Bloodborne Pathogens
Defining Bloodborne Pathogen
- OSHA defines BBPs as “pathogenic microorganisms the are present in human blood and can cause disease in humans.”
- Blood is described as any components of blood or products made from blood
- BBPs can be transmitted through “other potentially infectious materials” as well
- Includes:
- “Semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva, or any fluid contaminated with blood”
- “Any unfixed human tissue or organ (other than intact skin) from a human”
- “HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV”
- Includes:
Contamination
- “Presence or reasonably anticipated presence of blood or other potentially infectious materials on an item or surface”
- Commonly contaminated objects include, but are not limited to:
- Laundry
- Sharps
- Laboratory
- Surfaces
- Decontamination “use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal”
Exposure
- When the “eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties”
General Requirements of OSHA Bloodborne Pathogens Standard
- Appropriate PPE (gloves, gowns, eye protection, etc.) **defined later**
- Comply with Universal Precautions
- Pertains to blood and body fluids that contain blood (semen, vaginal fluid)
- Protection from the spread of disease from BBP (specifically HBV, HIV)
- Goal is to “prevent parenteral, mucous membrane, and non intact skin exposures of health-care workers to blood borne pathogens”
Developing an Exposure Control Plan
- OSHA requirements for developing and exposure control plan include:
- Determination of employee exposure (job classification)
- Implementation of various methods of exposure control, including:
- Universal precautions
- Engineering and work practice controls
- Personal protective equipment
- Housekeeping
- Hepatitis B vaccination
- Post-exposure evaluation and follow-up
- Communication of hazards to employees and training
- Record keeping
- Procedures for evaluating circumstances surrounding exposure incidents
- ECP are established by individual agencies/establishments
- However, the above elements should be included in each plan
Personal Protective Equipment
- Gowns, goggles, glasses, mask, face shield, gloves, respirators
- According to agency protocols and procedures
Methods of Control
- Engineering controls
- Reduce exposure in the workplace
- Isolate or remove hazard or isolate worker
- i.e. self-sheathing needles, puncture-resistant sharps containers, ventilations devices, etc.
- Work practices
- Behaviors that reduce the risk of exposure
- Reducing eating, drinking, touching of mucous membranes etc. while in possibly contaminated or exposed environments
- Washing hands properly
- Proper use of sharps and other procedural equipment, specifically that which is or may be contaminated with BBP or OPIM
Housekeeping
- Regular cleaning and disinfecting schedules must be made and adhered to for workplaces with exposure to BBP and OPIM
- Includes cleaning/disinfecting after procedures, spills, and shifts
- Use PPE when cleaning or disposing of infected or possibly infected materials
- Follow all agency rule on disposal of sharps, broken glass, and other contaminated equipment
https://osha.oregon.gov/OSHAPubs/2261.pdf
Exposure Incidents
- OSHA BBP standard states that if an employee is exposed, employers must provide confidential evaluation and follow-up available (at no cost to worker)
- “Specific eye, mouth, other mucus membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials (OPIM)”
- Incidents require immediate reporting
- Source of exposure must be identified (“unless infeasible or prohibited by state or local law”)
- Source may also be tested, if feasible, legal, and available
- Results may be shared with exposed worker
- Information on Exposure Incidents may be found at: https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact04.pdf
- Becoming familiar with reporting process for your employer and/or employees is crucial if you (or your employees) are at risk for exposure while at work
- After and Exposure, needlesticks and cuts should be washed with soap and water
- Nose, mouth, skin that has been splashed should be flushed with water
- Eyes should be irrigated with clean water, saline, or sterile wash
Worker Training Requirements
- Annual training is required for individuals at risk for exposure to BBP or OPIM while at work
- Examples: Healthcare workers
- Emergency Responders
- School and Day Care Staff
- Cleaning and Janitorial Staff
- Tattoo and Permanent Makeup Artists
- Required topics for BBP training, as stated by OSHA are as follows:
- “(A) - An accessible copy of the regulatory text of this standard and an explanation of its contents;
- (B) - A general explanation of the epidemiology and symptoms of bloodborne diseases;
- (C) - An explanation of the modes of transmission of bloodborne pathogens;
- (D) - An explanation of the employer's exposure control plan and the means by which the employee can obtain a copy of the written plan;
- (E) - An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials;
- (F) - An explanation of the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls, work practices, and personal protective equipment;
- (G) - Information on the types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment;
- (H) - An explanation of the basis for selection of personal protective equipment;
- (I) - Information on the hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine and vaccination will be offered free of charge;
- (J) - Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials;
- (K) - An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident and the medical follow-up that will be made available;
- (L) - Information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident;
- (M) - An explanation of the signs and labels and/or color coding required by paragraph (g)(1); and
- (N) - An opportunity for interactive questions and answers with the person conducting the training session.”
