gsk i l s bloodborne pathogens - ems safety...• how to respond safely to an emergency at work. •...

BloodbornePathogens

EMERGENCY RESPONSE FOR THEHOME, COMMUNITY AND WORKPLACEQuality Training Programs:

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Bloodborne Pathogens*Instructor Training

*Available in Spanish

EMS Safety Services, Inc.1046 Calle Recodo, Suite KSan Clemente, CA 92673(800) 215-9555www.emssafety.com

Instructor Manual

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1Bloodborne Pathogens Lecture Guide

Introduction ....................................................... 2The Bloodborne Pathogens Standard .............. 2Human Immunodeficiency Virus ....................... 3Hepatitis B and C.............................................. 4Workplace Transmission .................................. 6Personal Protective Equipment (PPE).............. 7Exposure Control Plan...................................... 8Management of Sharps .................................... 9Blood Spills ..................................................... 10

Section 3: BloodBorne PathogenS lecture guide

Labeling .......................................................... 10Hand Washing .................................................11Hygiene .......................................................... 12Maintenance and Housekeeping .................... 12HBV Vaccination ............................................. 12Responding to Emergencies .......................... 13Universal Precautions..................................... 13What If You’re Exposed on the Job? .............. 13

taBle of contentS

This course satisfies the Federal OSHA annual training requirement (29 CFR 1910.1030) on bloodborne pathogens in the workplace.

Course Overview• Training is required within 10 days of being designated as ‘at-risk’ for exposure to BBP or within

1 year of previous training.• Instructor-to-Student class ratio: No recommendation • Course Duration: 1-1½ hrs

Running a Course• Complete a Course Roster that includes the job titles of all students.• Provide each student with a Bloodborne Pathogens Student Workbook.• Show the Bloodborne Pathogens Training DVD.• Use this Lecture Guide or the PowerPoint to teach the course.• Skill Practice: Contaminated glove removal • Written Test: Located at the back of the Student Workbook. Review correct answers with the

students. There is no minimum passing grade required. Give the completed tests to the Organiza-tion’s training contact to keep with his/her training records.

• Issue a Course Completion Card or certificate for each student that is valid for 1 year after train-ing.

The Lecture Guide is the primary resource to guide the Instructor through the lecture and move the course along smoothly. The layout of the Lecture Guide follows the layout of the student workbook. Add statistics or points of interest to the Lecture Guide to customize your presentation.

2 © 2011 EMS Safety Services, Inc.

Learning Objectives• Understand the risks associated with BBP in the workplace.• Understand how to minimize the risks and potential for exposure in the workplace.• Determine the proper action if an exposure occurs.• Demonstrate the skill of soiled glove removal.

Key Concepts• 3.3 million workplace injuries and illnesses in 2009.• OSHA developed the Standard for employers to follow.• Purpose: to reduce the risk of occupational exposure to BBP.• Issued in 1991 to emphasize microorganisms that cause bloodborne diseases.• Expanded in 2001 to include needle safety protocols.• Can be viewed online at www.osha.gov.

the BloodBorne PathogenS Standard

• This training will satisfy the OSHA annual training requirement in BBP awareness.You will learn:

• What bloodborne pathogens are and why they are dangerous.• Basic information on HIV, hepatitis B (HBV) and hepatitis C (HCV).• The routes of exposure, techniques to reduce the risk of exposure, and the use of personal pro-

tective equipment (PPE).• The resources available to employees in the workplace.• How to respond safely to an emergency at work.• Guidelines for postexposure situations.

Instructor Note: Show the Bloodborne Pathogens DVD.

Why do you need this training?• To provide care to an injured or ill person.• To handle contaminated sharps.• To clean a blood or body fluid spill.• To learn what to do if you’re exposed to BBP.

You should know:• The risks of workplace duties that might involve blood or body fluid exposure.• The routes of entry for BBP. • Protective and preventive measures for handling blood or other body fluids.

