Q&A ON OSHAS
BLOODBORNE PATHOGENS STANDARD
WHO IS COVERED UNDER OSHAS BLOODBORNE PATHOGENS
- Anyone exposed to human blood, blood by-products, or other
potentially infectious materials during their job duties. (See the following
question for definitions.)
- Anyone whose job requires them to provide 1st Aid or CPR or use an AED.
(e.g., Student Health and Campus Recreation staff, Department of Public Safety, Health Sciences Faculty)
- Anyone whose job requires them to drive an injured employee
or student to the hospital. (e.g., Department of Public Safety)
- Anyone handling biohazardous or infectious waste. (e.g.,
Faculty, Laboratory Personnel, Student Workers, Environmental Health and Radiation Safety (EHRS)
- Anyone cleaning up spills of blood, blood by-products, or
other potentially infectious material. (e.g., Facilities Services Personnel,
Faculty, Laboratory Personnel, EHRS)
WHAT ARE THE DEFINITIONS OF BLOOD, BLOODBORNE PATHOGENS
AND "OTHER POTENTIALLY INFECTIOUS MATERIALS (OPIM)"?
"Blood" means human blood, human
blood components and products made from human blood. The term "human
blood components" includes plasma, platelets, and serosanguinous fluids
(e.g., exudates from wounds). Also included are medications derived
from blood, such as immune globulins, albumin, and factors 8 and 9.
"Bloodborne Pathogens" means
pathogenic microorganisms that are present in human blood and can cause
disease in humans. While Hepatitis B Virus (HBV) and Human Immunodeficiency
Virus (HIV) are specifically identified in the standard, the term includes
any pathogenic microorganism that is present in human blood or OPIM (other potentially infectious materials) and
can infect and cause disease in persons who are exposed to blood containing
the pathogen. Pathogenic microorganisms can also cause diseases such
as hepatitis C, malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, Creutzfeldt-Jakob disease, adult
T-cell leukemia/lymphoma (caused by HTLV-I), HTLV-I associated myelopathy,
diseases associated with HTLV-II, and viral hemorrhagic fever.
"Other Potentially Infectious Materials"
include: 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, all body fluids in situations where it is difficult or impossible
to differentiate between body fluids.
Any unfixed tissue
or organ (other than intact skin) from a living or dead human being.
or tissue cultures, organ cultures, and HIV- or HBV - containing culture media or other solutions; and blood,
organs, or other tissues from experimental animals infected with HIV or HBV.
WHERE IS OUR EXPOSURE CONTROL PLAN LOCATED?
- EHRS Department: McNeil Science & Technology Center, Room #223
- EHRS Department: Griffith Hall Stockroom, Griffith Building, Room B1
- EHRS Department: McNeil Science and Technology Center, room #112
- EHRS Web Page: http://www.usciences.edu/safety/bmanual/index.htm (The on-line Exposure Control Plan is the most up-to-date)
Any employee or student may request a copy of the Exposure Control Plan!
WHAT ARE THE SIGNS AND SYMPTOMS AND SOME ADDITIONAL INFORMATION ON HUMAN IMMUNODEFICIENCY VIRUS (HIV)?
- Human Immunodeficiency Virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). AIDS was first reported in the U.S. in 1981, and has since become a major worldwide epidemic. HIV is passed from one person to another through blood-to-blood and sexual contact. Pregnant women infected with HIV can also pass the virus to their baby during pregnancy or delivery, and through breast-feeding.
Body fluids in which HIV can be detected are human blood, semen, vaginal secretions, breast milk, and other body fluids containing blood. Contact with saliva, sweat, vomit, feces, and tears has never been shown to result in HIV transmission. HIV is not spread through casual contact. Mosquitoes and other insects do not transmit HIV. In addition, HIV does not survive well outside of the body.
HIV progressively destroys the body's ability to fight infectious and certain cancers. People diagnosed with AIDS may get life-threatening diseases called opportunistic infectious, which are caused by microbes such as viruses or bacteria that usually do not affect healthy people.
