Bloodborne Pathogens
HIV, which is the virus that causes AIDS, and the more common hepatitis B virus are the two most common diseases called “bloodborne pathogens,” because they live in human blood and other body fluids. In response to the greater risks from exposure to blood and other body fluids, the Occupational Safety and Health Administration developed the Bloodborne Pathogens Standard to help protect people on the job.
This Bloodborne Pathogens article is a reference tool that you can use to reinforce your understanding of the OSHA Bloodborne Pathogens Standard and how to minimize your risk of exposure to bloodborne pathogens.
Bloodborne Pathogens is divided into four parts:
- Blood as a Hazardous Material
- The Risks of Occupational Exposure
- Minimizing the Risks
- The OSHA Bloodborne Pathogens Standard
“Blood as a Hazardous Material” explains what bloodborne pathogens are and describes some of the effects of infection from HIV and HBV.
“The Risks of Occupational Exposure” describes some of the risks of exposure to bloodborne pathogens on the job.
“Minimizing the Risks” describes some of the ways to minimize the risks from exposure to bloodborne pathogens on the job.
“The OSHA Bloodborne Pathogens Standard” describes the general requirements of the OSHA Bloodborne Pathogens Standard, including the written Exposure Control Plan.
Blood as a Hazardous Material
It may be difficult to imagine blood being considered a hazardous material, since people have it in their bodies. What makes blood hazardous to an individual is the possible presence in someone else’s blood of what are called bloodborne pathogens.
DEFINITIONS
This part explains what bloodborne pathogens are and describes the general effects of HIV and HBV.
Bloodborne pathogens are microorganisms present in human blood that can infect or cause disease.
The term “blood” includes human blood components such as plasma, serum, and platelets, and products made from human blood.
The term “other potentially infectious materials” includes certain body fluids, human tissue, and human organs.
HIV AND HBV
The two most common bloodborne pathogens are the human immunodeficiency virus (HIV), which causes AIDS, and the hepatitis B virus (HBV).
HEPATITIS C VIRUS
Other bloodborne pathogens are not as common, but infection with the Hepatitis “C” virus is becoming more frequent.
Bloodborne pathogens are most often spread through sexual contact or needle sharing involved in the use of illegal drugs. Infection that is the result of occupational exposure is relatively rare.
INFECTION
Often, there is no outward indication that a person is infected. Therefore, workers whose jobs require them to perform tasks that may cause them to come in contact with blood or other infectious materials must always take precautions to avoid becoming infected. It is important to note that infection can result from a single exposure to HIV or HBV.
HIV AND AIDS
The emergence of the Acquired Immunodeficiency Syndrome (AIDS) in the early 1980’s increased the urgency to protect workers from the potential hazards of bloodborne pathogens, because AIDS is fatal in most instances. AIDS is caused by the Human Immunodeficiency Virus (HIV).
HIV INFECTION: STAGE 1
In general, there are four stages of HIV infection. Stage 1 can appear within a month of the time of infection, and it can be mistaken for the flu or other viral infection.
Symptoms might include enlarged lymph nodes, fever, skin rash, or extreme fatigue. However, not everyone who is infected will notice these symptoms.
HIV INFECTION: STAGE 2
In the second stage, which usually begins within 6 months of the time of infection, antibodies will be developed, and the infected person may show no symptoms at all.
HIV INFECTION: STAGE 3
In the third stage, the infected person may feel healthy, but he or she will have enlarged lymph nodes for months or even years.
HIV INFECTION: STAGE 4
AIDS is the fourth and final stage of HIV infection. The immune system, which is the system in the body that fights off infections and other diseases, is deteriorated by AIDS.. The infected person becomes more vulnerable to other infections and diseases that a normal immune system would protect the person from.
SPREAD OF HIV
The HIV virus can be spread in any of the four stages, even if there are no apparent symptoms. HIV is found in numerous fluids in the body besides blood. The following is a list of body fluids that have been found to contain HIV in infected persons.
- Blood
- Semen
- Vaginal secretions
- Breast milk
- Fluid around the brain and spinal cord (cerebrospinal fluid)
- Fluid from air sacs in the lungs (alveolar fluid)
- Fluid inside joints (synovial fluid)
- Fluid inside the uterus during pregnancy (amniotic fluid)
- Fluid in a sac around the heart (pericardial fluid)
- Any body fluid that is visibly contaminated with blood
Although the virus has been found in all of the listed locations in the body, only blood, semen, vaginal secretions, and breast milk have been proven to spread HIV from one person to another.
HBV
The hepatitis B virus (HBV) is much more common than HIV, and it is generally not fatal. Hepatitis B is spread in many of the same ways as HIV, and it is even spread by people who experience no symptoms and do not know that they are infected.