BloodBorne PathogenS introduction


Who is covered by the Occupational Exposure to BBP Standard?• All employees who could come into contact with blood or Other Potentially Infectious Materials

(OPIM) while performing their jobs.Can include:

• A coworker coming to the aid of a bleeding victim• Public safety, correctional officers, first responders• Healthcare or dental workers• Custodial or maintenance workers• Workers in labs, tissue or blood banks, laundries or mortuaries• Workers handling medical equipment or regulated waste• Workers who provide body art

What is a bloodborne pathogen?• Disease-causing microorganism that is present in human blood.• May be transmitted through exposure to the blood or certain body fluids of an infected person.• Most serious types: HIV, HBV, HCV

What are Other Potentially Infectious Materials?• Human body fluids• Unfixed tissue or organs from a human• Any cell, culture, fluid, tissue or organ containing the HIV or hepatitis B virus

What is an Exposure Incident?• OSHA definition: “A specific eye, mouth, or 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.”

human immunodeficiency ViruS (hiV)

HIV breaks down the immune system.• Kills T-Cells, which help the body fight against infection.• More than 1 million cases of HIV in the U.S.• 56,000 new cases annually. • In the US, 20% of HIV carriers are unaware they are infected.• No known cure or vaccine

AIDS is the most advanced stage of HIV infection• Allows opportunistic illnesses (Common cold becomes fatal pneumonia.)

How is HIV transmitted?• Must have a route of entry• Fluids that transmit HIV:

o Bloodo Semen, vaginal secretionso Breast milko Saliva from dental procedures (usually bloody)


hePatitiS B and c ViruSeS

Hepatitis is inflammation of the liver.• Usually caused by a viral infection.• HBV & HCV are the most serious workplace exposures to hepatitis.

HBV• 38,000 new cases in 2008• 90% of the time people recover completely.

o Amniotic fluid (from a mother’s pregnancy) o Cerebrospinal fluid (from the brain and spinal column)o Synovial fluid (surrounding the joints) o Pleural fluid (fluid around the lungs)o Peritoneal fluid (fluid in the abdomen)o Pericardial fluid (fluid around the heart)o Any body fluid containing blood

• Primary methods of transmission:o Unprotected sex with infected partnero Sharing needles during injection drug use

• Can still pass the disease without knowing you’re infected.HIV is not transmitted through casual contact.

• No transmission from saliva or tears.• No known transmission from sharing:

o Food and drinko Towels, tools, eating utensilso Restroom facilities

Signs and symptoms of HIV/AIDS• Initially flu-like symptoms that disappear• May have no other signs and symptoms for years• Common symptoms of HIV infection include:

o Anorexia, weight loss o Fatigue, weaknesso Persistent cough, swollen lymph nodeso Diarrhea, abdominal discomfort o Mouth lesions, dark skin blemisheso Afternoon fevers, night sweats, chillso Memory loss, neurological disorderso Increased illnesses due to a weakened immune system


• 5 – 10% develop chronic infection, which can cause:o Liver infectiono Cirrhosis (scarring) of the livero Liver cancero Liver failureo Death

• 30-50% of infected children become chronic carriers.• As many as 1.4 million Americans have chronic HBV.• More easily transmitted than HIV or HCV.• Vaccine preventable

HCV• Can cause acute or chronic (life-long) infection.• 75-85% develop chronic infection, which can cause chronic liver disease and death.• 3.2 million Americans with chronic HCV.• 18,000 new cases in 2008.

Transmission of HBV and HCV• HBC and HCV are contracted through direct contact with blood or OPIM.• Transmission is usually through:

o Needlesticks or other contaminated sharps exposureso Sharing needles during injection drug useo From an infected mother to her baby during birtho Unprotected sex with an infected individual (rarely HCV)

• Can transmit HBV or HCV without having signs or symptoms (carrier).• Not spread through casual contact (working, studying, or playing).• No known transmission from:

o Sharing food/drinko Sharing restroom facilitieso Insects

Signs and symptoms of HBV and HCV• May not have any signs or symptoms.• If signs and symptoms are present, may include:

o Jaundice (yellowing of the skin or sclera around the eyes)o Fatigueo Loss of appetite, nausea and vomitingo Abdominal pain, diarrhea, dark urineo Joint pain (HBV)


WorkPlace tranSmiSSion

Workplace transmission can occur when:• Responding to an emergency• Handling a contaminated sharp• Cleaning a blood or body fluid spill

