OSHA Bloodborne
Pathogen Standard
2005 Training


Karen D. Gillis, MS
Biological Safety Officer
Environmental Health & Safety
University of Florida


Contact Information:
(352) 392-1591 EH&S Switchboard
(352) 392-3647 fax

www.ehs.ufl.edu/

 

OSHA Bloodborne Pathogen Standard
29 CFR 1910.1030

Purpose
Limits occupational exposure to blood and other potentially infectious materials, since any exposure could result in transmission of bloodborne pathogens which could lead to disease or death.

Original regulation published the final rule in 1991. No significant changes since that date. All requirements are still in force.

 

Bloodborne Disease

  • Many diseases are transmitted by contact
    with blood.
  • Of primary concern:
    • Hepatitis (HBV and HCV)
      Caused by hepatitis B or C viruses
    • AIDS and HIV-related diseases
      Result from human immunodeficiency
      virus (HIV) infection

Please answer Question #1 now.

 

 

Universal Precautions

Approach to infection control in which all human blood, certain body fluids, and contaminated equipment/instrumentation are treated as if they are known to be infectious for HIV, HBV, and other bloodborne pathogens.

This is the basic premise for the entire OSHA Bloodborne Pathogens regulation. The regulation is "Performance Oriented" which means that the institution (like UF) must then determine the means and the program to best deal with meeting the various requirements of the standard.

Universal Precautions

Applies to all specimens containing:
- Blood - Serum - Plasma
- Semen - Vaginal secretions
- Body Fluid containing blood or suspected
of containing blood
- Body Fluids: Cerebrospinal, Synovial,
   Pleural, Peritoneal, Pericardial, Amniotic
- Saliva in a dental setting
- Breast milk
- Unfixed Human tissue, organs, cells
- Body fluids of UNKNOWN origin

Please answer Question #2 now.

 

 

Bloodborne Disease Transmission

Routes of Transmission in the Work Place:

  • Skin
    Through broken, non-intact or chapped skin
    Contamination of cut, graze, lesion, rash
    Cuts or puncture wounds with
    contaminated sharp objects or equipment
     
  • Mucous Membranes
    Linings of eyes, nose, and mouth
    Permeable, allows viruses to pass through

 

Here at the University of Florida, splashes to mucous membranes
and skin punctures are the most frequent incidents involving
blood and body fluids.

Non-intact skin, punctures and all mucous membranes are the
primary routes of exposure for bloodborne diseases.

Frequent Incidents involving blood and body fluids are the following:

  1. Splashes to the skin, eyes, and mouth

  2. Punctures to the skin with needles

  3. Punctures to the skin with scalpels and other sharp objects

Please answer Question #3 now.

 

 

Bloodborne Disease Transmission

Routes of Transmission in the Work Place:

  • Respiratory
    Inhalation of aerosols produced in
    laboratory situations
    Not normally a route for bloodborne diseases
  • Gastrointestinal
    Ingesting
    Not normally a route for bloodborne diseases

Tuberculosis (Mycobacterium Tuberculosis bacteria) is not considered a bloodborne pathogen for purposes of this OSHA regulation as it is not transmitted via blood and body fluid contact.

Tuberculosis is transmitted from person to person via the aerosol route when an individual with active productive Tuberculosis repeatedly exposes another individual in close proximity.

In a laboratory environment, Tuberculosis could be transmitted via the accidental creation of an aerosol that is then inhaled by an individual.

Includes eye, nose, and mouth, as well as through non-intact skin, punctures, and all mucous membranes.

Please answer Question #4 now.

 

 

Casual Contact with Common Fluids

Tears
Sweat
Urine
Feces
Nasal Secretions
Saliva (non-dental)

Universal Precautions Not Required since transmission of HIV and HBV not substantiated. (Exception: Human bite transmission of HBV with saliva to blood.)

In a work environment, gloves are typically worn for handling any of these fluids as a general practice.

 

 

Personal Protective Equipment (PPE)

Body - waterproof

  • Coats

  • Gowns

  • Aprons

  • Arm

  • Head

  • Shoe Covers

 

PPE must be chosen that best protects the worker in the event of an accident or spill/splash. Water-proof or liquid resistant material is a must.

The OSHA PPE regulation requires that a risk assessment be conducted for each task to determine the appropriate PPE.

PPE must be provided to the worker, fit correctly and be appropriate for the task.

 

 

Personal Protective Equipment (PPE)

Face and Eyes - appropriate to the task

  • Glasses (with side shields)

  • Goggles

  • Face Shields

  • Masks

Hands - Gloves - appropriate to the task

  • Latex

  • Nitrile

  • Rubber - cleaning only

  • Vinyl - DO NOT USE

 

Latex allergies are an issue. When there is a choice, Nitrile is the glove of choice.

