Bloodborne PathogensBloodborne Pathogensandand

Regulated Medical Regulated Medical WasteWaste

OSHAOSHA

Ensure employees can safely perform Ensure employees can safely perform their normal duties without undue health their normal duties without undue health risksrisks

Bloodborne Pathogen (BBP) Standard Bloodborne Pathogen (BBP) Standard developed to protect employees with developed to protect employees with occupational exposure to bloodborne occupational exposure to bloodborne pathogenspathogens– HIVHIV– Hepatitis BHepatitis B

Bloodborne Pathogen StandardBloodborne Pathogen Standard

Employers must:Employers must:

Ensure that Universal Precautions are observedEnsure that Universal Precautions are observed Provide free Hepatitis-B vaccination seriesProvide free Hepatitis-B vaccination series Provide all necessary PPE and ensure that is it usedProvide all necessary PPE and ensure that is it used Provide initial BBP training, and annually thereafterProvide initial BBP training, and annually thereafter Maintain records of all trainingMaintain records of all training Have a written Exposure Control Plan, update Have a written Exposure Control Plan, update

annually. Must be available for reviewannually. Must be available for review Record exposure incidents and follow-up activitiesRecord exposure incidents and follow-up activities

What are Bloodborne What are Bloodborne PathogensPathogens

Microorganisms that may be present in human Microorganisms that may be present in human blood and other potentially infectious materials blood and other potentially infectious materials (OPIM) that may cause disease in humans.(OPIM) that may cause disease in humans.

Diseases Caused by Diseases Caused by Bloodborne PathogensBloodborne Pathogens

MalariaMalaria RabiesRabies SyphilisSyphilis TularemiaTularemia Viral Hemorrhagic Viral Hemorrhagic

Fevers – West NileFevers – West Nile

Arboviral Arboviral infections – La infections – La Crosse, St. LouisCrosse, St. Louis

BrucellosisBrucellosis Creutzfeldt-Jakob Creutzfeldt-Jakob

DiseaseDisease Hepatitis CHepatitis C

HIV / AIDSHIV / AIDS Hepatitis BHepatitis B

Hepatitis BHepatitis B

A DNA virus that primarily affects the A DNA virus that primarily affects the liverliver

Transmitted by actual exposures to Transmitted by actual exposures to blood and other potentially infectious blood and other potentially infectious materialmaterial

Initial infection may have no symptoms Initial infection may have no symptoms to flu-like symptomsto flu-like symptoms– Symptoms included: jaundice, dark urine, Symptoms included: jaundice, dark urine,

anorexia, nausea, point pain, rash, and feveranorexia, nausea, point pain, rash, and fever Can develop into a chronic infection Can develop into a chronic infection

leading to cirrhosis, chronic active leading to cirrhosis, chronic active hepatitis, and liver cancerhepatitis, and liver cancer

Hepatitis BHepatitis B

The probability of being infected following The probability of being infected following an exposure to a known positive source is an exposure to a known positive source is about 30%about 30%

Nearly 1/3 of the world’s population has Nearly 1/3 of the world’s population has been or is actively infected with HBV. This been or is actively infected with HBV. This high prevalence leads to great potential high prevalence leads to great potential for infection following exposure to blood or for infection following exposure to blood or OPIMOPIM

It is preventable through vaccination (85-It is preventable through vaccination (85-97% effective) – a 3 shot series given over 97% effective) – a 3 shot series given over 6 months6 months

HIVHIV

A retrovirus that causes AIDS (Acquired A retrovirus that causes AIDS (Acquired Immune Deficiency Syndrome) by Immune Deficiency Syndrome) by infecting helper T cells of the immune infecting helper T cells of the immune systemsystem

Transmitted by actual exposures to Transmitted by actual exposures to blood and other potentially infectious blood and other potentially infectious material, frequently a needlestick injury.material, frequently a needlestick injury.

