Overview:

This article provides techniques to prevent bloodborne pathogen exposures. It also highlights best practices and includes a checklist for sharps injury prevention. This article focuses on work environments, needles and other sharps materials contaminated with bloodborne pathogens. A list of training resources is also included.

Preventing Bloodborne Pathogen Exposures

Many occupations and work environments come to mind when talking about bloodborne pathogen (BBP) prevention. First responders, maintenance workers, janitors/ housekeeping staff, nurses and other health care professionals benefit from understanding the hazards and controls associated with bloodborne pathogen exposures.

What Are Bloodborne Pathogens?
Bloodborne pathogens are microorganisms found in the blood that have the potential to cause illness or disease in humans. Two well-known bloodborne pathogens are Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV). They can enter the body through direct contact with broken skin, various skin conditions (acne, dermatitis, eczema) cuts, scrapes, abrasions, mucous membranes (eyes, nose, mouth) and contact with contaminated sharps.

BBP Exposures
Exposure to bloodborne pathogens can occur whether working directly with those affected by the virus or not. Healthcare workers are often the first group thought of when discussing this subject, but needlesticks are not the only way a person can be exposed to a BBP. Other ways include: providing first aid care, cleaning up after an accident, standing near a person involved in an accident, or walking through an accident area to offer assistance.

Housekeeping, maintenance and janitorial employees should be made aware of the hazard potential through training and they should understand the environment in which they work. These employees may be exposed to BBPs by cleaning restrooms (urine, feces, sanitary napkins), cleaning up after an accident in the workplace (blood, vomit or other bodily fluid) or repairing equipment contaminated with bodily fluids (toilets or equipment repairs after an industrial injury).

Employee awareness can be enhanced by properly labeling biohazard waste bags, containers and contaminated areas. Additionally, if an emergency requires cleanup and disposal of blood or other bodily fluids, housekeeping/janitorial staff trained in biohazard cleanup should be notified in addition to first responders and emergency personnel.

A cleanup kit should be provided for employees involved in the process. The kit should contain at a minimum:

• Latex gloves


• Absorbent powder


• Cleaning/disinfectant solutions (if not available, use a 10 to 1 water and bleach solution or ¼ cup of bleach per gallon of water)


• Face mask


• Face shield


• Apron


• Red biohazard plastic bags - double bagged to dispose of material

Some precautions to consider are:

• When handling waste collected from areas containing potential bloodborne pathogens, always wear latex or rubber gloves as a barrier.


• Always wash hands after handling or working around bodily fluids potentially contaminated with a BBP even when latex gloves have been used.


• Be aware of the potential for BBP contamination when cleaning up items like broken glass. Just because it cannot be seen with the naked eye doesn't mean it is not there.


• Always use "universal precautions." Utilizing universal precautions means considering the item handled as being contaminated with a bloodborne pathogen.

Trained health care professionals and trained first responders (Emergency Medical Technicians, emergency response team members, etc.) should always utilize universal precautions as the first line of defense when handling patients, especially when bodily fluids are involved. If latex gloves are not available, some type of barrier (rags, bags, work gloves) should be placed between the person giving assistance and the bodily fluid.
(First responders who are not trained should utilize the same precautions and only act as the primary responder when a trained responder is not available). Utilizing engineering controls, such as a needleless system or other sharps injury protection devices, is another method of reducing or preventing exposures.

Safety Devices

The following is a list, from The University of Virginia International Health Care Worker Safety Center Exposure Prevention Information Network, of some safety devices utilized in the healthcare industry to reduce the risk of bloodborne pathogen exposure. This list is not comprehensive.

Injection Equipment: Used for intramuscular and subcutaneous injections and includes disposable syringes (syringe and needle), needles with needle guards for attachment to syringes, and needleless jet injection systems.

Medication Vial Adaptors: Used to access ports of medication vials.

Intravenous (IV) Medication Delivery Systems: Used to administer medication or fluids through an IV catheter port or IV connector site. Many systems are offered with multiple components for medication vial and IV access for complete needleless IV delivery.