BBP must have a route of entry to a non-infected person:• Mucous membranes

o Unprotected eyes, mouth, noseo Unprotected sex

• Skin breakdowno Cut or open woundo Fresh scab o Rasho Hangnail

• Puncture o Needlestickso Handling contaminated sharp objectso Sharing needles during injection drug use

Protection against HIV, HBV and HCV infection:• Avoid unprotected sex with infected persons or multiple partners.• Do not share items possibly contaminated with blood or OPIM:

o Needles from injection drug useo Razorso Toothbrushes

Protection in the workplace against HIV, HBV and HCV infection:• Get vaccinated against HBV.• Use universal precautions when there is a risk of exposure to blood or body fluids. (We’ll discuss

this later.)• Use personal protective equipment (PPE) to protect routes of entry.• Follow your organization’s Exposure Control Plan.

If you suspect you’ve contracted HIV, HBV or HCV, get tested. • See your doctor for a blood test.• There may be no signs or symptoms.• A blood test is required for diagnosis.• Early diagnosis is important to:

o Ensure appropriate and early care.o Avoid spreading the disease to others.


PerSonal ProtectiVe equiPment

What is personal protective equipment?• Protects potential routes of entry from exposure to BBP.• The employer provides PPE to “at-risk” employees at no cost.

Standard PPE• Gloves (disposable and watertight)• Protective clothing

o Gowns, aprons, lab coats, shoe covers• Face shields or face masks• Eye protection• CPR barrier masks or bag masks for rescue breathing

PPE requires training for proper use.• Must fit correctly• Be appropriate for each situation• Practice selecting, donning and removing PPE before a real emergency.

PPE Location• Store at each workstation• First aid kits• Any site where there is a potential for exposure to BBP

PPE Disposal• Remove PPE as soon as possible after an exposure, before leaving the scene.• Contaminated PPE must be disposed of properly as regulated waste.

o Not with regular trash.o Use plastic red bag or other leak-proof, biohazard container.

• Uncontaminated PPE may be discarded in the regular trash.• Wash your hands thoroughly after removing PPE.

Gloves are the most common form of PPE.• Often made from latex.

o Use non-latex gloves for people with latex allergies.• Should be watertight and disposable.• Use gloves for patient care and clean up.• Bandage cuts before putting on gloves.• Double gloving (two pair) provides additional protection.• Remove soiled gloves with care.• Avoid splashing or creating droplets of blood in the air.

DISCUSS: Where IS yoUr PPe?

DeMoNSTrATe: DISPoSAble glove reMovAl

PrACTICe: DISPoSAble glove reMovAl


exPoSure control Plan

Exposure Control Plan• A written plan for management of bloodborne pathogens in the workplace.• Identifies those at risk for exposure.• Identifies how to determine if an exposure has occurred.• Written by the employer for workplace specific BBP issues.• Must be accessible to employees.• Should be reviewed annually for:

o New or modified activities or jobs that may result in exposure to BBP.o New technology, devices or procedures that could decrease risk of exposure.o Employee input.

• Includes engineering controls and work-practice controls.

Engineering Controls• Items or hardware that isolate or remove BBP hazards from the workplace.• Examples:

o Sharps disposal containerso Needleless injection systemso Self-sheathing needleso Blunt-tip suture needles for less-dense tissueo Specially marked bags for contaminated waste (regulated waste)

Work-practice Controls• Systems or everyday practices in the workplace that reduce risk and exposure to BBP. • e.g. A company policy that says to use watertight gloves when responding to emergencies.

An Exposure Control Plan should address:• Sharps management• Spill clean-up• Regulated waste• Contaminated laundry• Labeling • Hand washing• Hygiene • Maintenance and housekeeping• HBV vaccination• Postexposure follow-up and treatment

DISCUSS: Where IS yoUr exPoSUre CoNTrol PlAN?


management of SharPS

Needlesticks• Most common cause of occupational exposure to BBP• 800,000 needlesticks annually in the U.S.

A contaminated sharp is any object contaminated with blood or OPIM that can penetrate the skin.

