Bloodborne Pathogens

Bloodborne pathogens are microorganisms in the blood or other body fluids that can cause illness and disease in people. These microorganisms can be transmitted through contact with contaminated blood and body fluids.

When bloodborne diseases are mentioned, most people think automatically of AIDS, but actually HBV, or the hepatitis B virus, is much more common. AIDS is usually fatal, though it may take years for symptoms to appear. HIV, the virus that causes AIDS, is primarily transmitted through sexual contact, though it may also be contracted through contact with contaminated blood or some body fluids. HBV attacks the liver, and is sometimes fatal. It is transmitted through saliva, blood and other body fluids.

According to the Center for Disease Control (CDC), as of June 1994, there were 401,749 confirmed cases of AIDS in the U.S., and approximately 300,000 people become infected with hepatitis B annually. It is estimated that a further 1.5 million people in the U.S. are infected with HIV, and that most are between the ages of 25 and 49 and are active members of the workforce.

Means of Transmission

Bloodborne pathogens are transmitted when contaminated blood or body fluids enter the body of another person. This can occur through a number of pathways, such as:

• An accidental puncture by a sharp object contaminated with the pathogen. "Sharps" include objects such as:
  • needles
  • scalpels
  • broken glass
  • razor blades
• Open cuts or skin abrasions coming in contact with contaminated blood or body fluids
• Sexual contact
• Indirect transmission (a person touches dried or caked on blood and then touches the eyes, mouth, nose or an open cut) (HBV only)

There are also many ways that these diseases are not transmitted. For instance bloodborne pathogens are not transmitted by touching an infected person, through coughing or sneezing or by using the same equipment, materials, toilets, water fountains or showers as an infected person. It is important that people are educated as to which ways are viable means of transmission of these dangerous diseases, and which are not.

There are many everyday situations in the academic environment where the above events may occur. Consider the following examples:

A student in a Chemistry lab tries to insert a glass tube through a rubber stopper. The tubing snaps and impales the student in the palm, resulting in a jagged, bloody wound. The TA rushes to the assistance, grabbing papertowels and wrapping the wound. He applies pressure to stop the bleeding. The TA wipes up the blood on the benchtop with papertowels and throws them in the trash, while another student walks the victim to the Health Center, careful to maintain the pressure on the bloodsoaked papertowels. The next morning the housekeeping staff removes the papertowels from the trashcan with her unprotected hands. Three people have been exposed to blood.

Several students in a Biology lab are squeamish about stabbing their own fingers to look at blood under the microscope. One student is much braver than the rest and allows the others to take samples of her blood to examine. Ten people are exposed to contaminated blood.

In the woodshop, a student is working with the table saw when his hand slips and his finger is deeply cut on the saw blade. His supervisor runs over, turns off the saw and grabs the student, restrains him and uses his bare hands to put pressure on the wound. One person is exposed to contaminated blood.

In a Meat lab, an instructor is demonstrating a specific cut when his hand accidentally gets in the way of saw. When the blade strikes his hand, blood is thrown over the class. Six people are exposed.

A research scientist is studying the effects of an anticoagulant on blood. He draws up a sample of the blood he is working with using a needle and syringe. When he finishes with the process, he carelessly tosses the needle in the lab trash. The next morning, housekeeping comes to clean the lab and take out the trash. While removing the bag from the trashcan, the staffmember is stabbed through the plastic bag with the syringe. One person is exposed to contaminated blood.

These types of accidents must and can be avoided through education of all personnel who work in potentially dangerous environments!

OSHA Steps In

The number of infected persons in the workplace is staggering, and continues to increase. In answer to the growing problem, OSHA issued a standard regarding bloodborne pathogens in December 1991. This standard reaches more businesses than any other standard in that it applies to any workplace in which workers face potential exposure to human blood or other body fluids that may carry disease. The Bloodborne Pathogens Standard is composed of a written plan, entitled the Exposure Control Plan, training requirements and recordkeeping guidelines. The requirements of this standard applies to all workareas that have potential for exposure to blood or other body fluids.

Exposure Control Plan

Each workarea where employees may be exposed to blood or body fluids must formulate an Exposure Control Plan. This plan attempts to minimize the risks of infection by bloodborne pathogens. It covers:

• identification of employees who are covered by the plan and the tasks where there is a potential for exposure to blood
• train employees who are at risk
• specific measures the employer will take to minimize the risk of exposure; these will include:
  • adhere to "Universal Precautions"
  • engineering and work practice controls
  • personal protective equipment
  • housekeeping issues
  • hepatitis B vaccine
• procedures to follow if there is an exposure

If you are an "affected" employee or student, that is, if there is a potential for you to be exposed to human blood or body fluids, check with your supervisor and determine your and your supervisor's responsibilities and make certain that you understand those responsibilities.

Identifying Dangerous Tasks

Some tasks are by their nature more apt to involve potential exposure to blood or body fluids. In the academic environment, these may include any tasks requiring the use of sharp implements (needles, razor blades, saws, glass), tasks working directly with blood (research, education), tasks that require a staff member to handle contaminated waste or trash, or tasks that have someone acting in the role of a first-aid responder. All these, as well as a myriad of other tasks which could result in exposure, would be covered under the Bloodborne Pathogens Standard.