Initial symptoms may be a mild flu-like Initial symptoms may be a mild flu-like illness developing within 1 to 6 weeks of illness developing within 1 to 6 weeks of exposureexposure

HIVHIV

After a latent period, which may last After a latent period, which may last several years, AIDS develops and the several years, AIDS develops and the disease is characterized by the loss of T disease is characterized by the loss of T cell function and prevalence of cell function and prevalence of opportunistic infectionsopportunistic infections

The probability of being infected following The probability of being infected following an exposure to a known HIV positive an exposure to a known HIV positive source is about 0.4%source is about 0.4%

While the onset of AIDS may be delayed While the onset of AIDS may be delayed through drug therapy and opportunistic through drug therapy and opportunistic infections may be treatable, AIDS is at this infections may be treatable, AIDS is at this time time incurableincurable and and fatalfatal. .

Bloodborne Pathogen Bloodborne Pathogen ExposuresExposures

Typically occur by one of the following Typically occur by one of the following ways:ways:

Puncture from contaminated needles, Puncture from contaminated needles, broken glass, or other sharpsbroken glass, or other sharps

Contact between non-intact skin and Contact between non-intact skin and infectious body fluidsinfectious body fluids– cut/abrasion, scratch, acne, sunburncut/abrasion, scratch, acne, sunburn

Direct contact between mucous Direct contact between mucous membranes and infectious body fluidsmembranes and infectious body fluids– splash in the eyes, nose, or mouthsplash in the eyes, nose, or mouth

Disease TransmissionDisease Transmission

An exposure incident does not guarantee disease An exposure incident does not guarantee disease transmission. Several factors affect transmission:transmission. Several factors affect transmission:

Infected Source - disease stage of the sourceInfected Source - disease stage of the source Means of Entry - severity or depth of the Means of Entry - severity or depth of the

puncture wound, broken skin, or direct contact puncture wound, broken skin, or direct contact with mucus membranewith mucus membrane

Infective Dose - the amount and type of fluid, as Infective Dose - the amount and type of fluid, as well as the amount of infectious agent in the well as the amount of infectious agent in the fluid. Blood is the fluid of greatest concernfluid. Blood is the fluid of greatest concern

Susceptible Host – immunocompromised at riskSusceptible Host – immunocompromised at risk

Exposure PreventionExposure Prevention

The single most effective The single most effective measure to control the measure to control the transmission of Bloodborne transmission of Bloodborne Pathogens is:Pathogens is:

Universal PrecautionsUniversal Precautions

Treat all human blood and other Treat all human blood and other potentially infectious materials like potentially infectious materials like they are infectious for Hepatitis B they are infectious for Hepatitis B and HIVand HIV

Exposure PreventionExposure Prevention

Engineering ControlsEngineering Controls– Controls that isolate or remove the hazardControls that isolate or remove the hazard

Sharps containers, biohazard bags, disinfectants, safer sharps Sharps containers, biohazard bags, disinfectants, safer sharps

Administrative & Work Practice ControlsAdministrative & Work Practice Controls– Behaviors that protect the individual from exposure to Behaviors that protect the individual from exposure to

potentially infectious substancespotentially infectious substances Handwashing and proper use of PPEHandwashing and proper use of PPE Alcohol sanitizers ok when no soap & water, wash hands ASAPAlcohol sanitizers ok when no soap & water, wash hands ASAP

Personal Protective Equipment (PPE)Personal Protective Equipment (PPE)– Items worn to create a physical barrier between the Items worn to create a physical barrier between the

person and the potentially infectious material. person and the potentially infectious material. Gloves, gowns, eye and face shields, respiratorsGloves, gowns, eye and face shields, respirators

Safer SharpsSafer Sharps

Selecting PPESelecting PPE

For Routine WorkFor Routine Work– Latex, Nitrile, or Vinyl Exam GlovesLatex, Nitrile, or Vinyl Exam Gloves

All are single-use, cannot be decontaminatedAll are single-use, cannot be decontaminated Must be changed between patientsMust be changed between patients Should wash hands after removing glovesShould wash hands after removing gloves