The symptoms of HIV infection range from an asymptomatic state to severe immunodeficiency and associated opportunistic infections, cancers, and other conditions. Initial infectious can be followed by an acute flu-like illness within one or two months after infection, with such symptoms as: fever, headache, nausea, vomiting, diarrhea, swollen lymph glands, sweats, fatigue, myalgia, rash, sore throat.
As of July 2010, the CDC estimates that more than one million people are living with HIV in the United States. In addition, one in five (21%) of those people living with HIV is unaware of their infection. With the help of medications, life threatening symptoms may not occur for years, until the immune system is depressed enough for severe infections to occur. To date, no vaccine is available to prevent HIV or AIDS.
WHAT ARE THE SIGNS AND SYMPTOMS AND SOME ADDITIONAL INFORMATION ON HEPATITIS B VIRUS (HBV)?
- Acute viral hepatitis is a common, sometimes serious infection of the liver leading to inflammation and necrosis.
An estimated 1.25 million Americans are chronically infected with the Hepatitis B virus, and about 20% - 30% of those infected acquired the infection during childhood. 15% - 25% of chronically infected persons develop chronic liver disease, including cirrhosis, liver failure, or liver cancer. The Hepatitis B vaccine has been available since 1982, and routine Hepatitis B vaccinations have greatly reduced the rate of disease among children and adolescents.
About one-third of persons infected with HBV have no signs or symptoms. Symptoms begin an average of 90 days (range: 45 - 180 days) after exposure to HBV. Symptoms include: jaundice, fatigue, abdominal pain, fever, loss of appetite, nausea, vomiting, joint pain, dark urine, clay colored bowel movements.
Transmission of the Hepatitis B virus (HBV) occurs when an infected person's blood or body fluids enters the body of a person who is not immune. Transmission occurs primarily through; birth from an infected mother, sexual contact with an infected person, sharing of contaminated needles, syringes or other injection drug equipment, needle sticks and other sharp instrument injuries or blood splashed onto non-intact skin. HBV is not spread through casual contact with infected individuals. HBV is durable and can survive in dried form on countertops for at least 7 days.
The Bloodborne Pathogen standard requires employers to make the Hepatitis B vaccine and vaccination series available to all employees who have occupational exposure to HBV.
CDC Hepatitis B FAQ's updated 2009
WHAT ARE THE SIGNS AND SYMPTOMS AND SOME ADDITIONAL INFORMATION ON HEPATITIS C VIRUS (HCV)?
- The Hepatitis C virus (HCV) is a major cause of acute hepatitis and chronic liver disease, including cirrhosis and liver cancer. According to estimates from the Centers for Disease Control and Prevention, an estimated 3.9 million Americans (1.8%) have been infected with HCV, and 3.2 million are chronically infected. Approximately 75% - 85% of people who become infected with HCV develop chronic or lifelong infection. Serious liver problems can develop including liver damage, cirrhosis, liver failure, or liver cancer.
The number of new infectious per year has declined from an average of 240,000 in the 1980's to about 17,000 currently and most likely due to changing behaviors among intravenous drug users (education) and better screening of blood for Hepatitis C.
Although HCV is transmitted via the same routes as HBV and HIV (direct exposure to blood), according to the CDC contact with blood of an infected person through sharing of contaminated needles, syringes, or other injection drug equipment is the primary cause of infection. Many people infected with Hepatitis C have no signs or symptoms. Those that have symptoms and signs may exhibit the following: jaundice, fatigue, fever, dark urine, gray colored stools, abdominal pain, joint pain, loss of appetite, nausea and vomiting.
HCV can be detected in blood within 1-3 weeks after exposure. Incubation period is 14 to 180 days (average: 45 days). There is currently no vaccine to prevent Hepatitis C.
CDC Hepatitis C FAQ's updated 2009,
WHO SHOULD CLEAN UP A SMALL SPILL?
- No one is to clean up a blood/body fluid spill as
part of their job until they have had USciences' initial bloodborne pathogens training
which must be updated annually and have been offered the Hepatitis B vaccine.
- If the spill is a laboratory material,
the person directly responsible for that area should make sure that it is
cleaned up properly by trained personnel.
