OSHA

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OSHA

• Occupational Safety and Health Administration

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OSHA

• Establishes and enforces standards that protect
  workers from job-related illness and injuries.

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OSHA STANDARDS

• The Occupational Exposure to Hazardous Chemicals
  Standard
• The Blood borne Pathogen Standard

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The Occupational Exposure to Hazardous Chemicals
Standards

• Requires the employers to inform employees of all
  chemicals and hazards in the workplace
• Must provide the MSDSs (Material Safety Data
  Sheets)

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MSDSs provide

• Product identification information about the
  chemical
• Protection or precautions that should be used
  while handling the chemical
• Instructions for safe use of the chemical
• Procedures for handling spills, clean-up, and
  disposal
• Emergency first-aid procedures

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Mandated training for MSDSsproper procedure and
policies

• Identifying the types of chemicals
• Locating and using the MSDS manual
• Reading and interpreting chemical labels and
  signs
• Locating cleaning equipment and use of PPE
  (personal protective equipment) goggles, mask,
  gowns
• Reporting accidents and exposures

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BLOODBORNE PATHOGEN STANDARD

• Protects health care providers from diseases
  caused by exposure to body fluids (i.e.. stool,
  urine, semen, salvia, mucus)

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Bloodborne Pathogens

• Pathogenic micro-organisms present in human
  blood that can lead to diseases
• Human immuno-deficiency virus (HIV)
• Hepatitis B (HBV)
• Hepatitis C (HCV)

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Other Bloodborne Pathogens

• Syphilis
• Malaria
• Brucellosis
• Babesiosis
• Leptospirosis
• Arborviral Infections
• Relapsing Fever
• Creutzfeld-Jacobs Disease--Mad-cow
• Viral Hemorrhagic Fever--Ebola

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Potentially Infectious Materials All Can
Transmit Hepatitis B, C, and HIV

• Blood
• Semen
• Vaginal secretions
• Cerebrospinal fluid
• Pleural fluid
• Pericardial fluid
• Peritoneal fluid
• Amniotic fluid
• Saliva in dental proc.

• Any visibly contaminated body fluid
• Any body fluid where differentiation is difficult
• Any unfixed tissue or organ
• Aqueous and vitreous humors in the eyes

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Other Body Fluids

• These body fluids do NOT have enough virus in
  them to transmit disease UNLESS they are
  contaminated with blood
• Urine
• Feces
• Tears
• Sweat
• Vomitus
• Spit

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Modes of Transmission

• Stick or Cut
• Splash to mucous membranes of the eyes, nose,
  mouth
• Non-intact skin exposure

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Universal Precautions

• Must be observed
• All blood and body fluids are treated as if known
  to be infected with HIV, HBV, HCV, etc.
• Do not come into contact with another person's
  blood or body fluids

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Exposure Control Plan

• Employer's plan describing how compliance with
  the standard is achieved
• Describes what employees are covered
• Describes tasks that are covered
• Describes post-exposure follow-up procedures
• Must be reviewed and updated annually
• Must be accessible to employees
• Every employee should know the procedure to
  follow to obtain a copy

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Exposure Control Plan

• Safer Medical Devices
• The Exposure Control Plan must be updated every
  12 months to reflect evaluation, consideration,
  and selection of appropriate devices
• Document in the plan the devises evaluated and
  those currently used
• Front line employees must be involved in the
  selection of devices

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Handwashing

• The single most important aspect of infection
  control
• Wash hands when contaminated with blood or body
  fluids and after removing personal protective
  equipment
• Use antiseptic hand cleaner clean paper/cloth
  towels or antiseptic towelettes when "in the
  field"
• Wash hands with soap and water asap

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Needles/Sharp Objects

• Use sharps with sharps injury prevention or
  needleless systems for all procedures involving
  sharps
• Place in puncture resistant, labeled, leak-proof
  containers for transport, storage, and/or
  disposal
• Keep the container closed
• Do not bend, break, recap, or remove needles
• Do not pick up contaminated broken glass directly
  with the hands
• Do not reach by hand into containers where
  contaminated sharps are placed
• Do not overall sharps containers

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Eating/Drinking

• Do not eat or drink in areas where there is
  exposure to blood or body fluids
• Do not store food in refrigerators, freezers,
  cabinets, on shelves or countertops where blood
  or other body fluids are present

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Personal Protective Equipment (PPE)

• Wear PPE to prevent blood or body fluids from
  getting on your clothes, skin, underclothes, etc.
• Must be provided at no cost to the employee
• Employer must enforce the use
• Must be removed prior to leaving the work area
  and placed in designated area

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PPE

• Parental exposure
• stick or cut
• Mucous membrane
• splash
• Non-intact skin
• spill or splash

• gloves
• gowns
• glasses/ goggles
• masks
• pocket masks
• shoe covers

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Decontamination

• Clean and decontaminate all equipment and
  environmental and working surfaces after contact
  with blood and/or body fluids
• Decontaminate with appropriate disinfectant
• EPA registered tuberculocidal disinfectant
• EPA registered disinfectant with label stating it
  is effective against HIV and HBV
• Household bleach, diluted 110-1100, made fresh
  daily

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Contaminated Laundry

• Remove contaminated clothing when it becomes
  contaminated
• Place immediately in bag or container that is
  labeled
• Prevent leakage

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Regulated Waste

• Sharps containers
• Needles
• Blades
• Broken glass
• Red bags
• Liquid or semi-liquid blood or OPIM
• Items caked with dried blood or OPIM
• Items that could release blood or OPIM
• Pathological waste
• Microbiological waste

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HEPATITIS

• Hepatitis A HAV most common transmitted by feces,
  salvia, and contaminated food. Vaccine available
• Hepatitis B serum hepatitis is caused by HBV
  and is transmitted by blood, serum, and other
  body secretions. It affects the liver and cause
  scarring and destruction of liver cells.
  Infectious for life and vaccination available.
  Can cause liver cancer. Some people never have
  any sign and symptoms but are infectious.

