Text For Citation: 02 Item/Group: 001 Hazard: BLOODBORNE

Section 5(a)(1) of the Occupational Safety and Health Act of 1970: The employer did not furnish employment and a place of employment which were free from recognized hazards that were causing or likely to cause death or serious physical harm to employees in that employee(s) were exposed to the hazard of becoming infected with Hepatitis B Virus (HBV) and/or Human Immunodeficiency Virus (HIV) through possible direct contact with blood or other body fluids. (a) Laboratory Area; Not all employee(s) with the job title of Laboratory Technicans received training and education on Universal Precautions and Infection Control as outlined in the 1988 CDC Guidelines. Laboratory Technicans are exposed to blood or body fluids while performing blood tests, such as, but not limited to, tests for the Hepatitis Virus, Antibody Screening, and Blood Typing; On or about 7/3/91. (b) Home Care Department; Not all employee(s) with the job title of Phlebotomists who are exposed to blood or body fluids while drawing patient's blood, received training and education on Universal Precautions and Infection Control as outlined in the 1988 CDC Guidelines; On or about 7/3/91. (c) Laboratory Area; The employer's written and implemented Infection Control Plan did not adequately incorporate all elements outlined by the 1988 CDC Guidelines. The Program was deficient in providing accurate information on the Hepatitis B Virus vaccination; labeling and containment requirements for potentially infectious blood or body fluids; the disposal of contaminated sharp items; and the Follow-up Procedures after an exposure incident that involved blood or other body fluids; On or about 7/3/91. (d) Home Care Department; The employer's written and implemented Infection Control Plan did not adequately incorporate all elements outlined by the 1988 CDC Guidelines. The Program was deficient in providing accurate information on the Hepatitis B Virus vaccination; labeling and containment requirements for potentially infectious blood or body fluids; the disposal of contaminated sharp items; and the Follow-up Procedures after an exposure incident that involved blood or other body fluids; On or about 7/3/91. (e) Home Care Department; Employee(s) with the job titles of Phlebotomists, after exposure to potentially infectious blood or body fluids, did not receive appropriate Follow-up Procedures after an exposure incident that involved blood or other body fluids as outlined by the 1988 CDC Guidelines; On or about 6/25/91. (f) Laboratory Area; Employee(s) with the job titles of Laboratory Technicians, after exposure to potentially infectious blood or body fluids, did not receive appropriate Follow-up Procedures after an exposure incident that involved blood or other body fluids as outlined by the 1988 CDC Guidelines; On or about 6/25/91. The hazards of such exposure include, but are not limited to, the onset of clinical symptoms of acute Hepatitis B, anorexia, abdominal pain, jaundice and the potential for becoming a chronic carrier of the Hepatitis B and/or Human Immunod- eficiency Virus. ABATEMENT NOTES: Among other methods, one feasible abatement method to reduce this hazard, is to establish and enforce adequate procedures regarding exposure to and handling of blood or other body fluids, such as those stipulated by the Centers for Disease Control (CDC) Guidelines publish- ed in Morbidity and Mortality Weekly Report, June 24, 1988, Volume 37, Number 24. Elements essential to an Infection Control Program include at a minimum: ENGINEERING, ADMINISTRATIVE, AND WORKPRACTICE CONTROLS Sharp instruments and disposable items. Needles shall not be recapped, purposely bent or broken by hand, removed from disposable syringes, or otherwise manipulateed by hand. Resheathing instruments, self-sheathing needles, or forceps shall be used to prevent recapping needles by hand. Reusable Equipment. Standard sterilization and disinfection procedures currently recommended for Hepatitis B in a variety of health care settings are adequate to sterilize or disinfect instruments, devices, or other items contaminated with blood or other body fluids. A recommended source of information is the CDC's Guidelines for Hospital Environmen- tal Control: Cleaning, Disinfection, and Sterilization of Hospital Equipment. Bagging of Articles. Objects that are contaminated with blood or other body fluids shall be placed in a fluid resistant bag. If outside contamination of the bag is likely, a second fluid resistant bag shall be added. Handwashing. After removing gloves, or other contaminated personal protective equipment, hands or other skin surfaces shall be washed thoroughly and immediately after contact with blood or other body fluids. TRAINING AND EDUCATION Training