– May need face shield for squirting woundsMay need face shield for squirting wounds– When blood is anticipated, should have outer When blood is anticipated, should have outer

clothing like scrubs that can be changedclothing like scrubs that can be changed For spill cleanup and disinfection, may want a For spill cleanup and disinfection, may want a

glove resistant to chemicals – nitrile is goodglove resistant to chemicals – nitrile is good Waste disposal is coming upWaste disposal is coming up

Exposure PreventionExposure Prevention

Guidelines to reduce the risk of exposure:Guidelines to reduce the risk of exposure:

Frequent hand washingFrequent hand washing Use of PPE and Universal PrecautionsUse of PPE and Universal Precautions Regular cleaning and decontamination of Regular cleaning and decontamination of

work surfaces with a cleaning agent work surfaces with a cleaning agent labeled as effective against HIB/HbVlabeled as effective against HIB/HbV

Vaccination against Hepatitis-BVaccination against Hepatitis-B Proper Regulated Medical Waste disposalProper Regulated Medical Waste disposal

Exposure Incident ResponseExposure Incident Response

Wash exposed area with soap and waterWash exposed area with soap and water Flush splashes to eyes, nose, mouth or skin Flush splashes to eyes, nose, mouth or skin

with water for 15 minuteswith water for 15 minutes Report the exposure to supervisorReport the exposure to supervisor Follow your facility’s exposure response Follow your facility’s exposure response

planplan– Go straight to ER after washing, report that Go straight to ER after washing, report that

you’ve had a blood exposureyou’ve had a blood exposure Fill out an exposure incident reportFill out an exposure incident report Report all exposures, regardless of severityReport all exposures, regardless of severity

Exposure Incident ResponseExposure Incident Response

A confidential medical evaluation and follow-A confidential medical evaluation and follow-up will be made available to employees up will be made available to employees following an exposure incident. following an exposure incident. – Documenting route of exposure and Documenting route of exposure and

circumstances of incidentcircumstances of incident– Identifying and testing the source individual if Identifying and testing the source individual if

feasible feasible – Testing the exposed employee's blood if he/she Testing the exposed employee's blood if he/she

consents consents – Post-exposure prophylaxis Post-exposure prophylaxis – CounselingCounseling– Evaluation of reported illnessesEvaluation of reported illnesses

What is Regulated Medical What is Regulated Medical WasteWaste

- Medical waste capable of producing an - Medical waste capable of producing an infectious disease. infectious disease.

Waste is considered Infectious when it is:Waste is considered Infectious when it is:

Contaminated by an organism that is Contaminated by an organism that is pathogenic to healthy humans;pathogenic to healthy humans;

The organism is not routinely available in the The organism is not routinely available in the environment; andenvironment; and

The organism is in significant quantity and The organism is in significant quantity and virulence to transmit disease.virulence to transmit disease.

Regulated Medical Wastes Regulated Medical Wastes Include:Include:

Blood and blood Blood and blood products in a free products in a free flowing, unabsorbed flowing, unabsorbed state;state;

Contaminated sharps,Contaminated sharps, Laboratory wastes,Laboratory wastes, Unfixed pathology Unfixed pathology

tissuestissues

Bloodborne Pathogen StandardBloodborne Pathogen Standard

Defines Regulated Medical Waste as:Defines Regulated Medical Waste as:

Liquid or semi-liquid blood or other potentially Liquid or semi-liquid blood or other potentially infectious materials (OPIM),infectious materials (OPIM),

Contaminated items that would release blood Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if or OPIM in a liquid or semi-liquid state if compressed,compressed,

Items caked with dried blood or OPIM that Items caked with dried blood or OPIM that would dislodge during handling,would dislodge during handling,