- If the spill contains blood or body fluids from an injury
or illness on campus, trained Facilities Services personnel are responsible for
cleaning up the spill. (Contact Facilities Services at X8955)
- Anyone who does not feel comfortable cleaning up
a spill can call the Environmental Health and Radiation Safety (EHRS) Department
(X8925) or contact their Supervisor. You must receive training on proper spill clean-up procedures.
See the Biological Safety Emergency
Response section for spill clean-up procedures.
WHAT CLEANING AGENTS CAN BE USED TO CLEAN UP A BLOOD/BODY FLUID SPILL?
OSHA states that an EPA-registered tuberculocidal
disinfectant, or EPA-registered disinfectants effective against both HIV
and HBV, a diluted bleach solution (solution of 5.25 percent sodium hypochlorite
(household bleach) diluted between 1:10 (1cup of bleach to 9 cups of water)
and 1:100 (1/4 cup bleach per gallon of water) are acceptable for clean-up
of a contaminated surface or item. The bleach solution must be mixed daily to be effective. Remember,
it may be corrosive to some equipment and environmental surfaces and therefore
may not be an appropriate choice for all situations.
- When using disinfectant products, it is required that there
be strict adherence to the instructions on the label.
See the List
of EPA-registered disinfectants. It lists registered sterilizers, tuberculocides,
and antimicrobials. List A, B. D, and diluted bleach are appropriate. The
same disinfectants on these lists are often repackaged and renamed and distributed
by other companies. Therefore, just look for the EPA registration # on the
HOW DO I CLEAN UP A BLOOD/BODY FLUID SPILL?
- Warn others in the area and isolate the contaminated
area. (Prevent others from walking through or near the spill.)
- Put on personal protective equipment (PPE) appropriate for
the spill size. (e.g., double set of gloves, long-sleeved coveralls or lab coat, safety goggles, booties).
- Remove glass or sharps, if necessary, with forceps, tongs or scoop and place in a red sharps container or red bucket.
- For a wet spill, cover with disinfectant-soaked absorbent
towels, wipe, and remove toweling. (This decreases the likelihood of causing
a splash.) Any visible blood or body fluid must be cleaned thoroughly before proceeding
to the next step.
- Apply appropriate disinfectant to the area.
- Allow adequate contact time. (Approximately 10 minutes to
help ensure bloodborne pathogens are killed.)
- Wipe up and clean again with soap and water.
- Properly dispose of clean-up materials into red biohazard
waste bags/containers. Also, place glass, needles, rigid plastic or other
sharps into red biohazard sharps containers. No items are allowed to stick
out of any biohazard container. (e.g., mops, etc.) The containers must be
- Remove gloves and place gloves in the re-bagged waste, but put on a new pair of gloves.
- Bring the biohazard waste containers to the Griffith Hall
or McNeil Science and Technology Center stockrooms for proper disposal.
- Remove gloves. Throw in normal trash (if not contaminated).
- Wash your hands.
DO I HAVE TO GET THE HEPATITIS B VACCINE?
- No. You may decline the vaccinations, but you do have to
sign the Declination Form indicating that you do not want it. (Part II of the Hepatitis B Vaccination form) However, potentially exposed individuals may change their mind at any time and accept the vaccinations.
- The Hepatitis B Vaccinations are a series of 3 injections over a 6 month period. Possible side effects include: pain, itching and swelling at the vaccination site, flu-like symptoms, or an allergic reaction to the yeast component of the vaccine. These reactions were no more frequent than among those receiving a placebo (sugar water).
- If you attended an initial Bloodborne Pathogens classroom training and you would like to begin the vaccination series, complete the Hepatitis B Vaccination form (Part I) and return it to the EHRS Department at STC #221, box #85 or to email@example.com.
DO I HAVE TO PAY FOR THE VACCINE?
- If you are a USciences employee or a paid student worker,
and your job duties expose you to blood and other potentially infectious materials,
you do not have to pay for the vaccination series.
WHAT IS POST-VACCINATION TESTING FOR IMMUNE RESPONSE
AND DO I NEED IT?
Post-vaccination testing is when you have
your blood drawn to determine if there is an adequate immune response or
if there are adequate antibodies after receiving the 3 doses of Hepatitis B vaccine.
