osha training course: maintaining compliance with the bloodborne pathogen standard liza chapman,...

OSHA Training Course: Maintaining

Compliance with the Bloodborne Pathogen

StandardLiza Chapman, Pharm.D.

2015 Georgia Pharmacy Association Annual Meeting

FACULTY DISCLOSURE

Liza Chapman has no disclosures to declare at this time.

OBJECTIVES

o Identify bloodborne pathogens and the potential for exposure and routes of transmission

o Review the requirements for pharmacists and pharmacies to comply with the OSHA Bloodborne Pathogens Standard

o Explain and review work practices to minimize risks of exposure

o Discuss Hepatitis B virus vaccination requirements for pharmacists

o Review proper procedure for potential bloodborne pathogen exposures

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

OSHA Legislative Act passed in 1970 Covers all acts of occupational hazards

including the Bloodborne Pathogen Standard

OSHA STANDARD 1910.1030

o Bloodborne Pathogen Standardo Released in December, 1991o Effective March, 1992o Reviews all occupational potential exposure to

blood and other potentially infectious materialso Requires use of universal precautionso Requires use of Exposure Control Plano Requires employer to provide Hepatitis B vaccine

to employees with potential risk

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10051

OSHA TRAINING

Epidemiology of bloodborne pathogens, transmission, and diseases

Components of Exposure Control Plan Knowledge of tasks and activities involving

exposure Explanation of use and limitations of

methods that may prevent or reduce exposure using protective equipment and safety devices

NEEDLESTICK SAFETY AND PREVENTION ACT OF 2000

o Revises 1992 standard to reduce needlesticks among health care workers

o Requires training with annual updateso Universal precautions: Treat all body fluids as

infectiouso Mandates safer devices (safety needles)o Requires an exposure control plan (ECP)o Requires a sharps injury logo Requires documentation of device evaluationo Some states have more stringent

requirements

OSHA CITATIONS

o Failure to have an exposure control plano Failure to review and implement

commercially available “safer medical devices”

o Failure to include procedures for documenting exposure incidents

o Failure to review and update plan annuallyo Failure to follow universal precautionso Failure to comply with most current CDC

recommendations for post-exposure evaluation and follow-up

o Failure to discard used “unrecapped” needles

GA HB 1448 (1999)

Signed into law 04/2000 Provisions Requires the adoption of a bloodborne

pathogen standard applicable to public employees and "at least as prescriptive" as the federal OSHA standard;

http://www.cdc.gov/niosh/topics/bbp/ndl-law-1.html#ga

GA HB 1448 (1999)

Requires consideration of inclusion of specific standard sections related to training, education, increasing vaccination and personal protective equipment use and strategic placement of sharps containers;

Requires that the state develop and maintain a list of available safety devices for employers using resources, including NIOSH;

GA HB 1448 (1999)

Requires the use of the "most effective available needleless systems and sharps with engineered sharps injury protection be included as engineering and work practice controls" except under certain circumstances, including unavailability and objective evidence presented to an evaluation committee (including frontline workers) of patient or employee safety issues, and

GA HB 1448 (1999)

Requires that facilities: Develop a written exposure control plan,

including a safety device selection/evaluation procedure (including inclusion of frontline workers and training for the committee "in the proper method of utilizing product evaluation criteria");

Maintain a sharps injury log, and Train workers on the use of all

engineering controls before they are used.

GA HB 1448 (1999)

Unique: Requires use of most effective available

technology

BLOODBORNE PATHOGENS

BLOODBORNE PATHOGENS

o Pathogenic microorganisms that are present in human blood and can cause disease in humans

o Over 20 pathogens have been transmitted through sharps or needle stick injuries, greatest risk include:o Human Immunodeficiency Virus (HIV)o Hepatitis B Virus (HBV)o Hepatitis C Virus (HBC)

o Over 350,000,000 persons world-wide are infectedo At least 50% are not aware of infection

PREVALENCE

The Centers for Disease Control and Prevention (CDC) estimates for new U.S. cases of bloodborne pathogen infections per year HIV

40,000 cases HBV

60,000 cases HBC

26,000 cases

http://www.cdc.gov/niosh/topics/bbp/surveillance.html

INFECTIOUS MATERIAL-BODY FLUIDS

o Bloodo Semen o Vaginal Secretionso Cerebrospinal, synovial, peritoneal, pleural,

and amniotic fluidso Salivao Miscellaneous body fluids mixed with bloodo Unfixed human tissue, or organs other than

intact skino Cell or tissue cultureso Organ cultureso Any medium contaminated by HIV or HBV

