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) Lutheran Center for the Aging, Smithtown, NY - Employees with the job titles of Nursing Staff, Laundry Workers and Housekeeping Personnel who were subjected to potential exposure incidents such as skin punctures from a sharp contaminated with blood or other body fluids or splashes of blood or other body fluids to the eyes and face, were not provided with proper training and education concerning the use of Universal Precautions and Infection Control as outlined in the 1988 CDC Guidelines. The Employer's training program addresses only explanations of work practices to prevent or reduce exposure to blood or other body fluids and did not contain information on the following topics: Engineering Controls, Hepatitis B Vaccination, HBV and HIV follow-up procedures after an incident involving blood or other body fluid exposure, and instructions on identifying biohazrd signs and labels; on or about 3/19/91. (b) Lutheran Center for the Aging, Smithtown, NY - Employees with job titles of Nursing Staff, Laundry Workers and Housekeeping Personnel were subjected to potential exposure incidents such as, skin punctures from a sharp contaminated with blood or other body fluids or splashes of blood or other body fluids to the eye and face were not offered nor given the HBV vaccination at the time it was requested; on or about 3/19/91. (c) Lutheran Center for the Aging, Smithtown, NY - Employees with the job titles of Nursing Staff, Laundry Workers and Housekeeping Personnel. The employers' written Infection Control Program did not encompass all de- partments of the facility. The Nursing Department was the only division within the facility identified as a location where the use of Universal Precautions were requried. The employer has an Infection Control Program that focuses on Isolation Procedures rather than Universal Precautions; on or about 3/19/91. (d) Lutheran Center for the Aging, Smithtown, NY - Employees with the job titles of Nursing Staff and Housekeeping Personnel were not required to bag soiled linen at the site where it was generated, and where permitted to transport unbagged soiled linen by hand outside the patient area to the utility room; on or about 3/19/91. 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, Registered Nurses, Licensed Practical Nurses, Nurses's Aid, Housekeeping Personnel and Laundry Workers. 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 vaccinated; (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 health care workers, Registered Nurses, Licensed Practical Nurses, Laundry Workers and Housekeeping Personnel have a percutane- ous (needle-stick or cut) or mucous mem- brane (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 infections, 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. HANDLING OF LINEN The Infection Control Program shall have identified all laundry operations involving substantial risk of direct exposure to blood or body fluids. Linen soiled with blood or body fluids shall be handled as little as possible and with minimum agitation to prevent contamination of the person handling the linen. All soiled linen shall be bagged at the location where it was used; it shall not be sorted or rinsed in patient-care areas. Soiled linen shall be placed and transported in bags that prevent leakage.