|
Exposure to blood or other potentially infectious materials (OPIM) is an issue of growing concern for health care workers. Care must be taken to prevent the transmission
of bloodborne pathogens such as the Hepatitis B Virus
(HBV), Hepatitis C
Virus (HCV), and Human Immunodeficiency Virus (HIV), in the workplace.
Click on the
area for more specific information.
The
following topics relate to occupational safety and health hazards with
blood or OPIM:
Bloodborne
Pathogens Standard
Definitions for bloodborne
pathogens, other potentially infectious materials (OPIM), and
occupational exposure are
found in 1910.1030(b).
|
Hazard
 |
Possible
employee exposure to blood and OPIM because of an ineffective
Exposure Control Plan (ECP). |
Example Controls
Provide an effective
ECP and training as required by the Bloodborne Pathogens Standard
[1910.1030].
Each employer must:
- Identify employees
who have occupational exposure to blood or OPIM [1910.1030(b)],
and then establish and
implement a written Exposure Control Plan (ECP), designed to
eliminate or minimize employee exposure [1910.1030(c)(1)].
- The ECP must be made
available to all employees [1910.1030(c)(1)(iii)]
and be reviewed and
updated at least yearly [1910.1030(c)(1)(iv)].
-
Ensure that employees with occupational
exposure to bloodborne pathogens receive appropriate
training at no cost to employees, and during working
hours [1910.1030(g)(2)(i)].
- Training
requirements are listed in [1910.1030(g)(2)(vii)].
- It is recommended
that employers review recordkeeping
data required by the bloodborne pathogens standard to help evaluate the effectiveness of the
ECP.
|
Example
Exposure
Control Plans: |
- A Model
Exposure Control Plan is provided to assist employers in
developing their own plans [OSHA Directive CPL 2-2.44D Appendix D
(1999, November 5)]. The following sections and
downloadable forms are provided
below.
- Exposure Control
Plan
- Sample
Forms:
Additional Information:
|
Needlestick
Injuries
An estimated 800,000
needlestick injuries occur each year. Nursing staff are most
frequently injured. EPINET
Data show needlestick injuries occur most frequently in patient
rooms.
Needlestick injuries account
for up to 80 percent of accidental exposures to blood. (OSHA
JSHQ, 1998).
NOTE:
Recording of Exposure Incidents:
For recordkeeping
purposes, an occupational bloodborne pathogens exposure incident
(e.g. needlestick, laceration, or splash) should be classified as
an injury since it is usually the result of an instantaneous event
or exposure. CPL
2-2.44D,X.
|
Hazard
Exposure to
blood and OPIM from needlestick injuries due to:
Example
Controls
Engineering and Work
Practice Controls must be the primary means to eliminate or
minimize exposure to bloodborne pathogens. Where engineering
controls will reduce employee exposure either by removing,
eliminating or isolating the hazard, they must be used, and
changes to the Exposure Control Plan (ECP) must include these engineering controls [1910.1030(c)(1)(iv),
1910.1030(d)(2)(i) and
OSHA Directive 2.44D,
XIII (D)(2)].
- Engineering
Controls are controls (e.g., sharps disposal containers,
self-sheathing needles) that isolate or remove the
bloodborne pathogens hazard from the workplace [1910.1030(b)].
- NOTE: The
exposure control plan must document consideration and
implementation of appropriate commercially available and
effective engineering controls designed to eliminate or
minimize exposure [OSHA Directive
2.44D,XIII,C5].
- Suggested non-mandatory
forms are provided to assist
employers in evaluating engineering controls [Appendix
B, OSHA
Directive CPL 2-2.44D]. The appendix includes the sample evaluation form
developed by the Emergency Care Research Institute (ECRI).
- Work Practice
Controls are controls that reduce the likelihood of exposure by
altering the manner in which a task is performed (e.g.,
prohibiting recapping of needles by a two-handed technique) [1910.1030(b)].
- Needlestick prevention
program: The standard requires immediate follow-up of employees
after a needlestick [1910.1030(f)(3)].
It is recommended that
such follow-up include identifying injury patterns and accident analysis to determine if other
training, procedures, or safer needle devices
should be used to prevent future accidents.
- Post-exposure Evaluation
and Follow-up also includes:
Unsafe
Needle Devices: Most needlestick injuries result from unsafe
needle devices, rather than carelessness by health care
workers.
