MIOSHAPart 554 Bloodborne Infectious Diseases

Train the Trainer ProgramModule 1

Presented By: Presented By: Consultation Education & Training (CET) DivisionConsultation Education & Training (CET) Division

Michigan Occupational Safety & Health Administration Michigan Occupational Safety & Health Administration Michigan Department of Energy, Labor & Economic Growth Michigan Department of Energy, Labor & Economic Growth

www.michigan.gov/mioshawww.michigan.gov/miosha(517) 322-1809(517) 322-1809

Welcome

Welcome to the MIOSHA Bloodborne Infectious Diseases Online Training Program.

This program is designed to provide an overview of the MIOSHA bloodborne standard.

It does NOT fullfill all the training requirements in the Bloodborne Standard nor is it intended to replace facility specific training.

Intended Use: “Train the Trainer”

Provide bloodborne infectious diseases information to those who provide training to employees who are at risk of occupational exposure.

Provide additional resources to assist trainers in becoming more knowledgeable in topics related to bloodborne infectious diseases.

Module 1will provide an overview of the MIOSHA Bloodborne Infectious Diseases Standard Rules 1-9.

Overview of the Bloodborne Standard

Rule 1 Scope Rule 2 Definitions Rule 3 Exposure

determination Rule 4 Exposure control plan Rule 5 Universal precautions Rule 6 Engineering controls Rule 7 Work practices Rule 8 Protective work

clothing and equipment Rule 9 Housekeeping

Rule 10 Regulated waste Rule 11 Laundry Rule 12 HIV and HBV

research laboratories and production facilities

Rule 13 Vaccinations and postexposure follow-up

Rule 14 Communication of hazards to employees

Rule 15 Recordkeeping Rule 16 Information and

training Appendices

Module 1: Module 2:

Rule 1 Scope

These rules apply to all employers that have employees with occupational exposure to blood and other potentially infectious materials.

Rule 2 Definitions

Bloodborne Pathogens: pathogenic microorganisms present in human blood including HBV, HIV and [HCV].

Contaminated: presence or the reasonably anticipated presence of blood or other potentially infectious materials (OPIM).

Rule 2 Definitions Continued

*NOT included: Vomit Urine Feces Sweat Tears Spit

Materials included: Semen Vaginal secretions Amniotic fluid Synovial fluid Saliva in dental

procedures

Other Potentially Infectious Materials (OPIM)

*Unless visually contaminated with blood or OPIM

Rule 2 Definitions Continued

Contaminated Sharps: contaminated object that can penetrate the skin, including:NeedlesScalpelsBroken glassBroken capillary tubesExposed ends of dental wires

Rule 2 Definitions Continued

Engineering Controls: 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 pathogen hazard from the workplace.

Rule 2 Definitions Continued

Exposure: reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or [OPIM] that may result from the performance of an employee’s duties.

Exposure Incident: specific eye, mouth, other mucous membrane, nonintact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties.*

*Does not include incidental exposures which may take place on the job, which are neither reasonable nor routinely expected

Assessing Risk

Exposed person without HBV immunity (vaccine) via needlestick from confirmed HBV source: 6-30% acquire HBV if no post-exposure

follow-up Post-exposure administration of Hepatitis B

immune globulin and vaccine is >90% effective in preventing HBV infection.

HIV exposure via needlestick from positive source is average of 0.3% become HIV +

*NIOSH Alert Publication No. 2000-108 Preventing Needlestick Injuries in Health Care Settings (External link)

Rule 2 Definitions Continued

Needleless Systems: means a device that does not use needles for: Collection or withdrawal of bodily

fluids Administration of medication or fluids Other procedure involving potential for

occupational exposure Sharps with engineered sharps injury

protections: [devices that have] built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.

Examples of Safer syringes

Self-Sheathing

Retractable

Attached to syringe needle

Examples of Phlebotomy Safer Devices

Attached to blood tube holder

Examples of Retracting lancets with safety features

Before During After

Before During After

In use After use

Rule 2 Definitions Continued

Regulated Waste: Liquid or semiliquid blood or [OPIM] Contaminated items that would release blood or

[OPIM] if compressed. Items which are caked with dried blood or [OPIM] Contaminated sharps Pathological and microbiological waste that

contains blood or [OPIM]

Note: If material is dripping or caked (with dried blood), it must be disposed as regulated waste.

The next slide will provide questions to assist with reviewing the Bloodborne Infectious Diseases Standard Rule 2 Definitions

Rule 2 Definitions Questions and Answers:

True or False:1. Hepatitis C is a bloodborne pathogen.

True2. Blood exposure on intact skin is considered an exposure

incident. False. Rule 2 (o) Definition for exposure incident includes nonintact skin.

3. Fecal material is classified as an “other potentially infectious material.” False, unless visually contaminated with blood. Rule 2(s)(J)

Questions and answers will appear below. There will be delays to allow time to answer the questions.

Rule 3 Exposure Determination

Evaluate routine and reasonably anticipated tasks to determine employee exposure to blood or [OPIM]

Classify employees as either category A or B

Rule 3 Exposure Determination Category “A” involves exposure or reasonably

anticipated exposure during routine and nonroutine required tasks. Includes emergency/1st aid responders.

Category “B” do not require tasks that involve exposure to blood or other potentially infectious material.

Determine without regard to protective equipment. Determine/document rationale. Maintain list of all “A” job classifications.