Contaminated sharps, andContaminated sharps, and Pathological and microbial wastes containing Pathological and microbial wastes containing

blood or OPIMblood or OPIM

Other Potentially Infectious Other Potentially Infectious MaterialMaterial

OPIMOPIM Any body fluid with visible bloodAny body fluid with visible blood Amniotic fluidAmniotic fluid Cerebrospinal fluidCerebrospinal fluid Pericardial fluidPericardial fluid Peritoneal fluidPeritoneal fluid Pleural fluidPleural fluid Saliva in dental proceduresSaliva in dental procedures Semen/vaginal secretionsSemen/vaginal secretions Synovial fluidSynovial fluid Anywhere body fluids are indistinguishableAnywhere body fluids are indistinguishable

Regulated Medical Waste Is Regulated Medical Waste Is NotNot

Used personal hygiene productsUsed personal hygiene products– tissuestissues– feminine productsfeminine products– diapersdiapers

Gauze and dressings containing small amounts Gauze and dressings containing small amounts of blood,of blood,

Fixed pathological tissues,Fixed pathological tissues, Uncontaminated medical tubing and devicesUncontaminated medical tubing and devices

Tubing with any visible fluid blood must be Tubing with any visible fluid blood must be disposed in the biohazard wastedisposed in the biohazard waste

Is this Regulated Medical Is this Regulated Medical Waste?Waste?

Collection of Regulated WasteCollection of Regulated Waste

Regulated medical wastes must Regulated medical wastes must be collected at the point of be collected at the point of generation in the appropriate generation in the appropriate color coded bags color coded bags

Orange bags for autoclaved Orange bags for autoclaved waste, Red bags for all other waste, Red bags for all other treatment methodstreatment methods

Biohazard bags must be labeled Biohazard bags must be labeled with the international biohazard with the international biohazard symbol and appropriate wording; symbol and appropriate wording; “biohazard,” “biomedical waste,” “biohazard,” “biomedical waste,” “infectious medical waste,” or “infectious medical waste,” or “regulated medical waste”“regulated medical waste”

SharpsSharps Must be collected at the point of generation,

in a leak-proof and puncture-resistant container

Containers must bear the international biohazard symbol and appropriate wording

Containers should never be completely filled, nor filled above the full line indicated on box.

Do not recap needles

Packaging and StoragePackaging and Storage

Wastes collected in a lined, cardboard box or reusable plastic container; labeled with the biohazard symbol and appropriate wording.

Once the box or container is full, the bag lining it is sealed and the container then sealed shut

Boxes must be labeled with facility name, address, phone and fax numbers, and the date

A full, sealed container can be stored on site for no more than 30 days

Bloodborne Pathogen Spill KitBloodborne Pathogen Spill Kit

All medical facilities must have a spill kit and All medical facilities must have a spill kit and employees should know where it is located. employees should know where it is located.

It must contain: It must contain: 2 Red bags2 Red bags 1 Pair of gloves1 Pair of gloves 1 Face mask  (surgical type or equivalent)1 Face mask  (surgical type or equivalent) 1 Pair of goggles or equivalent eye protection1 Pair of goggles or equivalent eye protection 1 Absorbent material capable of absorbing 1/2 gallon of liquid1 Absorbent material capable of absorbing 1/2 gallon of liquid 1 Spray can of disinfectant effective against Tuberculosis / 1 Spray can of disinfectant effective against Tuberculosis /

mycobacteriummycobacterium A disposable dust pan and broom for sweeping up sharps, or tongsA disposable dust pan and broom for sweeping up sharps, or tongs

Items can be stored in a plastic tote, which can be used to contain Items can be stored in a plastic tote, which can be used to contain wastes if boxes are not available.wastes if boxes are not available.

Marshall Safety & HealthMarshall Safety & Health

Brian Carrico, Director Safety & HealthBrian Carrico, Director Safety & Health– carrico8@marshall.edu– 696-3432696-3432

Nathan Douglas, Chemical & Biological Safety OfficerNathan Douglas, Chemical & Biological Safety Officer– douglas2@marshall.edu– 696-3461, cell 304-208-7385 696-3461, cell 304-208-7385

Tracy Smith, Safety SpecialistTracy Smith, Safety Specialist– tsmith@marshall.edu– 696-2993696-2993