Post-vaccination testing should be completed 1 - 2 months after the 3rd
dose. However, OSHA does not require or recommend having the post-vaccination
testing unless you have on-going contact or are routinely exposed to blood or body fluids. [It is
always required after an exposure incident.]
Examples of job descriptions on campus
that require the University to offer and pay for post-vaccination testing
are: student health nurse/and other staff routinely exposed, individuals
who clean up blood spills, research conducted with human blood, cells, or
tissue that have not been certified to be free of Hepatitis B, Hepatitis
C, HIV, HTLV, syphilis, etc. Other job descriptions may be evaluated for
routine exposure to blood or body fluids. Post-vaccination testing will
be conducted at the Hospital of the University of Pa. Occupational Medicine
Department. You may decline the testing.
IF I ATTENDED THE TRAINING CLASS LAST YEAR, DO I HAVE
TO GO AGAIN THIS YEAR?
- OSHA requires that training be completed every year. However, if an employee attended an initial classroom training, subsequent trainings may be fulfilled by completing on-line training and a quiz on Bloodborne Pathogens.
WHAT IS AN EXPOSURE INCIDENT?
An exposure incident is when blood or
other potentially infectious material gets into your eye, mouth, or any
other mucous membrane (mucous membrane splash), or if it comes in contact
with non-intact skin (broken or damaged skin). If you stick yourself with a
contaminated needle or other contaminated sharp object, that is an exposure
incident also (percutaneous exposure). [Remember:
Hepatitis B virus can survive on surfaces, dried, and at room temperature
for at least one week].
WHAT DO I DO IF I HAVE AN EXPOSURE?
Immediately flood the exposed area with
copious amounts of water, and clean any wound with soap and water or a skin
disinfectant if available. Do not rub hard or abrade the skin.
splashes, flush the eyes with copious amounts of water. Hold eyelids open to flush out eyelids well. Seek medical attention. (Turn on eyewashes to flush once a week
for a minimum of 3 minutes to prevent the buildup of amoeba and bacteria. This will prevent eye infections, which can lead to blindness, during its
use in an emergency.)
When an injury or exposure occurs:
Any employement-related injury or illness to faculty or staff is to be reported immediately to the employee's supervisor, including those related to hazardous substance exposures.
- If it is an emergency,
call 911 and Public Safety at X7000. If Public Safety
transports the employee/student to the hospital, someone other than
the Public Safety Officer (co-worker, supervisor, etc.) must accompany the injured employee into the medical facility.
- Do not move a seriously injured person unless
they are in further danger.
- In the event of a hazardous substance exposure, do what is necessary to prevent further injury or illness. (i.e., flush
skin or eyes with copious amounts of water for approximately 15 minutes,
leave the area and get fresh air for an inhalation exposure) Also, someone should forward the Safety Data Sheet (SDS) to the medical facility.
- Laboratory incidents (i.e., injury, hazardous substance exposure, fire) involving employees, students, contract laboratory workers or visitors, must also be documented on a Laboratory Incident Report. Principal Investigators or Laboratory Supervisors must complete this form and forward it to the EHRS Department within at least 5 days of the incident.
- Notify the EHRS Department immediately of any major employment-related accidents that require an overnight stay in the hospital or of the unfortunate death of an employee.
Student and Visitor Accidents/Hazardous Substance Exposures
- Students must notify their instructor or resident director of all injuries or illnesses occurring at the University, including those related to hazardous substance exposures. The incident must then be immediately reported to Public Safety (X7000) so that it can be documented properly.
- Visitor accidents or incidents must also be immediately reported to Public Safety.
- If it is an emergency, call 911 and Public Safety at X7000. If Public Safety transports a student to the hospital, someone other than the Public Safety Officer (i.e., fellow student, instructor) should accompany the student into the medical facility.
- Do not move a seriously injured person unless they are in further danger.
- In the event of a hazardous substance exposure, do what is necessary to prevent further injury or illness. (i.e, flush skin or eyes with copious amounts of water for approximately 15 minutes, leave the area and get fresh air for an inhalation exposure) Also, someone should forward the Material Safety Data Sheet (MSDS) to the medical facility.