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• Hepatitis C caused by hepatitis C virus or HCV
  and is transmitted in blood and blood containing
  body fluids. 50 of people infected develop
  chronic hepatitis. Maybe present for years before
  patient is aware of it while destroying the
  liver. Leading cause for liver transplant.
• Hepatitis D is like A but not prevalent in this
  country

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Signs and Symptoms

• May mimic the flu
• Fatigue
• Malaise
• Headache
• Sore throat
• Sensitivity to light
• Cough
• Nausea
• Vomiting
• Jaundice stage dark color urine, clay colored
  stool, and skin is yellow

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PREVENTION FOR HEALTHCARE WORKERS

• Vaccination for A and B
• Use standard precautions
• Pay close attention to sharps
• Do not use illegal drugs
• Practice safe sex

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Hepatitis B Vaccination

• the HBV vaccination must be offered after the
  employee has received training and within 10
  working days of job assignment
• At no cost
• Provided by PLHCP
• According to US Public Health Service most
  current recommendations
• Immunization of Health Care Workers
  Recommendations of ACIP and HICPAC, MMWR, Vol.
  46, No. RR-18

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HBV Vaccination

• Employees who do not take the shots must sign a
  declination statement
• Highly recommended
• Few contraindications
• Three-shot seriestiter 1-2 months after last
  shot
• No booster currently recommended
• Each person must have a health care
  professional's written opinion
• A copy must be provided to the employee within 15
  days of completion of the evaluation
• An employee can decline now, take the shots later

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Written Opinion

• Each person must have a health care
  professional's written opinion for hepatitis B
  vaccination
• A copy must be provided to the employee within 15
  days of completion of the evaluation

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AIDS

• Acquired immunodeficiency syndrome is a worldwide
  epidemic caused by human immunodeficiency virus
  (HIV). Must have an HIV blood test performed to
  know if HIV positive.
• Attacks the immune system
• Spread thru sexual secretions, blood, or from
  mother to fetus during pregnancy, sharing
  intravenous needles.
• CANNOT GET thru casual contact, sharing toilet,
  telephones, closed mouth kissing, mosquitoes, or
  tattooing.
• Not everyone who comes in contact with will
  become infected.

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Disease progression

• Determined by the effect of the virus on the
  protective white cells known as CD4 (T cells).
• When number drops below 200cells/mm3 person
  diagnosed with AIDS
• Symptoms acute flulike, fever, night sweats,
  fatigue, swollen lymph nodes, sore throat

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Post-Exposure Follow-up

• After exposure incident
• Stick or cut
• Splash
• Non-intact skin exposure
• At no cost
• Begin ASAP after exposure incident
• Report exposure incident to your supervisor or
  designated personnel immediately

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Post-Exposure Follow-up

• Investigation of the incident
• ID source individual, obtain consent, and test
  their blood to determine HBV, HCV, and HIV
  infectivity ASAP
• Results of source individual's test given to
  exposed person
• Obtain and test exposed person's blood for HBV,
  HCV, and HIV serological status

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Labels

• Containers with contaminated items
• Can substitute red

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Training

• For all employees listed in the Exposure
  Determination
• At no cost to employees
• During working hours
• At the time of initial assignment
• Annually--within 1 year of last training date
• Must be opportunity for interactive questions and
  answers
• Train employees on adopted safer needle devices
  before implementation

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Training

• Five Easy Questions
• What is universal precautions?
• What do you do when there is a blood spill?
• Personal protection
• Clean-up and disposal procedures
• Disinfection (hazard communication applies)
• What do you do with contaminated sharps and
  laundry?
• Have you been offered the HBV vaccination free of
  charge?
• Where is the Exposure Control Plan?

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Additional Training

• Copy of the BBP standard, 29 CFR 1910.1030, must
  be accessible to you
• Explanation of methods of recognizing tasks that
  may involve exposure to blood and/or body fluids
• Information on types, use, location, removal,
  handling, decontamination, and disposal of ppe
• Basis of selection of ppe
• Actions to take and persons to contact in a
  bloodborne emergency that you do not know how to
  handle
• Procedure to follow if exposure incident occurs
• Opportunity for interactive Q A

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Records

• Medical records
• Name and social security number
• HBV vaccination status
• Results of exposure incident follow-up
• Health care professional's written opinions
• Info provided to health care professional
• Confidential

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Records

• Training
• Dates
• Contents
• Names and qualifications of trainers
• Names and titles of persons attending

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Records

• Sharps Injury Log
• Per the Tennessee Sharps Injury Prevention law
• Keep a log of all sharps injuries with
• Type and brand of device involved in the incident
• Department or work area where the incident
  occurred
• Explanation of how the incident occurred

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Resources

• www.osha.gov www.tennessee.gov/labor-wfd/tosha
• www.cdc.gov
• www.cdc.gov/niosh
• Memphis Office 901-543-7259
• Jackson Office 701-423-5641
• Nashville Office 615-741-2793
• 1-800-249-8510
• Knoxville Office 865-594-6180
• Kingsport Office 423-224-2042
• Chattanooga 423-634-6424
• Consultative Services 1-800-325-9901