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Hospital-wide Hazards
Bloodborne Pathogens (BBP)

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Common safety and health topics:

Bloodborne Pathogens Standard
As mandated by the Needlestick Safety and Prevention Act, OSHA revised the Bloodborne Pathogens Standard [29 CFR 1910.1030], effective April 18, 2001. Definitions for bloodborne pathogens, other potentially infectious materials (OPIM), and occupational exposure are found in 29 CFR 1910.1030(b).

Potential Hazard
  • Employee exposure to blood and OPIM [29 CFR 1910.1030(b)] due to ineffective Exposure Control Plan (ECP).

Possible Solutions

  • Identify employees who have occupational exposure to blood or OPIM [29 CFR 1910.1030(b)], and then establish and implement a written Exposure Control Plan (ECP), designed to eliminate or minimize employee exposure [29 CFR 1910.1030(c)(1)].

  • Exposure Control Plan requirements include:
    • Documenting an annual review and update of the written plan that reflects changes in technology for safer medical devices. [29 CFR 1910.1030(c)(1)(iv)(A)] Employers must also document consideration and implementation of the safer medical devices annually. [29 CFR 1910.1030(c)(1)(iv)(B)]

    • Employer must get input for the devices from those responsible for direct patient care. [29 CFR 1910.1030(c)(1)(v)] This input must also be documented.
  • Employer should ensure that the Exposure Control Plan (ECP) is accessible to all employees. [29 CFR 1910.1030(c)(1)(iii)] They should also review and update it at least yearly. [29 CFR 1910.1030(c)(1)(iv)]

  • Employer should ensure that employees with occupational exposure to bloodborne pathogens receive appropriate training, at no cost to employee, and during working hours. [29 CFR 1910.1030(g)(2)(i) and 29 CFR 1910.1030(g)(2)(vii)]

Book For additional information, see Healthcare Wide Hazards - Needlesticks/Sharps Injuries.

Additional Information

Post-Exposure Follow-up
Potential Hazard
  • No post-exposure follow-up made available after a needlestick/sharps injury to help document injury or offer medically indicated post-exposure prophylaxis.

Possible Solutions

Recordkeeping for Bloodborne Pathogens
Potential Hazard
  • Lack of information to adequately implement a bloodborne pathogens program or address bloodborne pathogen hazards.

Possible Solutions

  • Employer should establish and maintain both medical and training records [29 CFR 1910.1030(h)(1) and 29 CFR 1910.1020].

    • If an exposure incident occurs, employer should add reports to the medical record to document the incident, including testing results following the incident, follow-up procedures, and the written opinion of the health care professional.

      • Medical Records must be preserved and maintained for each employee with an occupational exposure to bloodborne pathogens [29 CFR 1910.1030(h)(1)] and for at least the duration of employment plus 30 years. They must be kept confidential (not disclosed without written permission of employee, except by law) and separate from other personnel records and must also include:

        • The employee's name and social security number, hepatitis B vaccination status, including the dates of vaccination and medical records related to the employee's ability to receive vaccinations.
      • Training Records must be established and maintained for all exposed employees for 3 years, from the date the training occurred. They must include [29 CFR 1910.1030(h)(2)]:

        • The names and job titles of all persons attending the training sessions, the dates, and content of the training sessions, and the names and qualifications of all trainers.
    • Whenever an employer is ceasing to do business and there is no successor employer to receive and maintain the records subject to this standard, the employer must notify affected current employees of their rights of access to records at least three (3) months prior to the cessation of the employer's business. [29 CFR 1910.1020(h)(2)]
  • Employer must make both medical and training records available upon request to: [29 CFR 1910.1030(h)(3)(ii)]

    • Director of NIOSH.

    • Assistant Secretary of Labor for the Occupational Safety and Health.

    • Employees or employee representatives (someone having written consent of the employee).
  • Employer must maintain a log of injuries from contaminated sharps [29 CFR 1910.1030(h)(5)] for each injury including:

NOTE: If an employer is not required to maintain injury/illness log under 1904, then this does not apply. [29 CFR 1910.1030(h)(5)(ii)]

Additional Information

Needlestick Injuries
Nursing staff are the most frequently injured employees from needlesticks [Exposure Prevention Information Network (EPINET)]. Data shows needlestick injuries occur most frequently in patient rooms.

Potential Hazard

Possible Solutions

  • Use safer needle devices and needleless devices to decrease needlestick or other sharps exposures. See Safer Needle Devices Section.

  • Proper handling and disposal of needles and other sharps according to the Bloodborne Pathogens Standard can help prevent needlestick injuries. See Handling Needles/Sharps.

Book For additional information, see Healthcare Wide Hazards - Needlesticks/Sharps Injuries.

Additional Information

Other Sharps
"Contaminated Sharps" means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires. [29 CFR 1910.1030(b)]

Potential Hazard
  • Exposure to blood and OPIM through other sharps:

Possible Solutions

  • Implement engineering and work practice controls to help prevent exposures.

Book For additional information, see Healthcare Wide Hazards - Needlesticks/Sharps Injuries.

Universal Precautions
An approach to infection control which treats all human blood and other potentially infectious materials as if they were known to be infectious for HIV, HBV or other bloodborne pathogens. [29 CFR 1910.1030(b)]

Potential Hazard
  • Exposure to bloodborne pathogens due to lack of universal precautions.

Possible Solutions

  • Employer should implement universal precautions. [29 CFR 1910.1030(d)(1)]

    • Treat all blood and other potentially infectious materials with appropriate precautions.

      • Use gloves, masks, and gowns if blood or OPIM exposure is anticipated.