and Education of employee(s) such as, but not limited to, Phlebotomists, Laboratory and Blood Bank Technicians. Such training and education shall be at the time of initial employment and at least annually thereafter. The training materials used shall be appropriate in content and vocabul- ary to educational level, literacy, and language background of the employees being trained. The Training and Education Program shall contain, at a minimum, the following elements: (i) A general explanation of the modes of transmission of bloodborne pathogens; (ii) An explanation of the employer's Infection Control Program; (iii) An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood or other body fluids and other potentially infect- ious materials; (iv) An explanation of the use and limitations of work practices that will prevent or reduce employee exposure, including approp- riate engineering controls, work practices, and personal protective equipment; (v) An explanation of the basis for selection of personal protective equipment; (vi) Information on the Hepatitis B vaccination, including information on its efficacy, safety and the benefits of being vaccinat- ed; (vii) Information on the appropriate actions to be taken and the person to contact in an emergency; (viii) 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; (ix) An explanation of the signs and labels and/or color coding used in the workplace; and (x) A copy of the Center for Disease Control (CDC) Guidelines. WRITTEN INFECTION CONTROL PROGRAM The employer shall design and implement a written Infection Control Program to minimize or eliminate employee exposure. This Infection Control Program shall be reviewed and updated as necessary to reflect significant changes in tasks or procedures. This program shall contain, at a minimum, the following: (i) A determination of the exposure potential of all employees; (ii) The schedule and method of implementation of the Infection Control Program. (iii) All the items related to the identifica- tion, evaluation, and control of bloodborne pathogens and exposure to blood or other body fluids contained in the employer's Infection Control Training and Information Program must be incorporated in the estab- lishment's overall written Infection Control Program. The written Infection Control Program shall be made avail- able to all employees during the training program and at all other times. HEPATITIS B VACCINATION The facility's infection control policy regarding Hepatitis B vaccinations shall address all circumstances warranting such vaccinations and shall identify employees of substant- ial risk of directly contacting blood or other body fluids. All such employees shall be offered Hepatitis B vaccinations in amounts and at times prescribed by standard medical practice. FOLLOW-UP PROCEDURES AFTER POSSIBLE EXPOSURE TO HIV/HBV: (i) If a Laboratory Technician, Phlebotomists has a percutaneous (needle-stick or cut) or mucous membrane (splash to the eye, nasal mucosa, or mouth) exposure to blood or body fluids or has a cutaneous exposure to blood or body fluids when the worker's skin is chapped, abraded, or otherwise nonintact, the source patient shall be informed of the incident and tested for HIV and HBV in- fections, after consent is obtained. (ii) If patient consent is refused or if the source patient tests positive, the health care worker shall be evaluated clinically by HIV antibody testing as soon as possible and advised to report and seek medical evaluation of any acute febrile illness that occurs within 12 weeks after exposure. HIV seronegative workers shall be retested 6 weeks post-exposure and on a periodic basis thereafter (12 weeks and 6 months after exposure). (iii) Follow-up procedures shall be taken for health care workers exposed or potentially exposed to HBV. The type of procedures depends on the immunization status of the worker (i.e., whether HBV vaccination has been received and antibody response is adequate) and the HBV serologic status of the source patient. The CDC Immunization Practices Advisory Committee has published its recommendations regarding HBV post- exposure prophylaxis in table format in the June 5, 1985, Morbidity and Mortality Weekly Report. (iv) If an employee refuses to submit to the procedures in (ii) or (iii) above, when such procedures are medically indicated, no adverse action can be taken on that ground alone since the procedures are designed for the benefit of the exposed employee. The National Health Laboratories was previously cited for a violation of the General Duty Clause (5(a)(1)) which was contained in OSHA Inspection Number 102270188, Citation Number 1, Item Number 1, issued on November 9, 1989, by the OSHA Corpus Christi, Texas Area Office and became a Final Order on December 6, 1989.