• e.g. Needles, scalpels, broken glass or capillary tubes, exposed ends of dental wiresSharps Injury Log

• Part of the Exposure Control Plan.• Tracks how sharps injuries occur in the workplace.• Helps future prevention efforts.• Is confidential between the employer and employee.• Must include:

o Type and brand of device used in the incidento Location of the incidento Description of the incident

Techniques for handling sharps:• Use a mechanical means (not your hands) to pick up broken glass and other contaminated sharps:

o Tongs, broom, dustpan• Wear PPE. • Dispose of all sharps in the proper container:

o Closeableo Puncture-resistant and leak-resistanto Properly labeled as a biohazard

• Keep sharps containers visible and within easy reach. o Avoid bending, stretching or straining to discard sharps. o Plainly visible to the workers, including how full it is.

• Do not overfill a sharps container.o Change a sharps container when it is 2/3 full to avoid injury when discarding sharps into

a full container. • Use a needleless system or other advanced technology in labs and healthcare settings.• Review sharps management policies at least annually or as needed to include:

o New technologyo New productso Employee input on sharps use

• Follow your state’s needle safety legislation.

Do not recap needlesDo not self-blunt (bend/break) needles


Blood SPillS

Clean-up of blood spills should occur as soon as possible. • Follow your workplace Exposure Control Plan.• The goal of clean-up is to disinfect the area of potentially infectious materials.• Use an EPA-registered germicidal for disinfection.• If no germicide is available, use chlorinated bleach:

o Mix one part chlorinated bleach to 10 - 100 parts water. (1:10 to 1:100)o Solution concentrations vary depending on the size and type of spill.o Change bleach/water solutions daily.

Guidelines for cleaning a blood or OPIM spill:1. Clear the immediate area to reduce further contamination or foot tracking.2. Locate the BBP spill kit – follow directions.3. Put on appropriate PPE.4. Clean the area of visible blood and OPIM with paper towels or an absorbent powder.5. Disinfect the area for at least 10 minutes.6. Dispose of soiled clean-up materials and PPE in a properly-labeled container according to

workplace policy. 7. Wash your hands.

laBeling

Regulated Waste• Definition:

o Soiled material from clean-upo Any discarded item contaminated with blood or OPIM

• Examples of regulated waste:o Bloody gauzeo Heavily soiled gloveso Shoe covers contaminated with blood or OPIM

• Requires special handling and disposalo Proper biohazard containero Disposal by a medical waste company

• Containers for regulated waste should be: o Closeable o Leak-proofo Labeled or color-coded to indicate a biohazard


Contaminated Laundry• Should be handled as little as possible. • Should be placed in a properly labeled, closeable, leak-proof container.• Should be cleaned by a professional service that provides pick-up.

Warning Labels• Must be attached to:

o Containers of regulated waste, contaminated laundry, used sharps.o Refrigerators and freezers containing blood or OPIM.o Any container used to ship, store or transport blood or OPIM.

• Biohazard label requirements:o Color: fluorescent orange or orange-redo Symbol: should contain the biohazard symbol in contrasting colorso Attached so that they cannot be accidentally removed or fall off

• If a biohazard label is unavailable:o Use a red bag or other red container as a temporary substitute.

• Post warning Signs:o At the entrance to HIV and HBV research and production facilitieso As otherwise specified by the Standard

DISCUSS: ShoW The ProPer bIohAzArD lAbel

hand WaShing

Proper hand washing• Prevents exposure from:

o Touching mucous membranes with contaminated handso Transfer of BBP from environmental surfaces to other people

• Wash hands as soon as possible after potential exposure to BBP. o Providing first aido Cleaning a blood spillo Handling regulated waste or contaminated laundry

Good hand washing technique• Wet hands with warm water and apply soap.

o Liquid soap reduces bacteria associated with bar soap.• Rub hands together vigorously on all surfaces.

o Under nail bedso Between fingers

• Create friction to dislodge and remove germs.• Continue scrubbing for at least 20 seconds.• Rinse well with warm water and dry hands.


hygiene

maintenance and houSekeePing

hePatitiS B Vaccination

Use good personal hygiene and common sense.• In areas where BBP may be present, do not store food, apply makeup or lip balm, smoke, eat,

drink or handle contact lenses.• Be careful around potentially infectious materials.• Use PPE at all times.• Minimize splashing or splattering of droplets of blood or OPIM.

