This article covers exposure, training, control measures, and more.
The Occupational Safety and Health Administration’s (OSHA's) bloodborne pathogens standard, 29 Code of Federal Regulations (CFR) 1910.1030 applies to all persons who may reasonably anticipate contact with blood or other potentially infectious materials (OPIMs) in the course of their employment. Within the standard, OPIMs are defined as, “semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids.” Potential routes of entry includes contact with skin, eyes, mucous membranes or contact from piercing the skin. The focus of the regulation is the creation of a written exposure control plan that describes how the employer will protect employees from exposure. The following outlines the components that must be included in an exposure control plan. (29 CFR 1910.1030(c))
An exposure determination is a listing of all job classifications in which employees will be exposed (e.g., doctors and nurses) or may occasionally be exposed, such as custodians and laundry workers, to potentially infectious materials on the job. Any specific procedures or tasks in which exposure occurs must also be listed. (29 CFR 1910.1030(c)(2))
Employee Education and Training
Employees must receive annual training to be sure they understand the hazards associated with bloodborne pathogens. Training include the following:
- An accessible copy of the regulatory text of this standard and an explanation of its contents;
- A general explanation of the epidemiology and symptoms of bloodborne diseases;
- An explanation of the modes of transmission of bloodborne pathogens;
- An explanation of the employer's exposure control plan and the means by which the employee can obtain a copy of the written plan;
- An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials;
- An explanation of the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls, work practices, and personal protective equipment;
- Information on the types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment;
- An explanation of the basis for selection of personal protective equipment;
- Information on the hepatitis B (HBV) vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine and vaccination will be offered free of charge;
- Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials;
- 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;
- Information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident;
- An explanation of the signs and labels and/or color coding required by paragraph (g)(1); and
In addition, there must be an opportunity for interactive questions and answers with the person conducting the training session (29 CFR 1910.1030(g)(2)).
OSHA Three Lines of Defense
OSHA recognizes the “Three Lines of Defense” as a way of thinking about and applying specific actions to reduce or eliminate potential exposures to identified hazards. This is a commonly used and understood practice within the safety community. In this philosophy you always apply the most effective method first, working down from there. This begins with eliminating/engineering the hazards out, then implement administrative controls such as policies and procedures. And lastly, if the first two lines of defense are not feasible, it incorporates the use of PPE. Preventing exposure to bloodborne pathogens is a critical step in eliminating the health hazard.
As introduced above, before turning to PPE the employer must take appropriate preventative measures to prevent occupational exposure to blood or OPIM. Engineering controls include biohazard fume hoods, puncture-resistant sharps containers, biohazard waste containers, mechanical pipette devices and others to permanently remove the hazard or help isolate the worker from exposure. These also include needleless devices, needles with sheaths and blunt suture needles. As new devices become available due to updated technologies, they should be incorporated as engineering controls. Work practice controls include hand-washing policies, sharps handling procedures, proper waste disposal techniques and more to reduce the likelihood of exposure through the alteration of the manner in which the task is performed. (29 CFR 1910.1030(d)(2))
Employers must provide PPE to employees with potential occupational exposure to eliminate or minimize the risk of infectious material entering their bodies. PPE is considered to be appropriate only if it does not permit blood or OPIMs to pass through or reach the employees' outer clothing, undergarments, skin, eyes, mouth or other mucous membranes under normal conditions of use. Following is a list of PPE and when it should be used.
- Gloves: Wear whenever hand contact with blood or OPIMs is possible. Disposable (single-use) gloves, such as examination gloves, must be replaced as soon as possible when contaminated or when their ability to function as a barrier is compromised. They are not to be reused. (29 CFR 1910.1030(d)(3)(ix)(A)) Utility gloves can be reused if decontaminated, but must be discarded if cracked, discolored, punctured or showing any signs of deterioration. (29 CFR 1910.1030(d)(3)(ix)(c))
- Masks, eye protection and face shields: Use in combination whenever splashes, spray or droplets of potentially infectious materials are generated. (29 CFR 1910.1030(d)(3)(x))
- Gowns, aprons and other protective clothing: Wear when exposure to the body, head, feet, or clothing is possible. The type and characteristics of the covering will depend on the task and the exposure anticipated. (29 CFR 1910.1030(d)(3)(ix))
- CPR masks: Use when CPR is given. Masks or face shields should have a one-way valve to prevent contamination from the victim. (29 CFR 1910.1030(d)(3)(i))
Once employees receive training, HBV vaccinations should be made available to those who run the risk of exposure. (29 CFR 1910.1030(f)(2))
Post-Exposure Evaluation and Follow-Up
Employers must provide a confidential medical evaluation for any employees involved in an exposure incident. The purpose of this evaluation is to document the exposure route and circumstances surrounding the incident, blood testing, Human Immunodeficiency Virus (HIV)/HBV status of source and appropriate medical and psychological treatment. (29 CFR 1910.1030(f)(3))
All forms of blood or OPIMs, contaminated items that could release infectious materials or contaminated sharps must be placed in appropriate sharps containers or closable, color-coded or properly labeled leak-proof biohazard waste containers or bags. OPIM waste must be disposed of in accordance with federal, state and local regulations. (29 CFR 1910.1030(d)(4)(iii))
Tags, Labels and Bags
Warning labels must be attached to all containers used for the storage or transport of potentially infectious materials. The labels must be orange or red-orange with the biohazard symbol in a contrasting color. Red containers or bags can be substituted for warning labels. (29 CFR 1910.1030(g))
Housekeeping and Laundry Practices
Employers must create a schedule for periodic cleaning and appropriate disinfecting to ensure that the worksite is kept clean and sanitary. Contaminated laundry must be placed and transported in properly labeled or color-coded bags and containers. (29 CFR 1910.1030(d)(4)), (29 CFR 1910.1030(d)(4)(iv))
The employer must maintain medical and training records for each employee who faces the possibility of being exposed or who has been occupationally exposed to a bloodborne pathogen (29 CFR 1910.1030(h)). Employers are also required to establish and maintain a sharps injury log.
Commonly Asked Questions
||What are sharps disposal containers?
||A sharps container is a place to deposit sharp instruments (e.g., needles or medical cutting tools) for disposal. These containers are puncture-resistant, leak-proof on the sides and bottom, closable and properly labeled or color-coded. They assure a higher level of safety than disposal bags.
||Can biohazard bags or containers be both labeled and color-coded?
||Yes. OSHA's bloodborne pathogens standard states that containers must be either properly labeled or color-coded. Having both simply exceeds the intent of the regulation.
29 CFR 1910.1030
Centers for Disease Control and Prevention (CDC) Bloodborne Infectious Disease Page