Bloodborne Pathogens

OSHA-compliant Online Course

Bloodborne Pathogens are microorganisms (such as viruses) that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV).

How Are Bloodborne Pathogens and Infections Spread?

The Chain of Infection

For disease to be spread, it requires that all of the following conditions be present:

• An adequate number of pathogens, or disease-causing organisms.
• A reservoir or source that allows the pathogen to survive and multiply (e.g., blood).
• A mode of transmission from the source to the host
• An entrance through which the pathogen may enter the host.
•  A susceptible host (i.e., one who is not immune).
   

Effective infection control strategies prevent disease transmission by interrupting one or more links in the chain of infection.

Modes of Transmission

• Direct contact occurs when microorganisms are transferred from one infected person directly to another person. For example, infected blood from one person enters a care giver’s body through an open cut.
   
• Indirect contact involves the transfer of an infectious agent through a contaminated object or person. For example, a caregiver doesn’t wash hands in between caring for someone with infected body fluids and other patients. For Example, Parenteral contact with a needle stick.
   
• Airborne transmission occurs when droplets or small particles contain infectious agents that remain effective over time and distance in the air. Tuberculosis is a common disease spread this way. Bloodborne pathogens are not typically spread this way.

How Are Bloodborne Pathogens Spread?

Bodily fluids, especially those visibly contaminated with blood, have the potential to transmit disease.

Sexual contact is the primary mode of transmission for Bloodborne Pathogens, however the risk of exposure does exist while providing medical or first aid care.
 

When a contaminated sharp object cuts or punctures the skin. (Parenteral examples: needle stick, illegal drug usage, cut from broken glass, bite).

When an infected body fluid gets into an open cut or mucous membrane (inside eyes, mouth, ears or nose).
 

When a contaminated object touches inflamed skin, acne, or skin abrasion.

HIV and AIDS

HIV attacks your body’s ability to protect itself against disease and it causes AIDS.

Approximately 1.1 million people in the US are living with HIV/AIDS. Approximately 50,000 people become infected with HIV each year. About 14,000 people every year in the USA die from AIDS.
 

Symptoms may or may not be present. You may be infected for years and not know it. Only a blood test can determine the infection, not symptoms:

• Fever
• Fatigue
• Weight loss
• Rash

The HIV virus is fragile and dies within seconds outside the body. The amount of HIV present in the body fluid and the conditions will determine how long the virus lives.
 

HIV is primarily spread by sexual contact with an infected person or by sharing needles and/or syringes (primarily for drug injection). Babies may become infected before/during birth or through breast-feeding. Only a fraction of less than 1% of the people contract the virus from providing medical care.
 

HIV it is not spread by casual contact like handshakes, sharing food, doorknobs, sneezing, toilet seats, swimming pools, etc.

There is no vaccination.

Hepatitis B

Hepatitis B virus reproduces in the liver causing inflammation and possibly cirrhosis or liver cancer. HBV affects over 1.25 million people in the US. About 70,000 people/year become infected with HBV. Each year, about 5,000 people die as a result of liver disease caused by HBV. Infections have decreased since 1982 because of the HBV vaccine.

Symptoms may or may not be present. The older, the more apt to have symptoms. Only a blood test can determine the infection. Symptoms may include:

• yellow skin (jaundice)
• yellowing eyes
• tiredness
• loss of appetite, nausea
• dark urine
• clay-colored bowel movements
• joint pain
• abdominal discomfort

Hepatitis B
 

Up to 100 times easier to catch than HIV. HBV can live outside of body for at least 7 days and longer.

90% adults who contract hepatitis B clear the virus from their systems within a few months and develop immunity. About 10% become chronic — the virus stays in the blood, infecting liver cells damaging them over time.

HBV is primarily spread by sexual contact with an infected person, sharing needles and/or syringes (primarily for drug injection), from an infected mother to her baby during birth, or sharps exposures on the job.

However, still like HIV it is not spread by casual contact like handshakes, sharing food, doorknobs, sneezing, toilet seats, swimming pools, etc.

Hepatitis B Vaccine

There is a vaccine available given in 3 doses over a period of 6 months. It is safe and effective.
 

Booster doses of hepatitis B vaccine are not recommended. Immune memory remains indefinitely following immunization.
 

The HBV vaccine must be offered free to employees who face occupational exposure to bloodborne pathogens.

Sample HBV Vaccine Declination Statement
 

I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me.

Hepatitis C

HCV reproduces in the liver causing inflammation and possibly cirrhosis or liver cancer. Disease can incubate for decades.
 