Safer
needle devices have built-in safety control devices,
such as those that use a self-sheathing needle, to help
prevent injuries before, during, and after use through
safer design features.
|
 |
-
The FDA
is responsible for clearing medical devices for marketing in
the U.S. It recommends safer needle devices with a fixed safety
feature that:
- Provides a
barrier between the hands and the needle after use; the
safety feature should allow or require the worker's
hands to remain behind the needle at all times.
- Is an
integral part of the device and not an accessory.
- Is in effect
before disassembly and remains in effect after disposal
to protect users and trash handlers, and for
environmental safety.
- Is as simple
as possible, and requires little or no training to use
effectively.
Improper
Handling and Disposal of Needles/Sharps:
Proper handling and
disposal of needles can reduce needlestick injuries. For
example, the Bloodborne Pathogens Standard:
-
Prohibits the recapping,
bending, or removal of contaminated sharps, to avoid accidental
punctures. Shearing or breaking of contaminated needles is
also prohibited [1910.1030(d)(2)(vii)].
- Unless the
employer can demonstrate that no alternative is feasible
or that such action is required by a specific medical or
dental procedure. In such cases the recapping or needle
removal must be accomplished through the use of a
mechanical device or one handed technique (2)(vii)(A)
and (d)(2)(vii)(B).
Requires
discarding of contaminated needles and other sharp
instruments immediately or as soon as feasible after use into appropriate
containers [1910.1030(d)(4)(iii)(A)(1)].
Containerization

|
Appropriate
containers must be [1910.1030(d)(4)(iii)(A)(1)]:
- Closable,
puncture-resistant and leak-proof
on sides and bottom.
- Accessible,
maintained upright and not allowed to overfill.
- Labeled
or color coded according to 1910.1030(g)(1)(i)
- Colored
red or labeled with the biohazard
symbol.
- The
label shall be fluorescent orange or orange-red,
with lettering and symbols in a contrasting
color [1910.1030(g)(1)(i)(C)].
- Red
bags or containers may be substituted for labels
[1910.1030(g)(1)(i)(E)].
|
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 [1910.1030(b)].
|
Hazard
Exposure to
blood and OPIM through other sharps:
|
- Glass
Capillary Tubes that break when used may
result in a penetrating wound and expose workers to
blood and OPIM.
|

|
- I.V.
Connectors that use needle systems increase the risk of exposure to bloodborne
pathogens through needlestick injuries.
|
- Disposable
razors that could be contaminated with blood
should be considered "contaminated sharps"
and disposed of properly in appropriate sharps
containers.
|
Example
Controls
Implement
engineering and work practice controls to help prevent
exposures.
- Capillary
Tubes:
- Broken glassware,
such as capillary tubes is not to be picked up directly
with the hands [1910.1030(d)(4)(ii)(D)].
- Regulated wastes
including capillary tubes need to be disposed of properly [1910.1030(d)(4)(iii)].
- Gloves must be
worn when among other things, handling or touching contaminated
items or surfaces, such as capillary
tubes [1910.1030(d)(3)(ix)].
- In
their joint document (Glass
Capillary Tubes: Joint Safety Advisory About Potential Risks
(1999, February)), OSHA, FDA and NIOSH warn health care workers about the hazards
from breakage of glass capillary tubes and recommend the use
of:
- Capillary tubes
that are not made of glass.
- Glass capillary
tubes wrapped in puncture-resistant film.
- Products that use a
method of sealing that does not require manually pushing
one end of the tube into putty to form a plug.
- I.V.
connector systems: The use of needleless connector
systems with I.V. setups is an engineering control that will
minimize occupational exposure.

|
FDA
urges the use of needleless systems or recessed needle
systems to reduce the risk of needlestick injuries and
exposure to bloodborne pathogens.
These
connectors use devices other than needles to connect one
I.V. to another. This example shows the plunger-type
system.
|
Additional
Information
|
Universal
Precautions
An approach
to infection control which treats all human blood and other potentially infectious
materials as if they were infectious for HIV and HBV or other
bloodborne pathogens [1910.1030(b)].
|
Hazard
 |
Exposure to
bloodborne pathogens because employees are not using Universal
Precautions. |
Example Controls
|
Implement
Universal Precautions according to the
Bloodborne Pathogens Standard [1910.1030(d)(1)].