Follow good housekeeping techniques.• Maintain a safe work area.• Clean and disinfect at the beginning and end of each shift.• Remove and replace equipment coverings that have been exposed to BBP. • Clean spills immediately.• Pick up sharps properly and discard ASAP.• Use the proper containers for:

o Contaminated or used sharpso Regulated wasteo Contaminated laundry

• Handle infectious materials as little as possible.• Ensure containers are labeled with a biohazard symbol.

Hepatitis B Vaccination• Most effective method to reduce the risk of HBV transmission.• Provides immunity to HBV 95% of the time.• Is safe for both adults and children.• A series of three shots.• Given under the supervision of a licensed physician or another healthcare professional.

At-risk employees are eligible for the HBV Vaccination.• Given at no cost to the employee• Within 10 days of being classified as “at-risk”

If hand washing facilities are unavailable:• Use a hand sanitizer that contains at least 60% alcohol.

o Temporary solution until hand washing facility is availableo Not a substitute for hand washing

• Wash hands properly at the earliest opportunity.


• After an exposure incident, the employer should offer post-vaccination testing for immunity.An employee has the right to refuse the vaccination.

• Must sign a declination form.• May choose to have the vaccination at any time in the future, even if refused initially.

Who should receive the HBV vaccination?• Employees who are “at-risk” for exposure to BBP.• Persons whose lifestyle or environment puts them at increased risk for exposure. • All infants and children under 19 years of age.

reSPonding to emergencieS

Responding to emergencies creates a risk of exposure to BBP.

• Put your own safety first.• Use Universal Precautions to prevent the transmission of BBP.

Universal Precautions• Designed to prevent transmission of BBP when providing medical aid.• Universal Precautions say to treat blood and body fluids as infectious.

o Even without a diagnosis of an infectious disease.• For additional protection, use Body Substance Isolation and Standard Precautions and treat

every body fluid as potentially infectious.o All body fluids, secretions and excretions regardless if they contain visible blood or not

Exception: sweato Non-intact skino Mucous membranes

• Body fluids may not carry BBP, but may contain other infectious microorganisms.For the most protection:

• Assume all moist body substances are infectious.• Wash hands thoroughly before and after each patient contact.• Put on PPE before providing medical aid.• Use CPR barrier devices for rescue breathing. • Follow your workplace Exposure Control Plan for cleaning and disposal of blood and OPIM.

What if you’re exPoSed on the joB?

Immediate Actions when Exposed• Wash hands and exposed areas immediately with soap and water.

o Flush splashes to nose, mouth, or skin with water. o Irrigate eyes thoroughly with water or saline.

Follow your workplace Exposure Control Plan.• Dispose of contaminated PPE, clothing or objects. • Ensure the clean-up of any blood spill.


Report immediately to your supervisor:• Date and time of the exposure• Body part exposed to BBP• Job classification• Work site location• Engineering controls being used• Work practices being followed• Activity being performed at the time of the exposure incident• Previous training for the activity

When a sharp is involved, report:• If the sharp had engineered sharps injury protection.• If the protective mechanism was activated, and if the incident occurred before or after activation.• If no engineered sharps injury protection, could engineered protection have prevented the injury?• Could any other engineering control, work-practice control, or administrative policy have pre-

vented the injury?

Postexposure Evaluation and Follow-up• Provided by the employer.• No cost to the employee.• Within 3-4 hours after the exposure:

1. Document the routes and circumstances of the exposure. 2. Identify & document the source individual (unless prohibited by law).3. Confidential medical evaluation by a qualified physician. 4. Laboratory testing of the source individual and person exposed.

a. Follow-up testing as needed.5. Treat the exposure.6. Postexposure medications as needed7. Employee counseling8. Continued follow-up as needed

• Answer questions.• Give the Written Exam.• Review the correct answers with your students.

Instructor Note: Scenarios may be found online at www.emssafety.com/Login.

DISCUSS: WhAT If yoU’re exPoSeD oN The job?

DISCUSS: WorkPlACe SCeNArIoS

gsk i l s bloodborne pathogens - ems safety...• how to respond safely to an emergency at work. •...

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