EFFECTS OF HBV
The most frequent response seen in healthy adults is the development of self-limited acute hepatitis and the production of antibodies. The antibodies eventually destroy the virus and render the person immune to it, usually for life.
The process of eliminating the virus causes serious symptoms in about one third of the cases. The symptoms can include jaundice, dark urine, extreme fatigue, nausea, and abdominal pain.
BODY FLUIDS
HBV is found in many of the same body fluids as HIV and, in general, the precautions against HBV are the same as for HIV.
The Risks of Occupational Exposure
According to the Occupational Safety and Health Administration, over 5,000,000 workers in the United States have been determined to be at risk for exposure to bloodborne pathogens.
This part identifies some job categories that are potentially at risk for exposure to bloodborne pathogens and describes some factors that determine the level of risk of infection due to occupational exposure.
RISK OF INFECTION
The risk of infection due to occupational exposure to bloodborne pathogens is based on whether a worker’s tasks involve contact with blood or other potentially infectious materials and, if they do, on the frequency of that contact.
THE HEALTHCARE INDUSTRY
Workers in the healthcare industry are generally considered to be at the greatest risk for occupational exposure.
Some job categories in the healthcare industry involve direct contact with patients or biological material that could be infected. Examples of these job categories include
- Physicians
- Nurses
- Pathologists
- Phlebotomists
- Dental workers
- Dialysis personnel
- Laboratory and blood bank technologists
- Paramedics
DIRECT CONTACT
In general, the more frequent the contact with blood or other infectious materials, the greater the possibility of exposure and infection.
One study of physicians and nurses showed that those whose contact with blood was described as frequent were more than twice as likely to have hepatitis B markers.
INCIDENTAL CONTACT
There are also many workers who do not normally have direct contact with patients or biological materials but still must take appropriate precautions to avoid infection.
Examples of these job categories include
- Hospital housekeeping and laundry workers
- Couriers who transport specimens to and from laboratories
- Technicians who repair medical equipment
In most of these categories, the presence of blood or other infectious material is incidental to the job tasks.
OTHER JOB CATEGORIES
In addition to healthcare workers, there are many other workers who can reasonably be expected to come in contact with blood or other potentially infectious materials as part of their job. Even though these workers are not primarily healthcare providers, they may provide emergency first aid to injured persons.
FIREFIGHTERS
For example, firefighters are often the first to arrive on the scene of an accident, and they may have to perform emergency medical procedures.
TEACHERS
Teachers or day-care providers might have to give first aid to an injured child.
INDUSTRIAL WORKERS
People who work in industrial plants might be designated first aid providers for an injured co-worker.
LAW ENFORCEMENT PERSONNEL
Police and other law enforcement personnel, such as those who work in correctional institutions, come in contact with potentially violent people who are often in high risk categories for HIV and HBV infection.
MORTICIANS
Morticians perform a number of tasks during the preparation of cadavers that put them at risk of exposure.
WASTE HANDLERS
People who work in commercial laundries that service hospitals, and workers who collect and process medical and biological waste materials are also at risk, most commonly from contaminated needles that have not been properly disposed of.
WORKPLACE EVALUATION
Every workplace should be evaluated to determine if there are any workers who might be at risk for exposure to bloodborne pathogens.
MINIMIZING THE RISKS
The “universal precautions” provide basic guidelines for minimizing the risks of occupational exposure to bloodborne pathogens.
Minimizing the Risk
This part explains the primary rule contained in the universal precautions, describes four routes of exposure for exposure to bloodborne pathogens in the workplace, and describes some protective measures that will help minimize the risks of occupational exposure.
UNIVERSAL PRECAUTIONS
The universal precautions were developed by the Center for Disease Control and Prevention as a broad set of guidelines for the prevention of transmission of HIV, HBV, and other bloodborne infections. The term “standard precautions” is also used to refer to these guidelines.
PRIMARY RULE
The primary rule of the universal precautions is that blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV and other bloodborne pathogens.
The universal precautions are designed to prevent exposure to bloodborne pathogens through the potential routes of exposure.
ROUTES OF EXPOSURE
There are four potential routes of exposure to bloodborne pathogens:
- By direct contact
- Through the mouth
- Through the eyes
- By injection
EXPOSURE BY DIRECT CONTACT
If your intact skin comes into contact with blood or other potentially infectious material, it is not considered an “exposure incident.” However, if any kind of break in the skin, such as a cut or dermatitis or even a hangnail, comes in contact with the potentially infectious material, you are exposed.
Intact skin will prevent you from becoming infected, but you should still always use appropriate gloves when there is a possibility of contact with blood or other potentially infectious materials.
Gloves should be used to protect against possible infection that could occur as a result of touching items or surfaces that are contaminated, such as soiled bandages or contaminated countertops.
Gowns or aprons should be worn during procedures that are likely to generate splashes of blood or other body fluids.
