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”

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
NJ Course Number: 141150
Total CE Hours: 1
Level: Basic
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.