- Any student who is working for the University, and their injury or illness occurs during the performance of their duties, will be covered under the University's worker's compensation carrier. Therefore, Human Resource's Supervisor's Accident Investigation Report should be completed, and procedures followed, as required under the "Employee Accident" section.
- An employee or paid student worker may follow-up with an occupational medicine specialist at University of Pennsylvania's Occupational Medicine Department. These physicians specialize in hazardous substance exposures. Medical reports and information will and must be kept in the strictest confidence.
See the Accident Reporting
section in the Safety Manual for more information.
WHERE DO I PUT MY BIOHAZARD WASTE?
- All contaminated or infectious dry solid type waste (e.g., gloves, personal protective equipment, paper towels, gauze/bandages, bodily fluid/blood saturated items, etc.) must be placed in double red bags stored inside proper biohazard boxes with lids. Do not put sharps or liquids into red-bagged boxes. Keep the weight of box reasonable, 30 lbs. or less.
- All contaminated needles, syringes, and blades must be placed into red sharps containers. (Not red buckets)
- Other contaminated sharps (e.g., glass and plastic pipettes, broken and unbroken glassware, slides, culture dishes, cover slips, rigid plasticware having sharp edges or points, capillary tubes, glassware, etc.) must be placed into the red buckets or sharps containers that are puncture-resistant and leakproof. Anything that could potentially puncture a bag should be placed into proper red sharps containers/buckets.
- By law, non-contaminated needles and syringes (with or without needles attached), must still be placed into a red sharps container. Containers must not be over-filled and must be closed and disposed of when 3/4's full.
- Contaminated laboratory liquid waste (aqueous biological or infectious solutions such as human blood and body fluids, liquid culture medias, viral supernatant, media from infected cells and stocks must be autoclaved or chemically disinfected (e.g., 10% bleach solution) prior to disposal. Upon obtaining a one-time approval from Environmental Health & Radiation Safety for compliance, the bleach disinfected waste may be flush ed into the sanitary sewer system (drain) if flushed with large amounts of water (and if non-hazardous, aqueous and soluble). Properly autoclaved liquids may only be flushed into the drain if biological indicator (spore) tests are being conducted and documented.
- Otherwise, these liquids must be in break-resistant containers that are tightly sealed before being placed into red biohazard waste buckets. There should be sufficient absorbent material in the bucket to absorb the entire contents of the liquid in the event of a release. (e.g., absorbent pads or vermiculite)
- Never place hazardous drugs/pharmaceuticals (including chemo drugs), chemicals, radioactive materials, or regular garbage into the biohazard waste containers.
- Autoclave or decontaminate all virulent pathogens, higher risk biosafety level 2 agents, cultures and stocks of infectious agents, recombinant or synthetic nucleic acids and transgenics, BSL-2 and BSL-1 agents if they present any risk to individuals or the environment, potentially infected animal cages and bedding or reusable labware and consumables used in the manipulation of these substances, prior to placing into the red biohazard waste containers for disposal.
- Never autoclave sealed containers, animal carcasses, bleach-treated waste, or items contaminated with flammables, corrosives, reactives, cytotoxic drugs, reproductive and carcinogenic hazards, volatile chemicals or radioactive materials.
- Dispose of all autoclaved waste through the biohazard/infectious waste stream. (red bags/containers)
Chemo/Cytotoxic and Hazardous Drug/Biotoxin Waste Disposal
- Review the Safety Data Sheet and other reference material for the toxin/agent you are using to determine what method(s) are recommended for inactivation and disposal of the toxin/agent, contaminated wastes and bedding.
- Discarded contaminated items containing trace amounts of chemo/cytotoxic drugs and hazardous pharmaceuticals may be disposed of into the appropriate red (for hazardous pharmaceutical and biotoxins) or yellow (for chemo/cytotoxic) biohazard waste container.