RISK OF TRANSMISSION OF BLOODBORNE INFECTION

Occupational Exposure Risk of Transmission

HIV 0.3%

HBV 2-40%

HCB 2.7-10%

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/InjuryPrevention.html#table1

HUMAN IMMUNODEFICIENCY VIRUS

Virus that causes AIDS Attacks human immune system Makes the body incapable of repelling

disease causing microorganisms

HIV SYMPTOMS

o Enlarged lymph nodeso Persistent fevero Involuntary weight losso Persistent fatigueo Diarrhea that doesn’t respond to standard

medicationso Purplish spots or blotches on skin or in moutho White, cheesy coating on tongueo Night sweatso Forgetfulness

HIV TRANSMISSION

3 methods of transmission: Sexual contact Blood contact Mother to child contact during pregnancy or

childbirth Persons of highest risk:

Homosexual men IV drug users Multiple blood transfusions Sexually promiscuous

HEPATITIS B VIRUS

o Disease caused by HBV which attacks the liver

o Virus can live on surfaces for up to a week if exposed to air

o HBV can live in bodily fluids for years and can cause the following:o Chronic Hepatitiso Cirrhosis of the livero Liver failureo Liver cancero Death

HEPATITIS Bo Transmission

o Bloodo Tearso Salivao Semen

o Symptoms vary from person to person, and 30% of persons infected are asymptomatic

o Symptoms are less common in kidso Most common symptoms

o Jaundiceo Rasheso Internal bleeding o Joint pain

HEPATITIS C VIRUS

o Contagious liver disease caused by Hepatitis C virus which inflames the liver

o Risk for chronic liver disease and other HCV related chronic disease during the first two decades following infection

o Transmissiono Primarily through long or repeated direct

percutaneous exposure to infected bloodo Blood transfusiono Needle sticks and sharingo Injecting-drug useo Mother to child transmission during birth

HEPATITIS C

80% of cases are asymptomatic Symptoms

Jaundice Fatigue Dark urine Abdominal pain Loss of appetite

METHODS OF TRANSMISSION

Needlesticks Broken glass Splatter Rubbing eyes, nose, and/or mouth Sores, cuts, and rashes

EXPOSURE CONTROL PLAN

EXPOSURE CONTROL PLAN (ECP)

Each employer having employee(s) with occupational exposure shall establish a written Exposure Control Plan designed to eliminate or minimize employee exposure

EXPOSURE CONTROL PLAN (ECP)

o Written plano Establish compliance officero ECP must be reviewed at least annually to reflect

changes in:o Tasks, procedures, or assignments which affect

exposure, and technology that will eliminate or reduce exposure

o Annual review must document employer’s consideration and implementation of safer medical devices

o Evaluate the effectiveness of prevention effortso Must receive input from employees with potential

for exposure in the identification, evaluation, and selection of engineering and work practice controls

o Employees must have access to ECP during work shift and given a copy within 15 days of request

ECP ELEMENTSo Exposure determination

o List of job classifications with occupational exposure

o List of jobs with some occupation exposureo List of tasks and procedures in which

occupational exposure may occuro Jobs with Exposure Risks

o Cleaning up bloodo Cleaning up broken contaminated glasso Dental procedureso Fingerstick Testingo Handling contaminated protective gearo Handling medical wasteo Performing first aid and CPR/BLSo Providing injections

ECP ELEMENTS-CONTINUED

o Universal Precautionso Treat all human blood and bodily fluids as if they

were contaminated with bloodborne pathogenso Must be observed in all situations where there is

a potential for contact with blood or other potentially infectious materials

o Eating, drinking, and smoking are prohibited in work areas where exposure to bloodborne pathogens is possible

o Storage of food and/or drinks in work areas is discouraged

o Engineering and work practice controlso Safer Medical Devices

ENGINEERING AND WORK PRACTICE CONTROLSo Hand washing facilities

o May use antiseptic hand cleansers if water is not immediately available, but must be washed with soap and water as soon as possible

o Wash hands after removal of gloves or other personal protective equipment (PPE)

o Wash immediately if contact with body fluid is made

o Personal Protection Equipment (PPE)o PPE is designed to be used in combination with

good work practices to aid in the protection of the employee

o Should be provided to employee at no cost and must be accessible at the worksite

o Use of PPE is to be enforced by the employer

ENGINEERING AND WORK PRACTICE CONTROLS

o PPE-continuedo Cleaning, laundering, disposal, repair, and

replacement is the responsibility of the employero Examples of PPE

o Disposable gloveso CPR microshields

o Used needles and lancets should not be bent or recapped and should be stored properly in Sharps containers that are the following:o Puncture resistanto Leak-proofo Labeled with appropriate markingso Closed during transport