Vinyl gloves are more porous than latex or nitrile allowing passage of micro-organisms.  Vinyl is NOT appropriate for work with blood or any body fluid.

PPE Equipment includes the following:

  1. Gloves, glasses, and liquid impervious gowns/coats

  2. Protective equipment worn to prevent bloodborne pathogens

  3. Disposable gloves made from nitrile or latex materials

Please answer Question #5 now.

 

 

Personal Protective Equipment

  • Closed toe shoes are required in all animal, lab or procedure areas

  • Adherence to site PPE requirements is critical

  • PPE must not be worn in any common area, hallway or office

 

Do not under any circumstances wear disposable gloves outside of the laboratory.

Do not under any circumstances wear sandals or other open toe or open foot wear in a laboratory.

If samples must be transported to another location:

  1. Samples must first be double contained in leak-proof, puncture resistant containers

  2. Then placed on a cart or other suitable carrier

  3. Disposable gloves removed

  4. Hands washed

  5. Then exit the laboratory

Please answer Question #6 now.

 

 

Hepatitis B or C (HBV/HCV)

  • Serum hepatitis

  • Attacks liver cells and replicates in them

  • Virus can enter body via:

    • Blood-to-blood contact

    • Sexual contact

    • Broken skin

    • Mucous membranes

    • Needle sticks, etc.

  • Not transmitted by casual contact, airborne, or through food and water

 

 

Hepatitis B Vaccine

  • Safe, current vaccines not based on human products

  • Three doses required (0, 1, 6 months)

  • Over 90% protection

  • Few side effects

  • Recombivax HB

    • Synthetic, DNA, yeast-based
       

  • Energix B

    • Boosts immunity quickly, Synthetic

No vaccine is yet available for HBC or HIV.

Please answer Question #7 now.

 

 

Hepatitis B or C (HBV/HCV)

  • Can result in severe liver damage, liver cancer, and death if not treated immediately

  • Systemic infection

  • Symptoms of acute hepatitis:

    • Jaundice (skin, eyes become yellow); dark urine

    • Abdominal pain

    • Enlargement of the liver

    • Nausea, vomiting, fatigue, loss of appetite

    • (i.e., flu-like symptoms)

    • Sometimes joint pain, rash, fever
       

  • Infected individuals can transmit disease to others

 

 

HIV prophylaxis

Must be given very soon following the exposure event according to CDC guidelines

 

 

CDC guidelines following HIV exposure

 Infection status of source

Exposure type

HIV-Positive

Class 1*

HIV-Positive

Class 2*

Source of unknown HIV status1

Unknown source2

HIV-Negative

Less severe3

Recommend basic

2-drug PEP

Recommend expanded 3-drug PEP

Generally, no PEP warranted: however, consider basic 2-drug PEP** for source with HIV risk factors

Generally, no PEP warranted; however, consider basic 2-drug PEP** in settings where exposure to HIV-infected persons is likely

No PEP warranted

More severe5

Recommend expanded 3 –drug PEP

Recommend expanded 3-drug PEP

Generally, no PEP warranted; however, consider basic 2-drug PEP** for source with HIV risk factors4

Generally, no PEP warranted; however, consider basic 2-drug PEP** in settings where exposure to HIV-infected persons is likely

No PEP warranted

*    HIV-Positive, Class 1 – asymptomatic HIV infection or known low viral load (e.g., < 1,500 RNA copies/mL). HIV-Positive, Class 2 – symptomatic HIV infection, AIDS, acute seroconversion, or known high viral load.  If drug resistance is a concern, obtain expert consultation.  Initiation of postexposure prophylaxis (PEP) should not be delayed pending expert consultation, and because expert consultation alone cannot substitute for face-to-face counseling, resources should be available to provide immediate evaluation and follow-up care for all exposures.

 1          Source of unknown HIV status (e.g., a needle from a sharps disposal container).

 2          Unknown source (e.g., a needle from a sharps disposal container).

 3          Less severe (e.g., solid needle and superficial injury).

 **   The designation “consider PEP” indicates that PEP is optional and should be based on an individualized decision between the exposed person and the treating clinician.

 4          If PEP is offered and taken and the source is later determined to be HIV-negative, PEP should be discontinued.

 5          More severe (e.g., large-bore hollow needle, deep puncture, visible blood on device, or needle used in patient’s artery or vein).

 

 

Packaging & Shipping

  • Infectious materials, diagnostic samples, and biological products require specific training and certification due to DOT, IATA & ICAO Regulations

  • Contact the Biological Safety Office (392-1591) or see the web site (www.ehs.ufl.edu/bio) for information on the classes

  • Training required every 2 years or whenever
    there is a change to the regulations

Definitions:

  • DOT - Department of Transportation

  • IATA - International Air Transport Association

  • ICAO - International Civil Air Organization

Significant penalties exist for non-compliance with training and packaging requirements.