      • Use engineering and work practice controls to limit exposure.

There are other concepts in infection control that are acceptable alternatives to universal precautions, such as Body Substance Isolation (BSI) and Standard Precautions [OSHA Directive CPL 02-02-069 [CPL 2-2.69], (November 27, 2001)]. These methods define all body fluids and substances as infectious and incorporate not only the fluid and materials covered by the Bloodborne Pathogens Standard, but expand coverage to include all body fluids and substances.

Book For additional information, see Healthcare Wide Hazards - (Lack of) Universal Precautions.

Personal Protective Equipment (PPE)
Potential Hazard
  • Exposure to blood and OPIM due to an ineffective Personal Protective Equipment (PPE) program.

Possible Solutions

  • Appropriate use of Personal Protective Equipment (PPE). PPE is required by the Bloodborne Pathogens Standard (if exposure to blood and OPIM is anticipated and where occupational exposure remains, after institution of engineering and work practice controls). [29 CFR 1910.1030(d)(2)(i)]

  • Wear gloves when hand contact with blood, mucous membranes, OPIM, or non-intact skin is anticipated, and when performing vascular access procedures, or when handling contaminated items or surfaces. [29 CFR 1910.1030(d)(3)(ix)]

  • Employer must ensure that employees wash hands and any other skin with soap and water or flush mucous membranes with water as soon as feasible after contact with blood or other potentially infectious materials (OPIM). [29 CFR 1910.1030(d)(2)(vi)]

  • Employers must provide readily accessible hand washing facilities. [29 CFR 1910.1030(d)(2)(iii)]

  • Dispose of PPE. Protective clothing must be removed before leaving the work area [29 CFR 1910.1030(d)(3)(vii)], and disposed of in an appropriately designated area or container for storage, washing, decontamination or disposal [29 CFR 1910.1030(d)(3)(viii)].

Latex Allergy
Potential Hazard
  • Exposure to latex in products like latex gloves and developing latex sensitivity or a latex allergy.

Possible Solutions

  • Employers must provide appropriate gloves when exposure to blood or other potentially infectious materials (OPIM) exists. [29 CFR 1910.1030]

  • Alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided. [29 CFR 1910.1030(d)(iii)]

Book For additional information, see Healthcare Wide Hazards - Latex Allergy.

Bloodborne Illnesses - Hepatitis B Virus (HBV)
Hepatitis is an inflammation of the liver that can lead to liver damage and death. The annual number of occupational infections has decreased 95% since hepatitis B vaccine became available in 1982. Hepatitis B vaccine immunizations and compliance with other provisions of OSHA's Bloodborne Pathogens standard may reduce infections.

Potential Hazard

Exposure to potentially fatal bloodborne illnesses such as Hepatitis B Virus (HBV).
  • Hepatitis is much more transmissible than HIV.

  • Risk of infection from a single needlestick is 6%-30%.

  • 50% of the people with HBV infection are unaware that they have the virus.

  • The CDC states that HBV can survive for at least one week in dried blood on environmental surfaces or contaminated needles and instruments. For more information, see Contaminated Work Environments.

Requirements under Bloodborne Pathogens Standard, 29 CFR 1910.1030

Additional Information

Bloodborne Illnesses - Human Immunodeficiency Virus (HIV)
HIV infection has been reported following occupational exposures to HIV-infected blood through needlesticks or cuts; splashes in the eyes, nose, or mouth; and skin contact. Most often, however, infection occurs from needlestick injury or cuts. Currently, no vaccine currently exists to prevent HIV infection, and no treatment exists to cure it.

Potential Hazard
  • Exposure to potentially fatal bloodborne illnesses such as Human Immunodeficiency Virus (HIV).

    • Risk of HIV infection after needlestick is 1 in 3,000 or 0.3%.

    • The CDC documented 55 cases and 136 possible cases of occupational HIV transmission to US healthcare workers between 1985 and 1999.

Possible Solutions

Additional Information

Bloodborne Illnesses - Hepatitis C Virus (HCV)
HCV infection is the most common chronic bloodborne infection in the United States. Hepatitis C infection is caused most commonly by needlestick injuries. HCV infection often occurs with no symptoms, however chronic infection can develop which may lead to active liver disease. Currently there is no vaccine available for hepatitis C.

Potential Hazard
  • Exposure to potentially fatal bloodborne illnesses such as Hepatitis C Virus (HCV), which is a major cause of chronic liver disease.

    • Risk of HCV infection after needlestick is 1.8%.

Possible Solutions

Additional Information

Labeling and Signs
Potential Hazard
  • Exposure to bloodborne pathogens due to improper labeling of potential hazards.

Possible Solutions

  • Implement labeling and signs.

    • Biohazardous Waste Container. Regulated waste, such as I.V. tubing used to administer blood, contaminated PPE, and needles etc., must be disposed of into appropriately labeled biohazardous waste containers. [29 CFR 1910.1030(g)(1)(i)(A)]

    • Biohazard Label. Containers that contain regulated waste (contaminated PPE, needles, etc.) as well as refrigerators and freezers containing blood or OPIM, must bear the biohazard symbol [29 CFR 1910.1030(g)(1)(i)(A)]

    • Exception for Blood Products. Individual containers of blood, blood components or products that are labeled as to their contents and have been released for transfusion or other clinical use need not be labeled as hazardous. [29 CFR 1910.1030(g)(1)(i)(F)]

    • Individual containers of blood or OPIM need not be labeled if placed in a labeled container for storage, transport, shipment or disposal. [29 CFR 1910.1030(g)(1)(i)(G)]

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