Introduction

In response to the threat created by occupational exposure to bloodborne pathogens, (Hepatitis B and HIV), OSHA created the Bloodborne Pathogens Standard which was made effective in 1992.

OSHA is the Occupational Safety and Health Administration, which was created to assure that employees are protected from hazards likely to cause death or serious physical harm.

In workplaces where there is a risk of exposure to bloodborne diseases such as health care workers, the employer has the responsibility of reducing or eliminating the risk of transmission of Hepatitis or HIV. These responsibilities are:

• Adherence to universal and standard precautions - which means treating all blood and bodily fluids as potentially infectious or contaminated.
• Determining which positions carry the risk of exposure to Hepatitis or HIV.
• Developing an Exposure Plan and updating it.
• Educational and training programs for those employees at risk for exposure.
• Using appropriate protective equipment and clothing.

Hazards of Bloodborne Pathogens

Bloodborne pathogens are microorganisms in human blood that can cause disease in humans. They include the Hepatitis B virus (HBV) and the human immunodeficiency virus (HIV), which causes AIDS.

Occupational transmission of HIV is relatively rare, but the lethal nature of HIV requires that we take every possible measure to prevent exposure. HBV on the other hand is more easily transmitted and is potentially life threatening. In addition to acute disease, persons infected with HBV are at risk for chronic HBV infection and severe morbidity and mortality from cirrhosis and hepatocellular carcinoma.

Approximately 8,700 health care workers each year contract Hepatitis B, and about 200 will die as a result. In addition, some who contract HBV will become carriers, passing the disease on to others. Carriers also face a significantly higher risk for other liver ailments, which can be fatal, including cirrhosis of the liver and primary liver cancer.

HBV infection is transmitted through exposure to blood and other infectious body fluids and tissues. Anyone with occupational exposure to blood is at risk of contracting the infection.

Employers must provide engineering controls; workers must use work practices and protective clothing and equipment to prevent exposure to potentially infectious materials. However, the best defense against Hepatitis B is vaccination.

Hepatitis B (CDC Data)

*Actual acute cases estimated to be 6.5 times the number of reported cases in any year

Before 1982, an estimated 200,000--300,000 persons in the United States were infected annually with HBV, including approximately 20,000 children. Since 1982, substantial progress has been made toward eliminating HBV transmission in children and reducing the risk for HBV infection in adults. During 1982--2002, an estimated 40 million infants and children and 30 million adults received hepatitis B vaccine. To eliminate HBV transmission, high vaccine-coverage rates must be sustained among infants, children, and adolescents, and programs to vaccinate adults at high risk for HBV infection must be expanded

Hepatitis B Vaccinations For Healthcare Workers

Anyone who may be exposed to blood or other potentially infectious materials as part of their job duties. A three-injection series is recommended. The vaccination must be offered within 10 days of initial assignment to a job where exposure to blood can be reasonably anticipated. Your employer is obligated to pay for the vaccination. If you want the vaccination from American Home Health, just tell our HR department or your nursing supervisor. We will set it up with a provider near your location. The vaccination involves three injections in the arm (with a non-infectious, yeast-based vaccine prepared from recombinant yeast cultures, rather than human blood or plasma. Since this preparation is not of human blood or plasma, there is no risk of contamination from other bloodborne pathogens nor is there any chance of developing Hepatitis B from vaccine.) The second injection is given one month after the first, and the third injection is given six months from the date of the initial dose. More than 90 percent of those vaccinated will develop immunity to the Hepatitis B virus. To ensure immunity, it is important for individuals to receive all three injections. At this point, it is unclear how long the immunity lasts. The CDC states that between 30% and 50% of persons who develop adequate antibody after three doses of vaccine will lose detectable antibody within seven years; however, immunity seems to be dependent upon the individual’s own immune system. For persons at occupational risk of needle stick injuries, it is recommended that a titer level be drawn every 3-5 years to verify immunity.

Standard Precautions: This is the name for the recommended policy for health care workers regarding blood and bodily fluids of all patients as potential sources of disease.

ASSUME THAT ALL BLOOD AND BODILY FLUIDS ARE INFECTED!!!

The general rule is to wear gloves and other barriers to reduce the risk of exposures. Specific precautions are to be taken with soiled linen, trash and used sharps.

Engineering and Workplace Controls: Engineering controls are methods that isolate or remove hazards from the workplace. Some examples are:

• Performing Hand Hygiene immediately after removal of gloves.
• Removing personal protective equipment and clothing contaminated with blood or other potentially infectious material as soon as possible prior to leaving the treatment area and placing the article in the appropriate designated area for decontamination and disposal.
• Contaminated needles must not be sheared or broken.
• Contaminated needles must not be bent or recapped (recapping may be done using the one-handed scoop method)
• Contaminated reusable sharps must be placed in appropriately labeled leak proof container.
• Employees are prohibited from eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses in work areas.
• Employees are required to perform all procedures involving blood with other infectious or potentially infectious materials in such a way as to minimize splashing, spraying, spattering, and generating droplets of blood.

Personal Protective Equipment and Clothing (PPE)

In addition to engineering controls, employees must use appropriate personal protective equipment and clothing. The employer is required to provide necessary equipment and clothing when there is a significant probability for exposure to blood.

Specific Requirements:

• Gloves must be worn when the employee has the potential to have hand contact with any body fluids.
• Gloves must not be washed or reused.
• Eye and face protection - you must wear masks in combination with eye protection devices, such as goggles or glasses with side shields or chin length face shields whenever splashes or sprays may be generated.
• Gowns and other protective clothing must be worn in exposure situations. The type of procedure determines the type of clothing to be worn. The clothing must form an effective barrier such as gowns, lab coats, clinic jackets or similar outer garments.

When an Exposure Occurs:

For the purpose of post exposure management of a blood exposure, employers must provide Hepatitis immunization and periodic HBV and HIV testing at the discretion of the affected employee. The following steps 1-4 are in order of the recommendations of the CDC.

• Wash needle sticks and cuts with soap and water
  Flush splashes to the nose, mouth, or skin with water
  Irrigate eyes with clean water, saline, or sterile irrigants
• Seek Medical Attention.
• By reporting the exposure to your supervisor, the office will assist you with getting medical attention and consultation.
  • Complete an incident report.
  • The attending physician will counsel you about what happened and how to prevent further spread of any potential infection

YOU MUST REPORT AN EXPOSURE INCIDENT AND RECEIVE MEDICAL TREATMENT. IMMEDIATE INTERVENTION CAN FORESTALL THE DEVELOPMENT OF HEPATITIS B OR ENABLE YOU TO TRACK POTENTIAL HIV INFECTION. IMMEDIATE ACTION IS CRUCIAL!!!

In Summary Complying with the procedures concerning blood borne pathogens is tantamount to reducing your risk of exposure and maintaining a safe environment for you, your peers and your clients.

The specific responsibilities of the employee include:

• Observing standard precautions (see policy on this procedure)
• Identifying areas where you are at risk.
• Using appropriate housekeeping and infection control measures.
• Reporting exposures.
• Informing the American Home Health office of potential hazards.

Resources: Policy #11.006 Standard Precautions