Rule 4 Exposure Control Plan Exposure Determination (Category A or B) Summary of the training program. Procedures for evaluating exposure incidents Task specific Standard Operating Procedures (SOPs) to

include: Employee recognition of exposure Personal Protective Equipment (PPE) selection, use,

maintenance, and disposal Contingency Plans

Task-specific SOPs for management of inadvertent exposures such as needlesticks

Rule 4 Exposure Control Plan Continued

Review at least annually: Tasks and procedures Changes in technology that eliminate or reduce

exposure Document consideration and implementation of

medical devices that are: Appropriate: does not cause death, injury or

illness in the patient Commercially available Effective: reduces or eliminates potential for

employee exposure to blood and OPIM

Rule 4 Exposure Control Plan

Employer shall solicit input from non-managerial employees involved in direct patient care in the: Identification;Evaluation; and,Selection of effective engineering and

work practice controls. Must document in the plan

The next slide will provide questions to assist with reviewing the Bloodborne Infectious Diseases Standard:

Rule 3 Exposure Determination

Rule 4 Exposure Control Plan

Rule 4 Exposure Control PlanQuestions and Answers:

True or False:

1. Annual review of the exposure control plan is required.

True. Rule 4(d)

2. Non-managerial employees are to be involve in the selection of effective engineering controls.

True. Rule 4(h)

3. The exposure control plan must include task specific standard operating procedures.

True. Rule 4(b)(v)

Questions and answers will appear below. There will be delays to allow time to answer the questions.

Rule 6 Engineering Controls

SHALL be used in combination with work practice controls to minimize or eliminate employee exposure

Provide hand washing facilities which are readily accessible to employees… [or] appropriate antiseptic hand cleanser with clean cloth

Rule 7 Work Practices

PPE shall be removed before leaving the work area Garment penetrated with blood or [OPIM] shall be

removed immediately Wash hands immediately after removing gloves or

other protective clothing* Wash hands after contact with blood or [OPIM]

*If blood or OPIM are present, hands must be washed. If no contact with blood or OPIM, waterless cleansers may be used. See Federal OSHA documentation (External link).

Rule 7 Work Practices Continued

Needles shall not be sheared, bent or broken, recapped, resheathed or *removed unless no alternative is feasible

Eating, drinking, smoking, applying cosmetics or lip balm, or handling contact lenses is prohibited where there is reasonable anticipation for exposure.

*Reuse of tube holders is prohibited. See Federal OSHA document (External link).

Rule 7 Work Practices Continued

Food and drink shall not be stored in refrigerators, freezers, shelves….or in areas of possible contamination

All procedures shall be performed in a manner that minimizes splashing, spraying and aerosolization of blood or [OPIM]

Mouth pipetting is prohibited.

The next slide will provide questions to assist with reviewing the Bloodborne Infectious Diseases Standard:

Rule 6 Engineering Controls

Rule 7 Work Practices

Rule 6-7 Engineering and Work Practice Controls Questions and Answers:

True or False:1. Use of engineering controls is optional.

False. Rule 6 (1) states that engineering controls shall be used.

2. Employees are required to wash hands following exposure to blood.True. Rule 7(2)(d)

3. Blood collection needles may be removed from blood collection tube holders before disposal.False. Review Rule 7 and Federal OSHA Document (External link)

Questions and answers will appear below. There will be delays to allow time to answer the questions.

Rule 8 Protective work clothing and equipment

PPE shall be provided and used Employer shall ensure that an employee

uses PPE Assure appropriate PPE readily accessible

at no cost Provide for cleaning, laundering, or

disposal of PPE Repair or replacement of PPE Gloves shall be worn

Rule 9 Housekeeping

An employer shall assure that the worksite is maintained in a clean and sanitary condition.

•Work surfaces•Coverings•Equipment•Bins, pails, etc

•Broken glassware•Specimens•Reusable items

Appropriate Disinfectants

One to ten through one to one hundred concentration of household bleach to water (made fresh within 24 hours & not stored in glass containers)

Environmental Protection Agency (EPA) registered disinfectants effective against Mycobacterium spp. (Tuberculocides)

EPA Lists

All on the following EPA lists are appropriate:List A: Sterilants List B: Tuberculocides List D: Against HBV & HIV-1List E: TB, HIV-1 and HBV

NOT LIST C (Effective against HIV-1 only)

EPA Approved Disinfectants (External Link)

The next slide will provide questions to assist with reviewing the Bloodborne Infectious Diseases Standard:

Rule 8 Protective work clothing and equipment

Rule 9 Housekeeping

Rule 8-9 PPE and Housekeeping Questions and Answers:

1. The employer is required to ensure employees wear personal protective equipment.

True. Rule 8(1)(b)

2. Bleach is the only appropriate disinfectant.

False. Rule 9 (1)(a) states that an appropriate disinfectant be used. EPA registered disinfectants at least effective against HIV and HBV are appropriate.

Questions and answers will appear below. There will be delays to allow time to answer the questions.

Contact MIOSHA for Additional Information

Questions: www.michigan.gov/askmiosha Consultation Education and Training

Division: (517) 322-1809 General Industry Safety and Health

Division (Compliance): (517) 322-1831 Link to additional online resources. Return to the MIOSHA homepage.

Thank you for participating

Continue to Bloodborne Infectious Diseases Training program Module-2