bloodborne summary

The Occupational Safety and Health Administration's (OSHA) bloodborne pathogens standard is designed to protect more than 5.6 million workers and prevent more than 200 deaths and 9,200 bloodborne infections each year. Bloodborne pathogens are microorganisms in human blood that can cause disease in humans. They include the hepatitis B virus (HBV), hepatitis C virus (HCV), and the human immunodeficiency virus (HIV), which causes AIDS. The greatest bloodborne risk to worker's is infection from the hepatitis B virus. OSHA estimates that occupational exposures account for roughly 5,900 to 7,400 cases of HBV infection each year. More than three quarters of the affected workers - five million- are employed in healthcare facilities. Other occupations with occupational exposure to blood include police, rescue workers, athletic trainers, housekeepers, plumbers, and lifeguards.

Purpose: The purpose of the standard is to reduce on-the-job risks for employees exposed to blood and other potentially infectious materials (OPIM).

Scope: The standard covers employees who may be reasonably anticipated to be exposed to human blood and OPIM as part of their job duties. "Good Samaritan" acts such as assisting a co-worker who has a nosebleed are not covered. The standard does not cover students unless they are employed by the university.

Infectious Materials: Workers must treat blood and OPIM as if infectious. OPIM includes semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid visibly contaminated with blood, and all body fluids in situations where it is impossible to differentiate between body fluids. Also included are unfixed tissue or organs other than intact skin from a human (living or dead).

Exposure Control Plan: Employers must develop a a written exposure control plan identifying workers with occupational exposure to blood and OPIM and specifying means to protect and train them. It calls for engineering controls such as puncture-resistant containers for used needles; work practices such as handwashing to reduce contamination; and appropriate personal protective equipment such as gowns and gloves. It must describe the schedule for implementing other provisions of the standard and specify the procedure for evaluating circumstances surrounding exposure incidents. The plan must be accessible to employees and must be reviewed and updated annually.

Methods of Compliance: Universal precautions, emphasizing engineering and work practice controls, are mandated by the standard. The standard stresses handwashing and requires employers to provide proper facilities and ensure that employees use them following exposure to blood. It describes procedures to minimize needlesticks, reduce splashing and spraying of blood, ensure appropriate packaging of specimens and regulated wastes, and describes methods to handle contaminated equipment. Employers must provide and require employees to use appropriate personal protective equipment such as gloves, gowns, masks, and CPR mouthpieces. The employer must clean, repair and replace these when necessary. The standard requires a written plan for cleaning surfaces exposed to blood, including the method of decontamination. It specifies methods for disposing of contaminated sharps and describes standards for containers and other regulated waste. Further, the standard includes provisions for handling contaminated laundry to minimize exposures.

Hepatitis B Vaccination: Vaccinations must be made available within 10 working days of assignment to all employees who have occupational exposure to blood, at no cost, at a reasonable time and place, and under the supervision of a licensed physician/healthcare professional. Employees must sign a declination form if they choose not to be vaccinated, but may decide to receive the vaccine later. If a booster dose is required in the future, employees must be offered it at no cost.

Post-Exposure Evaluation and Follow-Up: Specific procedures are described for employees who have had an exposure incident. An exposure incident is a needle stick, or blood splash to the mucous membranes or non-intact skin. All laboratory tests must be conducted by an accredited laboratory at no cost to the employee. Follow-up must include a confidential medical evaluation documenting the circumstances of exposure, testing the source individual if feasible, testing the exposed employee's blood if he/she consents, post-exposure prophylaxis, counseling, and evaluation of reported illnesses. All diagnoses must remain confidential.

Hazard Communication: Warning labels including the biohazard symbol must be affixed to containers of regulated waste, refrigerators and freezers and other containers which are used to store or transport blood or other potentially infectious materials. Red bags or containers may be used instead of labeling if everyone understands the meaning of a red bag.

Information and Training: The standard mandates training upon assignment and annually thereafter. Training must include a general discussion on bloodborne diseases, exposure control plan, engineering and work practice controls, personal protective equipment, hepatitis-B vaccine, responding to emergencies, exposure incidents, post-exposure evaluation, and signs/labels/color-coding. There must be an opportunity for questions and answers, and the trainer must be knowledgeable in the subject matter.

Recordkeeping: Medical records must to be kept for each employee with occupational exposure for the duration of employment plus 30 years. Records must be confidential and include; 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 include dates, contents of the training program, trainer's name and qualifications, and names and job titles of all persons attending the sessions. Medical records must be made available to the employee, anyone with written consent of the employee, and OSHA. Employers must also keep records of needle stick injuries and evaluations of safer medical devices.