HIV, HBV, HCV
- Three of the most common BBP of concern
- The others that will be discussed include Malaria, Brucellosis, Syphilis, and West Nile Virus
HIV
- Human Immunodeficiency Virus
- Works by destroying cells of the immune system responsible for combating disease and infection
- HIV may progress, if untreated or if treatment is ineffective, into AIDS (Acquired Immune Deficiency Syndrome) which means almost total destruction of immune system - leading patients vulnerable to even simple colds or infections with the inability to recover
- Contraction of HIV occurs through exposure to infected bodily fluids (blood, semen, vaginal fluid, rectal. fluid, breastmilk)
- Needle sticks (specifically when sharing needles)
- Sexual contact (vaginal or anal)
- Sharing of breastmilk
- Not spread through saliva, sweat, tears, touching (as long as none of the above fluids are involved and skin is intact), toilet seats, mosquito bites etc.
Hepatitis B
- Causes liver damage and cirrhosis. May result in cancer.
- Preventible with vaccine
- Transmitted via blood, semen, vaginal secretions
- Any shared items that result in exposure to blood
- Symptoms include:
- Fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored stool, joint pain, jaundice
- Incubation period for symptoms is 60-150 days
- Symptoms last from a few weeks to 6 months
- Some individuals may develop a chronic infection (more common in infants or those with compromised immune systems)
Hepatitis C
- More commonly a chronic infection compared to hep b
- Liver infection
- No vaccine
- Typically spread by sharing needles/other drug paraphernalia
- Treatment may cure hep C in 8-12 weeks
- Symptoms often do not occur until patients have advanced liver disease
- Chronic infection often does not result in many symptoms (may last 10-20 years)
- Primary cause of liver transplant
Malaria
- Fever, chills, flu-like illness “acute febrile illness”
- Parasite (plasmodium) passed via mosquitos (mosquito-borne illness)
- Preventible and curable
- Vector control is ideal for prevention
Brucellosis
- Comes from contact with infected animals
- Eating undercooked or unpasteurized meats/dairy products
- Breathing bacteria in (most common for those in close, regular contact with contaminants
- Through skin or mucous membranes
- Not common to pass this from person-to-person, although transmission via breastmilk may occur
- Symptoms include fever, sweats, malaise, anorexia, headache, pain in muscles, joints, back, fatigue
- Rarely results in death, although it can take weeks or months to treat
- Long term symptoms may include: recurrent fevers, arthritis, testicular/scrotum swelling, endocarditis, neurologic symptoms, chronic fatigue, depression, liver or spleen swelling
Syphilis
- Spread most commonly through sexual contact with painless sores on the genitals, rectum, or mouth, may also spread from mother to unborn baby
- May remain dormant for years following initial infection
- Early infections may be cured with antibiotics, but infections that are untreated may cause damage to the heart, brain, etc. and may cause death
- Typical disease progression:
- Chancre sore at infection site (primary)
- Rash on trunk and possibly hands/feet; may also have wart-like sores in mouth/genitals; possible hair loss, muscle aches, fever, swollen lymph nodes (secondary)
- Symptoms may come and go for up to a year
- May go dormant and never return, or simply stay dormant for years (latent)
- 15%-30% progress, if untreated, to stage with brain, nerve, eye, heart, blood vessel, liver, bone, joint damage (tertiary)
West Nile
- Mosquito-borne illness
- Many infections do not result in symptoms
- 1 in 5 develop mild symptoms (fever, headache, body aches, joint pains, vomiting, diarrhea, rash, fatigue)
- 1 in 150 develop serious and possibly fatal illness
- High fever, headache, stiff neck, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness, paralysis
- >60 yo are at high risk as well as other comorbidities
- OTC medications
- Hospitalization may be necessary for severe cases
Content Creator: Carli Wymore
CAPCE Course Number: 20-EMTP-F3-1316
Total CE Hours: 1
NJ Course Number: 1743053884218
Level: Basic
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.