Bloodborne Pathogens

Needlestick/Sharps Injury Prevention

Office of Engineering Safety Texas Engineering Experiment Station (TEES)

& The Dwight Look College of Engineering

“A safe, healthful, and secure environment for scholarship and research.”

Bloodborne Pathogens

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• Scope and Coverage

– Original thrust was aimed at:• Hospitals• First Responders (ambulance, fire, police)• Dental practices

– Non medical classifications:• Funeral directors and morticians• Police crime labs• Barbers and cosmetologists

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Bloodborne Pathogens• Scope and Coverage also effects:

– Maintenance and Custodial workers

– Housekeeping and Laundry services

– Waste Handling and Disposal services

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• OSHA Regulation 29CFR 1910.1030

• History & Effective Dates

• Purpose of the Regulation

• Employer Requirements

• Scope and Coverage

• Exposure Control Plan

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Bloodborne Pathogens• 1991- OSHA publishes the final regulation for

Bloodborne Pathogens in December.

• 1992- OSHA regulation effective in March

• 1992- Deadline for the completion of the written Exposure Control Plan (May)

• 2000- Needlestick Safety and Prevention Act

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sNeedlestick Safety and Prevention Act Timeline

• P. L. 106-430 signed; November 6, 2000

• Revised Standard published in Federal Register; Jan. 18, 2001

• Effective date; April 18, 2001

• Enforcement of new provisions; July 17, 2001

• Adoption in OSHA state-plan states; October 18, 2001

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sRevisions to Standard

• Additional definitions, paragraph (b)

• New requirements in the Exposure Control Plan, paragraph (c)

• Solicitation of input from non-managerial employees, paragraph (c)

• Sharps injury log, paragraph (h)

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Bloodborne Pathogens StandardMajor Provisions by Paragraph

(b) Definitions

(c) Exposure Control Plan (ECP)

(d) Engineering and Work Practice Controls- Personal Protective Equipment (PPE)

(e) HIV and HBV Research Labs

(f) Vaccination, Post-Exposure Follow-up

(g) Labeling and Training

(h) Recordkeeping

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Bloodborne Pathogens• To assure that no employee will

suffer material health or functional impairment due to an exposure to hazardous agents while in the course of their employment.

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• Requirements of the Employer

– Employee education and training

– Protective measures and equipment

– Written Documentation

– Record keeping

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sBloodborne Pathogens

• There is one exemption to the rule!

• The Good Samaritan clause– A De minimus classification

– No penalties for violation

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Bloodborne PathogensOccupational Exposure Any reasonably anticipated skin, eye,

mucous membrane, or parental contact with blood...

.... or any other potentially infectious materials that may result from the performance of an employees duties.

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sExposure Determination

• The employer must:

– Identify worker exposures to blood or other potentially infectious material

– Review all processes and procedures with exposure potential

– Re-evaluate when new processes or procedures are used

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sBloodborne Pathogens

• Determination of Exposure

– “Potentially Infectious” materials include:•Semen•Vaginal secretions•Cerebrospinal fluid•Synovial fluid•Pleural fluid•Pericardial fluid•Peritoneal fluid•Amniotic fluid•Saliva in dental procedures

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Needlestick Prevention and Bloodborne Pathogens

• Needlestick incidents do happen!

• Be prepared!

• All needlestick incidents are preventable!

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• Once the worker has been stuck he has been exposed!

• Record the incident!!

• Treat the worker!

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• Employee Education and Training

– Epidemiology of bloodborne diseases is the study of the incidence, distribution and control of Hepatitis B and HIV/AIDS•Hepatitis is an inflammation of the

liver•HIV/AIDS destroys the ability to fight

infections

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– Symptoms of Hepatitis B•Yellow Eyes & Skin (Jaundice)•Abdominal pain•Fever and Vomiting•Dark Urine•Fatigue

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Bloodborne Pathogens• Employee Education and Training

– Symptoms of AIDS•Fever•Swollen Glands•Diarrhea•Extreme Weight Loss•Skin Lesions•Mental Disorientation

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• Needles come in all shapes and sizes.

• Check manufacturers for the safest needle!