Studies have shown that infection can occur through breaks in the skin that are not apparent. It only takes one exposure incident to become infected.
There is a very high risk of infection associated with exposure through the mouth.
A protective mask or face shield may be needed if the work you are doing has the possibility of generating airborne droplets of blood or other body fluids.
EXPOSURE THROUGH THE MOUTH
Aside from the possibility of getting infectious material splashed into your mouth, there is a great danger to laboratory workers if they pipet by mouth. This is so risky that it is specifically forbidden by the OSHA Bloodborne Pathogens Standard.
If your job requires pipetting, always use a mechanical pipet device.
It is also possible that infectious material can move into your mouth when you eat, drink, or use cosmetics. Wash your hands thoroughly and often, and always wash them before eating or handling food.
EXPOSURE THROUGH THE EYES
The eyes and mucous membranes are very vulnerable to exposure to infectious materials, because they present a very fast entry into the bloodstream.
If you work in a lab or other location where there is a possibility of a splash or the creation of visible airborne droplets of blood or other potentially infectious materials, you should always wear eye protection to prevent exposure.
EXPOSURE BY INJECTION
One of the most common ways that workers are exposed to bloodborne pathogens is by the skin being penetrated by a needle or other sharp object that is contaminated with blood or body fluids.
Workers who use needles regularly must handle them very carefully and dispose of them properly. Proper disposal generally means using a hard-sided sharps disposal container that is clearly labeled as containing potential biohazards.
Hospital housekeeping employees and laundry workers must take care to avoid being stuck with contaminated sharps that have been inadvertently left in linens or other laundry.
A procedure must be established about what to do if someone is exposed, including free medical evaluation and treatment of the exposed employee.
GOOD HOUSEKEEPING
In addition to personal protective equipment, there are some other ways to minimize exposure to bloodborne pathogens. For example, good housekeeping is very important.
The hepatitis B virus can live on a surface for up to several days. For this reason, work surfaces and equipment should be decontaminated using an approved disinfectant, and disposable materials must be disposed of in approved and properly labeled containers.
WARNINGS AND PRECAUTIONS
All potentially infectious materials must be labeled with appropriate warnings.
Workers should always be alert to the presence of blood or potentially infectious materials and take the proper precautions to protect themselves.
HEPATITIS B VACCINE
If you could be exposed to hepatitis B while doing your job, you employer must make the vaccination available at no cost to you. You are not required to have the vaccine, but healthcare professionals recommend that most persons who are at risk for possible exposure to HBV receive the vaccine.
All evidence shows that the HBV vaccine is safe and 85-95% effective. Research shows that the vaccine remains effective for at least 9 years in most cases.
If you are eligible to receive the vaccine, your employer can provide you with more detailed information to help you decide if you should receive it.
The Osha Bloodborne Pathogens Standard
The OSHA Bloodborne Pathogens Standard builds on the universal precautions and is designed to help protect people from bloodborne infections on the job. This part describes the general requirements of the OSHA Bloodborne Pathogens Standard and the general requirements of the written Exposure Control Plan.
STANDARD REQUIREMENTS
The OSHA Bloodborne Pathogens Standard requires that employers take specific steps to limit potential exposure to bloodborne pathogens such as HIV and HBV. The employer must evaluate each job task to determine who in their workplace is covered.
COVERED EMPLOYEES
Any employee who can reasonably be anticipated to have contact with blood or other body fluids during the performance of his or her normal job, is covered by the standard.
Even if only one employee can reasonably be anticipated to have contact with blood or other potentially infectious materials in the performance of normal job duties, the employer must meet all of the requirements of the Bloodborne Pathogens Standard.
EXPOSURE
Covered employees must receive initial and annual training about requirements of the OSHA standard; the hazards associated with blood, body tissue, and fluids; and the protective measures that will minimize the risk of exposure. The standard also requires the employer to offer the HBV vaccine free to all covered employees.
WARNING SIGNS AND LABELS
The Bloodborne Pathogens Standard requires the use of the universal biohazard symbol to warn people of the presence of potentially infectious materials. Labels are also required to follow the same general color scheme as the biohazard symbol.
EXPOSURE CONTROL PLAN
An important requirement of the Bloodborne Pathogens Standard is the written Exposure Control Plan, which must detail the policies and procedures that the employer will implement to eliminate or minimize employee exposure.
The plan specifies which job tasks and employees are covered by the standard and describes the methods that the employer will use to eliminate or minimize employee exposure. These methods of compliance include information about how the employer will communicate the hazards to employees and information on protective measures, including engineering controls, work practices, and personal protective equipment.
The plan also includes the employer’s procedures for post-exposure evaluation and follow-up, and the information about the HBV vaccination.
The plan must be readily available to covered employees, and it must be reviewed and updated at least annually, or whenever necessary to cover new tasks or revised employee positions.
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