IV Insertion Equipment: Used to access the bloodstream for IV administration.

Blood Collection Equipment: Used to collect blood. Included are blood collection needles, reusable and disposable needle holders/housing and vacuum blood collection tubes.

Agency Requirements

While each agency is required to comply with the OSHA bloodborne pathogens standard, tools are available to assist in development of individual programs. The Virginia Occupational Safety and Health Administration has policy templates available to all agencies to use as a guide. These templates can be found on DHRM's website at http://www.dhrm.state.va.us/workerscomp/doliforms.html.

The following is a list of Occupational Safety and Health Administration requirements for compliance with the bloodborne pathogens standard:

• Have a written exposure control plan




• Periodically review and update the plan




• Train employees annually




• Communicate information to all affected employees




• The employer shall provide a training program to employees who have no prior experience in handling human pathogens


• Provide readily accessible handwashing facilities for employees




• Antiseptic hand cleaner with paper towels, or


• Antiseptic hand towels




• Establish and maintain an accurate record of each employee who experienced an exposure


• Maintain a sharps injury log for injuries resulting from contaminated sharps


• Prohibit eating, drinking, applying cosmetics, etc. where there is a likelihood of occupational exposure

Available Training Resources obtained from OSHA's website at http://www.osha.gov/SLTC/bloodbornepathogens/otherresources.html

• OSHA Outreach Training Program


• OTI Education Centers


• Centers for Disease Control and Prevention (CDC), Public Health Training Network (PHTN)


• Bloodborne Pathogens


• Needlestick PowerPoint Presentation


• OSHA Publications

Other Resources:

• American Association of Occupational Health Nurses, Inc. OSHA alliance signed May 7, 2003


• American Biological Safety Association (ABSA)


• National Center for Infectious Diseases


• CDC Prevention Guidelines Database


• Record Summary of the Request for Information on Occupational Exposure to Bloodborne Pathogens due to Percutaneous Injury. OSHA (1999, May), 22 pages, and Press Release. This report summarizes nearly 400 comments from healthcare facilities, workers and others who responded to OSHA's request for information of Fall, 1998.


• Guidelines for Isolation Precautions in Hospitals. Centers for Disease Control and Prevention (CDC) (1996), 1 page. This is an outline of standard precautions, a single set of precautions to be used for the care of all patients in hospitals regardless of their presumed infection status.


• A Case-Control Study of Seroconversion in Health Care Workers after Percutaneous Exposure. The New England Journal of Medicine (NEJM) Vol. 337:1485-90, (1997, November 20), 3 pages. This is an abstract, to view the full text, one must be a subscriber or pay a fee.

References:

Bloodborne Pathogens and Needlestick Prevention Additional Resources. Retrieved January 5, 2004, from http://www.osha.gov/SLTC/bloodbornepathogens/otherresources.html

BLR's Safety Training Presentations: Bloodborne Pathogens. Retrieved January 27, 2004 from (Guy Butts) http://safety2.blr.com/

Checklist for Sharps Injury Prevention. Retrieved January 5, 2004, from http://www.med.virginia.edu/medcntr/centers/epinet/chcklst2.pdf

OSHA's Safety and Health Topics: Bloodborne Pathogens and Needlestick Prevention. Retrieved January 5, 2004, from http://www.osha.gov/SLTC/bloodbornepathogens/index.html

Preventing Occupational HIV Transmission to Healthcare Personnel. Retrieved January 5, 2004, from the Centers for Disease Control Web site: http://www.cdc.gov/hiv/pubs/facts/hcwprev.htm

The University of Virginia International Health Care Worker Safety Center Exposure Prevention Information Network, Safety Device List. Retrieved January 5, 2004 from http://www.med.virginia.edu/medcntr/centers/epinet/products.html.

Virginia Occupational Safety and Health Program Templates. Retrieved February 11, 2004 from http://www.dhrm.state.va.us/workerscomp/doliforms.html.