ENGINEERING AND WORK PRACTICE CONTROLS

o Communication of Hazardso Labels must be attached to all containers of

wasteo Must be fluorescent orange or orange-red with

wordage of “BIOHAZARD” attachedo Safer Medical Devices

o Eliminate needles or use needless systems when possible

o Sharps with engineered sharps injury protectiono Must involve healthcare workers actively

employed in activities when evaluation and selecting devices and must be documented

SAFER MEDICAL DEVICES

Include the following features: Provides a barrier between the hands and the

needle after its use Requires the HCW’s hand to remain behind the

needle at all times Safety feature is an integral part of the device

and not a separate accessory Device can not be deactivated and remains in

effect after disposal Device is simple and requires minimal training to

use

www.healthsystem.virginia.edu/internet/epinet

SAFER MEDICAL DEVICE EXAMPLES

GOOD HOUSEKEEPING MEASURES

Develop a written schedule and procedure for daily cleaning of work surfaces with documentation

Contaminated surfaces must be disinfected after exposure EPA approved disinfectant or 1:10 chlorine

bleach and water solution Protective coverings are to be removed and

replaced after contamination Wash hands after changing gloves

EXAMPLES OF BIOHAZARD DISPOSAL SYSTEMS

HEPATITIS B VACCINATION

Employer must offer vaccine at no cost to employee, except: If the employee has had the vaccination If antibody testing reveals immunity

Provide at a reasonable time and place within 10 working days

Follow current CDC guidelines If the vaccine is refused by the employee:

Must be given at no charge if employee wishes to be vaccinated at a later time

Must sign “Wavier of Vaccine Declination” document

“WAVIER OF VACCINE DECLINATION” DOCUMENT “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 me; 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.”

SIGNED____________________________DATE_______________

POST-EXPOSURE EVALUATION AND FOLLOW-UP


Provide to employee’s health care professional In writing Copy of regulation Description of exposed employees duties as

related to exposure Documentation of events of exposure Results of source blood testing, if available Employees medical records as related to

exposure, including vaccination status


Health care professional written opinionProvide to employee within 15 daysHCP’s written opinion for Hepatitis B

vaccinationEmployee has been informed of the results

Employee has been told about medical conditions and recommendations for treatment and further evaluation

All other findings shall not be included in the report

REQUIRED RECORD KEEPING Must maintain the following information for medical records

of employees with exposure Name SSN Vaccination status/dates Results of tests and follow-ups Written opinions of HCP Copy of information provided to HCP Keep duration of employment + 30 years

For all training records, the following information must be recorded: Dates Contents Name and qualification of trainer Names of attendees

REQUIRED RECORD KEEPING

Sharps Injury LogMust include:

Detailed information on injuryType and brand of device involved in injury

Department of work where incident occurred

Explanation of incidentRecords must be confidentialNot required if fewer than 10 employees

are involved in the service

L.C. LEARNING ACTIVITY

L.C. is a 37 y/o pharmacist who is providing point of care health screenings in her pharmacy. In addition, she is healthy and doesn’t take any prescription medications.

In order for L.C. to be protected from bloodborne pathogens, what vaccine(s) does she need to receive?

How many dose(s) of Hep B does L.C. need to be protected against BBPs?

L.C.-CONTINUED

After reviewing L.C.’s vaccine record, you discover that she received the following doses of Hepatitis B:

Dose #1 on 09.20.1998Dose #2 on 10.30.1998

Based on the information above, does the vaccine series need to be restarted?

L.C.-CONTINUED

When should L.C. have the titer drawn after completing the vaccine series? A. The same day the last dose is given B. 1 month from the date of completion C. 12 months from the date of completion D. No need, having titers drawn isn’t

recommended

CONCLUSION

For more information visit: www.cdc.gov/niosh/topics/bbp www.osha.gov/bloodbornepathognes/index.htm

Questions

osha training course: maintaining compliance with the bloodborne pathogen standard liza chapman,...

Documents