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sMethods of Compliance

• Universal Precautions

• Engineering Controls

• Work Practice Controls

• Personal protective equipment

• Housekeeping

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– Modes of Transmission of Bloodborne Pathogens• Parental

» Intravenous Injection » Accidental Needlestick

• Sexual– Unprotected Sex

• Mucous Membrane– Respiratory tract– Alimentary tract (Nutrition/Digestive)

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Bloodborne Pathogens• Control Measures

– Engineering Controls• Serve to reduce employee exposure in the workplace by

either isolating the worker from the exposure or removing the hazard

– Examples• Surgical gloves• Self retracting needles• Sharps Containers

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– Work Practice Controls•Reduce the likelihood of exposure

through the alteration of the manner in which the task is performed.

– Examples•Using Gloves•Handwashing•Method of removing contaminated

gloves•Recapping needle procedures

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– Personal Protective Equipment (PPE)• Minimizes the risk of infectious materials entering into the

workers body through – skin lesions or – entry through the eyes, nose, or mouth

– Examples• Gloves• Gowns• Face Shields

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• Control Measures

– Universal Precautions•An approach to infection control •All human blood and human body fluids

are treated as if they are infected!

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Bloodborne Pathogens• HBV Vaccinations

– HBV Vaccinations are the most important part of HBV infection control

– Gloves and other PPE do not prevent puncture wounds or unanticipated exposures.

– Set of three inoculations

– Good for ten years

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Bloodborne Pathogens• Post Exposure Evaluation & Follow Up

– Exposure Incident means a specific eye, mouth, other mucous membrane, non-intact skin, or parental contact with blood or other infectious materials that result from the performance of an employees duties.

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Bloodborne Pathogens• Post Exposure Evaluation & Follow Up

– Following a report of an exposure incident, the employer provide a confidential medical evaluation which will include:•Documentation of route of exposure•HIV/HBV status of the source individual•Serological testing of the blood ASAP•Post exposure vaccine (HBIG) if

indicated•Medical evaluation of the reported

illness•Counseling of the exposed individual

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Bloodborne Pathogens• Regulated Waste Disposal

– Contaminated items that:

– Would release blood or other potentially infectious materials•IF they are

– Pourable– Drippable– Compressible

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Bloodborne Pathogens• Housekeeping and Laundry

– Keep the worksite clean and sanitary

– Use a hospital grade VIRUCIDE

– OR a 1:10 bleach to water solution

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• Tags, Labels & Bags

– Tags and Labels • Fluorescent orange or red-orange • Lettering in a contrasting color• Biohazard symbol in a contrasting color.

– Bags must have this label on them (or they must be red in color) and leak proof.

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Bloodborne Pathogens• Record keeping

– The employer shall establish and maintain an accurate record for each employee with an occupational exposure incident.

– Records shall include:•Name & Social Security Number of

employee•Copy of employees HBV vaccination

records•Copy of all medical testing and findings•Copy of physicians written opinion

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Bloodborne Pathogens• Record keeping

– The employer shall maintain records for:•The duration of the employment•PLUS 30 years•Records must be kept CONFIDENTIAL!

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Bloodborne Pathogens• Exposure Control Plan Must Address:

– Exposure Determination

– Employee Education and Training

– Control Measures

– HBV Vaccinations

– Post Exposure Evaluation and Follow Up

– Regulated Waste Disposal

– Tags, Labels, and Bags

– Housekeeping and Laundry

– Record keeping

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sNeedlestick Prevention and Bloodborne Pathogens

• Contaminated needles and sharps– Account for 20 infectious agents

– OSHA’s primary concern•HIV•HBV•HCV

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• CDC

– Hospital workers- 348,000 sticks a year!

– Non-Hospital Healthcare- 590,000 sticks a year

• OVER 1600 needle sticks daily!

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• OSHA Bloodborne Pathogen Standard

– Published in 1991

– Did not address safer devices

– Did not address safer “best practices”

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• Needlestick Safety and Prevention Act

– November 6, 2000

– Directed OSHA to revise their standard

– Federal Register can be found at www.osha.gov

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• Four changes to OSHA’s regulation

– Refined definitions

– Exposure Control Plan modification

– Mandatory employee input

– Updated recordkeeping

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Exposure Control Plan:1910.1030(c)New ProvisionsThe ECP must be updated 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

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sEngineering ControlsNew Definition

“… means controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace.”

