qualifications, names and job titles of all
persons attending the sessions.
Medical records must be made available to the subject employee,
and anyone with written consent of the employee, but they are not
to be available to the employer.

39. Exposure Incidents
Even the most comprehensive infection control
program cannot guarantee that no accidental
exposures to bloodborne pathogens will occur.
Human error or an unexpected circumstance can
result in a sudden needlestick injury or a splash of
blood in an employee's eyes. For this reason,
postexposure management must be an integral
component of a complete program to prevent
infection following bloodborne pathogen
exposure.

40. Exposureincident
An exposure incident is an event resulting from the performance
of an employee's duties in which there has been:
• A percutaneous injury involving a potentially contaminated
needle or other sharp
• A splash of blood or other potentially infectious materials to
the eyes, mouth, or mucous membranes
• Blood or other potentially infectious materials contacting
broken skin
• An occupational exposure should always be considered an
urgent medical concern to ensure timely postexposure
management and administration of hepatitis B immune
globulin (HBIG), hepatitis B vaccine, and/or HIV post-exposure
prophylaxis (PEP).