Sooo ... who is at risk?

If a survey of Texas A&M University departments was performed to determine which employees were at risk to exposure to bloodborne pathogens, those at greatest risk would likely be those with the following job titles and task descriptions:

• Lab Research Personnel
• Health Care Workers
• Physicians
• Blood Bank Workers
• Campus Police Officers
• Fire & Rescue Personnel
• Janitors & Waste Handlers
• Craftsmen

ANYONE WORKING WITH HUMAN BLOOD IS AT RISK!

Educating At-Risk Personnel

Employers must provide training to all personnel who may be exposed to infectious materials. The following subjects must be considered:

• what are bloodborne pathogens and how are they spread
• the Exposure Control Plan that has been implemented
• appropriate engineering and work practice controls
• what to do in case of accidental exposure
• signs and labels that will be used to alert other personnel of danger involving infectious material

There are a number of education resources that are available to help with training or can provide information regarding bloodborne pathogens and AIDS:

 	CDC National AIDS Hotline				800-342-AIDS
 			In Spanish				800-344-7432
 			TDD					800-243-7889
 		
	 CDC's Business Responds to AIDS
	 		Resource Center				800-458-5231
 		
	 National AIDS Clearing House				800-458-5231
	 							800-243-7012
 								
	 American Red Cross					202-434-4074
 

Minimizing Exposure

The employer must minimize the exposure of students and employees to bloodborne pathogens whenever the potential for that exposure exists. OSHA has taken the position that there are no "risk-free" populations, and enforcement of OSHA's "general duty clause" implies that employers must be knowledgeable of and comply with the bloodborne pathogens standard. Risk is minimized through improved engineering design and work practices, through the use of protective equipment as appropriate and by addressing housekeeping issues in the following manner:

• Universal Precautions

  Universal Precautions are the Center for Disease Control's (CDC) recommendations for handling body fluids and blood in the workplace. The CDC's position is that all body fluids and blood should be handled as if they were contaminated.

  Engineering and work practice controls

  Use autoclaves to sterilize all equipment and to treat infectious waste.

  Use puncture resistant, labeled sharps containers for disposal of needles, razor blades, etc.

  Do not break, bend or recap needles - place them directly in the sharps container.

  Do not pick up broken glass with your hands - sweep it up.

  Wash hands immediately after removing gloves and after any hand contact with blood contaminated surfaces.

  Don't keep food or water in areas where blood is worked with.

  Don't eat, drink, smoke or apply make-up in areas where blood is worked with.

  Eliminate splashing of infectious materials when possible.

  Never pipette by mouth!

  Protect open wounds from infectious materials.

  Personal protective equipment

  Employers must make available and employees must use personal protective equipment (PPE) when the possibility of exposure to blood or infectious materials exists.

  Employees must be trained in the use off PPE.

  PPE must be accessible and clean.

  Disposable gloves must be replaced as soon as they are torn or punctured.

  Eye protection must be worn if there is a chance for a splash to occur.

  The level of protection required is dependent upon the task at hand.

  Housekeeping issues

  Clean up all blood or body fluid spills immediately.

  Clean and decontaminate all surfaces and equipment which have been in contact with blood thoroughly.

  Contaminated laundry must be handled with extreme caution and contact minimized.

  Hepatitis B vaccine

  Must be provided at no cost to at-risk personnel

  85% to 97% effective

Exposure Response

Earlier, several scenarios were given that could occur in an academic environment. These are considered exposure incidents whenever the eyes, mouth, other mucous membrane or broken skin contacts blood or other infectious materials on the job. If an exposure occurs, arrange for an immediate medical evaluation that includes the following:

• document what happened
• identify and test the source individual if feasible
• test the exposed person's blood, if consent is obtained
• provide counseling
• evaluate any reported illness

Do's and Don'ts Checklist

Do these things:

• Use appropriate PPE when working with blood or infectious materials.
  • Check it first for damage.
  • Remove PPE carefully to avoid self-contamination.
  • Dispose of contaminated PPE correctly in leakproof containers for disposal or for decontamination.
  • Make sure you have been trained in the use of PPE and it is documented!
• Use good personal hygiene
  • Wash exposed skin immediately with soap and water.
  • Wash thoroughly after removing PPE.
  • Flush exposed eyes, nose or mouth quickly and thoroughly with water.
  • Cover open cuts.
• Use good work practices.
  • Minimize splashing of infectious materials.
  • Clean up spills immediately.
  • Clean and decontaminate all equipment and surfaces in contact with blood or other infectious material.
  • Dispose of sharps in a puncture-proof, labeled container.
• Know the proper response for accidental exposures.
  • Know the Bloodborne Pathogens Standard so you can respond without fear.
  • Report on-the-job exposures promptly and seek immediate medical attention.

Don't do these things:

• Don't have unprotected sex, use illicit drugs or share needles.
• Don't worry about getting one of these diseases through casual contact.
• Don't eat or drink, or keep food and drinks in areas where infectious materials are used.
• Never pipette by mouth.
• Never break, bend or recap contaminated needles.
• Don't clean up broken glass by hand, use a broom and dustpan.

Copyright © 1996 by College of Science, Texas A&M University