Certificates are issued upon completion of the course.

Due to regulatory changes, all persons involved in the packaging or shipping of any of these classes of materials must be retrained.

Basically, all diagnostic specimens and infectious substances must be properly packaged.

Department of Transportation and International Air Transport Regulations must be followed.

Please answer Question #8 now.

 

 

Biological Waste

Regulated biological/medical waste

  • Properly decontaminated prior to packaging

  • Placed in red bag lined bio-hazard boxes

  • Properly taped with clear tape

  • Properly labeled in indelible ink

    • Name of generator with phone number

    • Date of packaging

    • Location of generation

 

Bio-medical waste information can be found on the web site at www.ehs.ufl.edu.

  • Broken glass should be in a secondary box.

  • Boxes need to be closed and boxes are taped along the seams.

  • Generator's (your) name, location, telephone number, and date on box.

  • 3/4 full, sealed, autoclaved, sharps containers should be placed within red bag lined boxes.

Please answer Question #9 now.

 

 

Biological Waste Issues

  • Do not over-fill

    • (3/4 maximum)

  • Do not mix with nonbiological waste

  • Do not put sharps in the boxes directly

  • Do not add liquids to waste boxes

 

All sharps must first be placed in a rigid, puncture-proof, leakproof container.

Once 3/4 full, the sharps container is sealed and then placed in the red bag lined biohazard box.

Needles must never be re-capped, bent, broken or otherwise destroyed. All needles and needle/syringe combinations must be placed directly into a sharps container for proper disposal.

Needles and needle/syringe units should never be left unattended in a laboratory or other environment.

 

 

Decontamination

Surfaces, Equipment or Instrumentation

  • Start with SOAP and WATER

  • Follow up with freshly prepared 10% bleach in water (by volume 1:10) if corrosion is NOT a concern

  • Follow up with 70% isopropyl alcohol in water if corrosion is a concern

Dispose of all materials to the BMW

Instrumentation and equipment sensitive to corrosion, can be cleaned with foaming alcohol. This material easily gets into the many crevices in tools and will not cause corrosion. Steris is an example of one of the suppliers of foaming alcohol. 100% Alcohol does not disinfect – it preserves.

The reason Soap and Water makes a good first line of defense is that most contamination is accompanied by significant organic material which is best removed by soap and water leaving any infectious organisms open to the action of the bleach or alcohol.

Be aware that diluted bleach solutions rapidly lost their effectiveness and must be prepared fresh every day for maximum activity.

Alcide and other EPA listed tuberculocidal disinfectants can be substituted for bleach.

Decontamination: Making the equipment, instrumentation, or surface safe for handling

Please answer Question #10 now.

 

 

Steps to Take When Exposure Occurs

  • In the event that an individual is exposed to a potentially infectious material, take the following steps:

  • Wash the effected area thoroughly with soap and water

  • Get immediate medical attention

  • Notify supervision

  • Complete an Incident Report

  • Allow Medical to follow up with the appropriate testing and the required healthcare professional’s written opinion

The EH&S web site has the current information for response and follow up of a blood or body fluid exposure.

Time is critical for treatment and any necessary prophylaxis. Get medical attention within 1-2 hours maximum for the most effective results.

www.ehs.ufl.edu/bio

 

 

Decontamination

Spills

  • Pour freshly prepared 10% bleach on the spill area working from the outside toward the center & leave for 30 minutes

  • Wash with Soap & Water then Rinse

  • Dispose of all materials to the BMW

If the spill has significant organic material involvement, a double cycle of the above will be more effective in decontaminating the spill.

Bleach can leave a surface very slippery. The final washing is essential to remove any residue.

Decontamination makes equipment or a surface 'safe to handle or use' - it is not sterilization.

Recommended disinfectants are the following two:

  1. EPA registered tuberculoidal listed agents

  2. Freshly prepared bleach solutions from 1 - 10% by volume

Please answer Question #11 now.
 

 

Sharps Containers

  • Never Re-Cap Needles

  • Place directly into the container

  • Replace container when ¾ full

  • Never attempt to open lid

  • If accidentally stuck with a needle, then call the NEEDLE STICK HOTLINE number
    (866-477-6824)

Filled, sealed sharps containers must then be placed within the red bag lined biohazard boxes for pick up or treatment and biological/regulated medical waste.

No lone sharps containers can be accepted for disposal.

Do not use for other than sharps waste. No gloves, paper, etc may be placed in a sharps container.

Sharps containers must be:

  • Puncture Resistant

  • Color Coded-red

  • Labeled with indelible ink

  • Leak-Proof

Please answer Question #12 now.