- Original cytotoxic/hazardous drug/biotoxin bottles or dilutes stocks containing drugs/agents must be disposed as hazardous chemical waste, tagged and brought to the Central Stockroom(s). [Biotoxins must be inactivated before disposal as hazardous chemical waste.] In addition, bottles, tubing, vials, syringes and other discarded contaminated items containing residual or trace amounts of these drugs/agents may be placed into the appropriate red (for hazardous pharmaceuticals and biotoxins) or yellow (for chemo-cytotoxic) biohazard containers.
- Carcasses and bedding containing chemo/cytotoxic drugs must be placed in yellow "chemo-labeled" double bagged, yellow biohazard containers only. While storing carcasses with bedding the refrigerator/freezer, these should be double-bagged in sealed yellow chemo-labeled bags.
- Carcasses and bedding containing hazardous pharmaceutical and biotoxins must be placed in red double-bagged, biohazard boxes. While storing carcasses with bedding in the refrigerator/freezer, these should be double-bagged in sealed red biohazard bags.
- Sharps containing trace chemo/cytotoxic drugs must be placed in yellow chemo/cytotoxic biohazard sharps containers only. Sharps containing trace hazardous pharmaceuticals and biotoxins must be placed in red biohazard sharps containers.
Non-contaminated sharps whether plastic or glass, (except needles, syringes and blades), must be placed into blue and white
laboratory glassware boxes. (Not in regular trashcans)
While storing biohazard/hazardous material bags and containers
in the laboratory, THEY MUST BE KEPT CLOSED, unless adding waste. Before transport
from the laboratory, check to make sure that they are sealed and not leaking.
Do not leave a waste container unsecured. (It must be locked up or in a locked laboratory when unattended)
Do not store biohazard waste in hallways or
near general traffic. Biohazard waste may be stored
at room temperature until the storage container is full, but no longer than
30 days from the date of generation. It may be refrigerated for up to 30 days
and frozen for up to 90 days from the date of generation (excluding used sharps). Biohazard waste must
be dated when refrigerated or frozen for storage. Storage of biohazard waste
in a freezer must be approved by the Environmental Health and Radiation Safety
All bags and containers are available in the Central Stockrooms.
Bring the waste to the appropriate stockroom only if you have been Department of Transportation trained or contact the Central Stockrooms at X8843 or X3141 to schedule a pick-up.
See the Biohazard Waste
Disposal procedures in the Biosafety Manual for more information.
HOW CAN I PROTECT MYSELF?
- Your risk of infection of Hepatitis B or HIV is very small, but you do need to protect yourself.
- Assume that all blood and body fluids are infectious. This is called "universal" precautions.
- Wear appropriate personal protective equipment (PPE) for the job that you are doing. Wear gloves whenever there is a possibility of contact with blood or other body fluids. Inspect all personal protective equipment before wearing for damage, punctures or tears.
- Identify and use engineering controls. These are devices that isolate or remove bloodborne pathogen hazards, which may include fume hoods, biological safety cabinets, sharps containers, self-sheathing or retractable needles and needleless systems.
- Re-capping of needles is prohibited. Contact EHRS if re-capping is unavoidable. It is required to document that no other alternative is feasible. If approved, then either a safety device for re-capping must be used (e.g., self-sheathing or retractable needles) or a one-handed "scoop the cap" technique must be used.
- Wear face shields and/or goggles if there is the possibility of blood or body fluids splashing.
- Other types of PPE include; masks, gowns, coveralls, shoecovers, pocket CPR mouth to mouth resuscitation masks. Check with your supervisor or the EHRS Department, if you are unsure if these are needed.
- Supervisors must identify all equipment and clothing that is needed and ensure it is available to you at no cost, you are using it and you are trained on how to use it properly. OSHA requires that this PPE evaluation and training be documented. Use EHRS's PPE Hazard Assessment form.
- Follow the established work practices and procedures to limit or prevent exposures.
- Dispose of all waste properly.
- Seriously consider the offer of Hepatitis B Vaccination.
- Report any exposure to potentially infectious materials immediately and undertake the necessary medical review and treatment.
An excellent resource is the CDC's Publication, Biosafety in Microbiological and Biomedical Laboratories (BMBL) which may be found at http://www.cdc.gov/biosafety/publications/bmbl5.
If anyone has any additional questions, please
do not hesitate to contact the EHRS Department (X8925).