Bloodborne pathogens are microorganisms that are present in human blood and can infect and cause disease in people who are exposed to blood containing the pathogen. These microorganisms can be transmitted through contact with contaminated blood and bodily fluids.
Bloodborne pathogens include, but are not limited to:
Human Immunodeficiency Virus (HIV)
Human Immunodeficiency Virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). AIDS was first reported in the U.S. in 1981, and has since become a major worldwide epidemic. HIV is passed from one person to another through blood-to-blood and sexual contact. Pregnant women infected with HIV can also pass the virus to their baby during pregnancy or delivery, and possibly through breast-feeding. People with HIV have what is called HIV infection. Many of these people may eventually develop AIDS as the result of their HIV infection. By killing or damaging cells of the body's immune system, HIV progressively destroys the body's ability to fight infections and certain cancers. People diagnosed with AIDS may get life-threatening diseases called opportunistic infections, which are caused by microbes, such as viruses or bacteria that usually do not affect healthy people. The symptoms of HIV infection range from an asymptomatic state to severe immunodeficiency and associated opportunistic infections, neoplasm and other conditions. Initial infection can be followed by an acute flu-like illness, with such symptoms as:
The risk of disease progression increases with the duration of the infection. Most studies show that less than 5% of HIV infected adults develop AIDS within 2 years of infection. Without therapy, approximately 20-25% of infected adults develop AIDS within 2 years of infection, and 50% within 10 years. According to the joint United Nations Program on HIV/AIDS (UNAIDS), in 2004 nearly 40 million people worldwide were estimated to be living with HIV. Over 3 million people died from AIDS in 2004, and close to 5 million people acquired the HIV infection in 2004.
The Centers for Disease Control (CDC) estimates that 850,000-950,000 persons in the U.S. were infected with HIV as of 2002. The cumulative estimated number of diagnoses of AIDS through 2003 in the U.S. was 929,985.
Acute viral hepatitis is a common, sometimes serious infection of the liver leading to inflammation and necrosis. There are at least five distinct viral agents that cause acute viral hepatitis:
Hepatitis B Virus (HBV)
An estimated 1.25 million Americans are chronically infected with the Hepatitis B virus, and about 20-30% of those infected acquired the infection during childhood. A Hepatitis B vaccine has been available since 1982, and routine Hepatitis B vaccinations have greatly reduced the rate of disease among children and adolescents. About one-third of persons infected with HBV have no signs or symptoms. Symptoms can include:
Transmission of the Hepatitis B virus (HBV) occurs when an infected person's blood or bodily fluids enters the body of a person who is not immune. The Bloodborne Pathogen standard requires employers to make the Hepatitis B vaccine and vaccination series available to all employees that have occupational exposure to HBV. Employees who decline the vaccination must sign a statement indicating that they understand they are at continued risk for acquiring Hepatitis B.
Hepatitis C Virus (HCV)
The Hepatitis C virus (HCV) is a major cause of acute hepatitis and chronic liver disease, including cirrhosis and liver cancer. According to estimates from the Centers for Disease Control and Prevention, an estimated 3.9 million Americans (1.8%) have been infected with HCV, and 2.7 million are chronically infected. The number of new infections per year has declined from an average of 240,000 in the 1980s to about 30,000 in 2003. Illegal injection drug use is the primary cause of infection. Approximately 80% of the persons infected with Hepatitis C have no signs or symptoms. Those that have symptoms and signs may exhibit the following:
Transmission of Bloodborne Pathogens
Bloodborne pathogens are transmitted when contaminated blood or bodily fluids enter the body of another person. In the workplace setting, transmission is most likely to occur through:
An accidental puncture by a sharp object, such as a needle, broken glass, or other "sharps", contaminated with the pathogen.
Contact between broken or damaged skin and infected bodily fluids
Contact between mucous membranes and infected bodily fluids
Unbroken skin forms an impervious barrier against Bloodborne pathogens. However, infected blood or bodily fluids can enter your system percutaneously through:
Bloodborne pathogens can also be transmitted through the mucous membranes of the eyes, nose, or mouth. For example, a splash of contaminated blood to your eye, nose, or mouth could result in transmission.
There are also many ways that Bloodborne pathogens are not transmitted. For example, Bloodborne pathogens are not transmitted by:
Touching an infected person
Coughing or sneezing
Using the same equipment, materials, toilets, water fountains or showers as an infected person
It is important that you know which ways are viable means of transmission for the Bloodborne pathogens in your workplace, and which are not.
Exposure Control Plan
The Bloodborne Pathogen Standard requires that employers develop an Exposure Control Plan and make it accessible to all employees. The Exposure Control Plan is a written plan that identifies the tasks and procedures, as well as job classifications, where occupational exposure to blood occurs--without regard to personal protective clothing and equipment.
The plan also establishes the schedule by which the employer will implement other provisions of the standard, and specifies the procedure for evaluating circumstances surrounding exposure incidents.
Employers must update their Exposure Control Plan to include:
Changes in technology that reduce/eliminate exposure
Annual documentation of consideration and implementation of safer medical devices
Solicitation of input from non-managerial employees
Methods of Compliance
The Bloodborne Pathogen Standard specifies methods that are to be used to minimize the transmission of Bloodborne pathogens in the work place. These methods include:
The Bloodborne Pathogen Standard requires that employers implement a standardized approach to infection control called Universal Precautions.
The concept of Universal Precautions is that all blood and potentially infectious materials must be treated as if they are known to contain HIV, HBV, or other Bloodborne pathogens.
Body Substance Isolation (BSI)
Body Substance Isolation is an alternative infection control method in which all bodily fluids and substances are defined as infectious. Workplaces that use BSI as an alternative to Universal Precautions extend the coverage of the Bloodborne Pathogen standard to include all bodily substances. Such workplaces must also comply with the other provisions of the standard.