- Treat all blood
and other potentially infectious materials with
appropriate precautions such as:
- 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 CPL
2-2.44D, Section D):
- 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.
|
Additional
Information
|
Personal
Protective Equipment (PPE)
|
Hazard
Exposure to
blood and OPIM due to an ineffective PPE program. Common
problems include improper:
Example
Controls
Personal
Protective Equipment (PPE) is required by the
Bloodborne Pathogens Standard and can provide some protection
from infectious materials as a barrier to protect skin and
mucous membranes from contact with blood and other potentially
infectious materials.
- Appropriate
PPE, addressed in 1910.1030(d)(3)(i),
must be provided by the employer, at no cost to the
employee, in appropriate sizes and be used by personnel if blood
or OPIM exposure is anticipated. The type and amount of PPE
depends on the anticipated exposure. PPE includes:
- Gloves, gowns,
laboratory coats, masks, face shields, eye protection,
mouthpieces, resuscitation bags, pocket masks, or other
ventilation devices.
- Gloves must be
worn 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 [1910.1030(d)(3)(ix)].
Handwashing
according to the Bloodborne Pathogen Standard:
- Employers 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) [1910.1030(d)(2)(vi)].
- Employers must provide
readily accessible handwashing facilities, [1910.1030(d)(2)(iii)]
and ensure that employees wash their hands immediately or as
soon as feasible after removal of
gloves [1910.1030(d)(2)(v)].
Disposal
of Protective Clothing:
- Protective clothing
must be removed before leaving
the room; [1910.1030(d)(3)(vii)],
and disposed of in an appropriately designated area or
container for storage, washing, decontamination or disposal [1910.1030(d)(3)(viii)].
|
Latex Allergy
It
is estimated that 8-12% of health care workers are latex sensitive
with
reactions ranging from irritant contact dermatitis and
allergic contact sensitivity, to immediate, possibly
life threatening, sensitivity.
|
Hazard
 |
Developing
latex sensitivity or latex allergy from exposure to latex in products
like latex gloves. |
Example Controls
Use appropriate gloves
for latex-sensitive employees:
- The employer shall
ensure that appropriate personal protective equipment, in the
appropriate sizes, is readily accessible at the worksite or is
issued to employees. Hypoallergenic gloves, glove liners,
powderless gloves, or other similar alternatives shall be
readily accessible to those employees who are allergic to the
gloves normally provided [1910.1030(d)(3)(iii)].
- Among the alternatives
are synthetic, low protein, and powder free gloves. Powder free gloves may reduce systemic allergic
responses.
- Eliminate the
unnecessary use of latex gloves when no risk of exposure to
blood or OPIM exists.
- Note:
Hypoallergenic gloves, glove liners, or powderless gloves
are not to be assumed to be non-latex or latex free.
- The FDA now requires labeling statements for
medical devices that contain natural rubber and
prohibits the use of the word
"hypoallergenic" to describe such products.
(Federal
Register, Volume 62, No. 189, effective September 30,
1998). A summary is provided in the FDA talk paper
Latex
Labeling Required for all Medical Devices (1997, September
30).
- Hand washing is required by OSHA's Bloodborne Pathogens
Standard after removal of gloves or other personal protective
equipment. This helps
to minimize powder and/or latex remaining in contact with
the skin [1910.1030(d)(2)(v)].
It is recommended that
thorough clean-up of
any residual powder in the workplace with appropriate vacuum
filters will reduce latex sensitivity and decrease employee exposure.
The Laundry
and Pharmacy modules
also address latex allergy issues.
Additional
Information
|
Labeling
and Signs
|
Hazard
Exposure to
bloodborne pathogens due to improper labeling and
signs of potential hazards.
Example
Controls

|
Implement
labeling and signs required by the Bloodborne Pathogens Standard,
such as:
|

|
- 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 [1910.1030(g)(1)(i)(A)].
|
|
|
|
- These
labels shall be fluorescent orange or orange-red,
with lettering and symbols in a contrasting color
[1910.1030(g)(1)(i)(C)].
|

|
- Red bags
or red containers may be substituted for labels
[1910.1030(g)(1)(i)(E)].
|
|
- 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 [1910.1030(g)(1)(i)(F)].