4.1 million carriers in the USA. About 26,000 new cases each year. Deaths from chronic disease each year: 8,000-10,000.
 

About 80% of exposed people develop a chronic infection. 20% are able to clear the virus by naturally building immunity.
 

Symptoms are not a reliable way to detect HCV. A blood test is needed. Symptoms may look the same as HBV.

Hepatitis C

Unlike HIV or HBV, HCV is spread primarily through parenteral contact:

• Illegal injection drug use
• Transfusion or transplant from infected donor
• Tattoos

Occupational exposure to blood mostly through needle sticks

It is also spread through:

• Birth to HCV-infected mother
• Multiple sex partners

There is no cure or vaccination.

Standard Precautions

Treat all body fluids from every person as potentially infectious.

Follow the recommendations in the employer’s Bloodborne Pathogens Exposure Control Plan.

An employer’s Bloodborne Pathogens Exposure Control Plan should include:
 

• Various levels of risk of employees that may have occupational exposure
• Training requirements
• Work practice controls
• Engineering controls
• Procedure for an exposure incident

Use Personal Protective Equipment (PPE)
 

PPE should be provided by your employer. It includes gloves, CPR shields, masks, gowns, and eye protection.

Know where PPE is at your workplace.

Know what PPE is available and how to use it.

Make sure first-aid kits and emergency supplies include disposable gloves and CPR face shields or rescue masks.

Do not eat, drink, smoke, apply cosmetics or handle contact lenses in areas where there is the possibility of exposure to BBP.

Use Personal Protective Equipment (PPE)
 

When emptying trash containers, do not use your hands to compress the trash in the bag. 

Lift and carry the trash bag away from your body.

Follow your facility’s procedures for handling laundry General Laundry procedures:

• Wear PPE
• Keep contaminated laundry separate from other laundry
• Bag potentially contaminated laundry where it is used
• Use leak-proof bags for wet laundry
• Transport in properly labeled bags

Use Personal Protective Equipment (PPE)
 

The Needlestick Safety and Prevention Act requires appropriate, commercially available, and effective safer medical devices designed to eliminate or minimize occupational exposure.
 

Needles and other sharps must be discarded in rigid, leak-proof, puncture resistance containers.

Do not bend, shear, break or recap needles. If you must recap, use one-handed method.

Hazardous Disposal

• Liquid or semi-liquid blood or other potentially infectious materials (OPIM)
• Contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed
• Dispose of in a properly labeled biohazard container: either a red bag or container labeled in orange or orange-red with the Bio-Hazard symbol.
• Properly labeled and bundled waste needs to be handled according to your facility’s disposal procedures.

Cleanup Procedures

• Use a solution of 1 part household bleach mixed with 9 parts water (a 1:10 solution).
• Other commercial disinfectants registered with the EPA as effective against HIV/HBV may be used. Check the label.
• Use Personal Protective Equipment.
• If a Body Fluid Spill Kit is available, use according to manufacture’s directions
• First, put on Personal Protective Equipment
• Remove visible material with absorbent towels
• If any sharp object or broken glass is visible, remove with tongs or dust pan and place in a ridged sealable container. Never use bare hands.
• Spray disinfectant on contaminated area and let stand for several minutes
• Once the area has been disinfected, dry area with absorbent towels and dispose of towels in regular trash

Glove Removal

• Grip one glove near the cuff and peel it down until it comes off inside out. Cup it in the palm of your gloved hand.
• Place two fingers of your bare hand inside the cuff of the remaining glove.
• Peel that glove down so that it also comes off inside out and over the first glove.
• Properly dispose of the gloves.
• Remember, only touch glove to glove and skin to skin.

Wash Your Hands

• Wet your hands and apply liquid, bar, or powder soap.
• Rub hands together vigorously to make a lather and scrub all surfaces.
• Continue for 20-30 seconds! It takes that long for the soap and scrubbing action to dislodge and remove stubborn germs. Need a timer? Imagine singing “Happy Birthday” all the way through– twice!
• Rinse hands well under running water.
• Dry your hands using a paper towel or air dryer.
• If possible, use your paper towel to turn off the faucet

An exposure incident is defined as a specific mucous membrane, broken skin, or puncture contact with blood or OPIM that results from the performance of an employee’s duties.
 

If you think you’ve been exposed, decontaminate, report to supervisor, and seek medical treatment. An immediate confidential medical evaluation and follow-up needs to be conducted by a physician.
 

Complete forms as soon as possible after incident. Don’t delay medical treatment to fill out paperwork. Forms and continued action will proceed according to employer’s policies and procedures.

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