• Engineering Controls - includes additional definitions and examples:

– Sharps with Engineered Sharps Injury Protections - [SESIP]

– Needleless Systems

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sSolicitation of Non-Managerial EmployeesNew Provision

• Identification, evaluation, and selection of engineering controls

• Must select employees that are:

– Responsible for direct patient care

– Representative sample of those with potential exposure

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sEngineering and Work Practice Controls


– Evaluate available engineering controls (safer medical devices)

– Train employees on safe use and disposal

– Implement appropriate engineering controls/devices

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– Document evaluation and implementation in ECP

– Review, update ECP at least annually

– Review new devices and technologies annually

– Implement new device use, as appropriate and available

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The employer must:

– Train employees to use new devices and/or procedures

– Document in ECP

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• Definitions

– Engineering Controls

– Needleless Systems

– Sharps with Engineered Sharps Injury Protection

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• Definition

– “Engineering Control”

– Revised to include:•Safer medical devices•All control methods to isolate or

remove hazards•Includes blunt suture needles, plastic

wrapped capillary tubes•Includes sharps containers and bio-

safety cabinets

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Engineering and Work Practice Controls: 1910.1030(d)

Employers must select and implement appropriate engineering controls to reduce or eliminate employee exposure.

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“Where engineering controls will reduce employee exposure either by removing, eliminating, or isolating the hazard, they must be used.”

CPL 2-2.44D

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Selection of engineering and work practice controls is dependent on the employer’s exposure determination.

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• Definition

– “Sharps with Engineered Sharps Injury Protection”

– A needle device or a non-needle device with a built in safety feature

Non-needle sharp or a needle with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.

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• Definition

– “Needleless Systems”

– New methods that do not use needles to collect bodily fluids, blood or deliver medication

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Hypodermic syringes with “Self-Sheathing” safety feature

Self-sheathed protected position

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Hypodermic syringes with “Retractable Technology” safety feature

Retracted protected position

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Phlebotomy needle with “Self-Blunting” safety feature

Blunted protected position

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“Add-on” safety feature

Attached to syringe needle

Attached to blood tube holder

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Retracting lancets with safety features

Before During After

Before During After

In use After use

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Disposable scalpels with safety features

Retracted position

Protracted position Protracted position

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• Changes to the Exposure Control Plan

– Annual review must reflect changes in technology

– Review of commercially available devices must be addressed

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• Non-managerial employees must have input to Exposure Control Plan Review

• May include:

– Lab technicians

– Housekeeping Staff

– Maintenance Workers

– Direct patient care providers

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• Employee Input

– A representative sample

– A range of exposure situations

– Document it!

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• Recordkeeping

• Needlestick Log!!

– Confidential

– Use to determine high risk areas

– Evaluate devices

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sSharps Injury Log

At a minimum, the log must contain, for each incident:

• Type and brand of device involved

• Department or area of incident

• Description of incident

• Only mandatory for those keeping records under 29 CFR 1904

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• Recordkeeping-

• Needlestick Log must contain:

– Type of device

– Brand of device

– Department or work area

– Explanation of how the incident occurred

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• OSHA 200 system

– Separate needlestick log required

– May or may not be recordable!

– OSHA 200 to be replaced by OSHA 300

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• OSHA 300 system

– Sharps injuries recorded on OSHA 300. • Must include brand and type of device• Must be able to segregate sharps injuries

– Use a separate OSHA 300 form for the needlestick log

– OSHA 301 form for each incident!

– Computers must be able to sort by needlesticks!

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Bubonic and Pneumonic Plague!

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Hanta Virus

• 46 year old elementary school teacher

• Colorado’s fifth Hanta Virus victim in a year

• She lasted five days –

• Lived on a ranch with husband and 3 children

• 200 cases nationwide

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sWash Your Hands

• After using toilet:

– Women 74%

– Men 61%

• New York City- 60%

• Chicago- 78%

• New Orleans- 69%

• Atlanta Braves Game-

– Women 89%

– Men 46%

– Pass the popcorn!!

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sPrepared by:

http://engineering.tamu.edu/safety/

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Needlestick/Sharps Injury Prevention

Office of Engineering Safety Texas Engineering Experiment Station (TEES)

& The Dwight Look College of Engineering

“A safe, healthful, and secure environment for scholarship and research.”


Bloodborne Pathogens

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