- Note: Individual
containers of blood or OPIM need not be labeled if placed in a
labeled container for storage, transport, shipment
or disposal [1910.1030(g)(1)(i)(G)].
|
|
Bloodborne
Illnesses - Hepatitis B Virus
Hepatitis is
an inflammation of the liver that can lead to liver damage and/or
death. The CDC estimates 800 health care workers became
infected with HBV in 1995. This figure represents a 95% decline in new
infections from the 1983 figures. The decline is largely due to
the immunization of workers with the Hepatitis B vaccine, and
compliance with other provisions of OSHA's Bloodborne
Pathogens Standard.
|
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% (CDC 1997).
- 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.
Example Controls
- Prevent the exposure in
the first place by implementing an effective Exposure
Control Plan as required by the Bloodborne Pathogens
Standard [1910.1030(c)(1)].
- Employers must offer to
all employees who have occupational exposure to blood or OPIM,
under the supervision
of a licensed physician the hepatitis b vaccination [1910.1030(f)(2)]:
- Health care workers who
have ongoing contact with patients or blood and are at ongoing
risk for injuries with sharp instruments or needlesticks must
be offered testing for antibody to hepatitis B surface antigen
one to two months after the completion of the three-does
vaccination series.
- Employees who do
not respond to the primary vaccination series must be
offered a second three dose vaccine series and retesting.
Non-responders must be offered medical evaluation
[1910.1030(f)(1)(ii)(D)].
- Following a report of
an exposure incident the employer shall make immediately
available to the exposed employee a confidential medical
evaluation and follow-up [1910.1030(f)(3)].
- If a worker is exposed to
HBV, timely post-exposure follow-up with hepatitis b immune
globulin and initiation of hepatitis b vaccine which must be
offered [1910.1030(f)(1)(ii)(D)],
are more than
90% effective in preventing HBV infection.
- A health care
professional's written opinion is required after an exposure
incident [1910.1030(f)(5)].
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.
|
Hazard
Exposure to
potentially fatal bloodborne illnesses such as HIV.
- Risk of HIV
infection after needlestick is 1 in 3000 or 0.3%.
- The CDC documented
55 cases and 136 possible cases of occupational HIV
transmission to U.S. health care workers between 1985 and
1999.
Example
Controls
- Prevent the exposure in
the first place by implementing an effective Exposure
Control Plan as required by the Bloodborne Pathogens
Standard [1910.1030(c)(1)].
- Under certain
circumstances post-exposure prophylaxis for HIV must be
provided to health care workers who have an exposure
incident, as defined in 1910.1030(b).
- Limited data
suggests that such prophylaxis may considerably reduce
the chance of becoming infected with HIV. However, the
drugs used for prophylaxis have many adverse side
effects.
- No vaccine
currently exists to prevent HIV infection, and no
treatment exists to cure it.
- Employees who have
an incident must be offered a confidential medical evaluation
and follow-up [1910.1030(f)(3)].
- A health care
professional's written opinion is required after an exposure
incident [1910.1030(f)(5)(ii)].
Additional
Information
|
Bloodborne
Illnesses - Hepatitis C Virus (HCV)
HCV infection is the most common chronic bloodborne infection
in the United States, affecting approximately 4 million
people. Hepatitis C infection is caused most commonly by
needlestick injuries. HCV infection often occurs with no
symptoms, but chronic infection develops in 75% to 85% of
patients, with 70% developing active liver disease (CDC 1998).
|
Hazard
Exposure to
potentially fatal bloodborne illnesses such as Hepatitis C
Virus (HCV), which is:
- A major cause of
chronic liver disease.
- The leading reason
for liver transplants in the United States in 1997 (CDC).
Example
Controls
- Prevent the exposure in
the first place by implementing an effective Exposure
Control Plan as required by the Bloodborne Pathogens
Standard [1910.1030(c)(1)].
- Employees who have
an exposure incident shall be offered a confidential
medical evaluation and follow-up [1910.1030(f)(3)].
- A health care
professional's written opinion is required after an exposure
incident [1910.1030(f)(5)].
- No vaccine is
available for hepatitis C. Immunoglobulin or antiviral
therapy is not recommended and no effective post-exposure
prophylaxis is known at this time (CDC 1998).
Additional
Information
|
|