Work Practice Controls
Hand washing is one of the simplest and most effective practices used to prevent the transmission of Bloodborne pathogens. Hand washing keeps you from transferring contamination from your hands to other areas of your body, or to other surfaces you may contact later.
Here are a few useful hand washing guidelines:
Thoroughly wash hands or other exposed skin with soap and water as soon as possible following an occupational exposure to blood or other potentially infectious materials.
Wash your hands with soap and water every time you remove your gloves. If your gloves are intact and you have had no occupational exposure to blood or other potentially infectious materials, antiseptic hand cleaners may be used as an appropriate hand washing practice. However, washing with soap and running water every time you remove your gloves is the recommended practice.
Use soft, antibacterial soap, if possible. Avoid harsh, abrasive soaps, as these may open fragile scabs or other sores.
If skin or mucous membranes come in direct contact with blood, wash or flush the area with water as soon as possible.
Where hand-washing facilities are not available, use antiseptic hand cleansers or antiseptic towelettes. However, these should be used as a temporary measure only. You must still wash your hands with soap and running water as soon as you can.
Personal hygiene involves using good judgment when working in areas with the potential for exposure. Examples of good personal hygiene practices include:
Minimizing splashing, spraying, spattering and generation of droplets when attending to an injured person.
Refraining from eating, drinking, smoking, applying cosmetics or lip balms, or handling contact lenses where there is a reasonable likelihood of occupational exposure.
Keeping food or drink away from refrigerators, freezers, shelves, and cabinets or on countertops or bench tops where blood or other potentially infectious materials are present. Refraining from mouth pipetting /suctioning of blood or other potentially infectious materials.
Personal Protective Equipment
The type of protective equipment appropriate for your job or research varies with the task and the degree of exposure you anticipate. Equipment that protects you from contact with blood or other potentially infectious materials (OPIM) may include:
Gloves should be made of latex, nitrile, rubber, or other water impervious materials. If gloves are particularly thin or flimsy, double gloving can provide an additional layer of protection. If you have cuts or sores on your hands, cover these with a bandage or similar protection as an additional precaution before donning your gloves. Always inspect your gloves thoroughly before putting them on. Never use gloves that are damaged, such as torn or punctured. Remove contaminated gloves carefully, avoiding touching the outside of the gloves with bare skin. Dispose of contaminated gloves in a proper container.
Bloodborne pathogens can be transmitted through the mucous membranes of the eye. Consequently, you should use eye protection whenever there is a risk of splashing or vaporization of contaminated fluid, such as while cleaning up spills or during certain laboratory procedures.
Response to Emergencies Involving Blood or Bodily Fluids
If you are faced with a spill of blood or bodily fluids, here are some key points to keep in mind:
Housekeeping and Waste Disposal
Keeping the worksite clean and sanitary is a necessary part of controlling worker exposure to Bloodborne pathogens. Cleaning schedules and decontamination methods depend on the type of surface to be cleaned, the type of soil that is present, and the particular tasks or procedures that are being performed. General housekeeping guidelines are:
Clean and decontaminate all equipment and working surfaces after contact with blood or other potentially infectious materials.
Contaminated work surfaces, such as counters, fume hoods, or biosafety cabinets, should be decontaminated with an appropriate disinfectant as follows:
Handling and Disposing of Broken Glassware
Handling Contaminated Laundry
The Bloodborne Pathogens Standard does not generally cover soiled laundry in a non-healthcare setting. However, employees handling laundry that is soiled or contaminated with blood or other potentially infectious materials should follow the recommendations of the standard, which include:
Handle soiled linen as little as possible and with minimum agitations, to prevent exposure to the handler.
Facilities that use Universal Precautions for handling all soiled laundry may mark laundry bags or containers, containing contaminated laundry, with an alternative label or color-code provided all employees recognize the containers as requiring compliance with Universal Precautions. If the contaminated laundry is sent off-site for cleaning to a facility which does not use Universal Precautions in the handling of all soiled laundry, it must be placed in a bag or container which is red in color or labeled with the biohazard label.
When sending soiled linen to an off-site facility for laundering, place and transport the linen in specially marked, leak-proof bags.
If laundry is washed on-site, ensure individuals performing the laundering are trained and use Universal Precautions. Wash laundry in accordance with decontamination practices recommended by the Centers for Disease Control (CDC).
Regulated waste refers to:
All regulated waste must be placed in properly labeled containers or red biohazard bags for disposal at an approved facility. Discarded feminine hygiene products, such as sanitary napkins, are not generally considered regulated waste. Under most circumstances, the absorbent material in such products prevents the release of liquid or semi-liquid blood or the flaking off of dried blood. Feminine hygiene products should be discarded into waste containers lined with plastic or wax paper bags to protect housekeeping employees from physical contact with the contents.
Non-regulated waste (i.e., does not fit the definition of regulated waste provided above) that is not generated by a medical facility or human health-related research laboratory may be disposed in regular plastic trash bags if it has been decontaminated or autoclaved prior to disposal. However, all bags containing such materials must be labeled, signed, and dated, verifying that the materials inside have been decontaminated according to acceptable procedures and pose no health threat.
Even the most comprehensive infection control program cannot guarantee that no accidental exposures to Bloodborne pathogens will occur. Human error or an unexpected circumstance can result in a sudden needle stick injury or a splash of blood in an employee's eyes. For this reason, post-exposure management must be an integral component of a complete program to prevent infection following Bloodborne pathogen exposure. An exposure incident is an event resulting from the performance of an employee's duties in which there has been:
If you are injured or exposed, tell your supervisor immediately. Your supervisor is responsible for reporting your injury correctly.
Early treatment can significantly reduce the chance of disease transmission!
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