Blood Borne Pathogen: Study Guide for Blood Borne Pathogen Class

A bloodborne pathogen is an infectious microorganism present in blood that can cause disease in humans. Common Bloodborne Pathogens that cause human disease include human HIV, Hepatitis B and C, Malaria, Syphilis, and Brucellosis. These are usually transmitted through exposure to blood, cuts, abrasions, burns, punctures, needle sticks, bites, rashes, and mucous membranes.

Bloodborne pathogens such as HBV and HIV can be transmitted through contact with infected human blood and bodily fluids such as:

• Semen
• Vaginal fluids
• Pleural
• Synovial fluid
• Cerebrospinal fluid.
• Peritoneal fluid
• Amniotic fluid
• Saliva in dental procedures

Bloodborne Pathogens cannot be transmitted through

• Vomit
• Nasal
• Sweat
• Tears
• Sputum
• Urine

Individuals vaccinated against a pathogen can still become infected as vaccinations are not always 100% effective, and effectiveness may decrease over time.

OPIM stands for "Other Potentially Infectious Materials." OPIM includes any fluid, tissue, culture, or cloth contaminated with human blood, human blood components, or products made from human blood.

Here is a list of bodily fluids that should always be considered as potentially infectious materials:

• Semen and vaginal secretions
• Fluid from the spinal column and brain
• Fluid found in joints
• Fluids found in tissues around the lungs (Pleural fluid)
• Fluids found in tissues around the heart (Pericardial fluid)
• Fluids found in the abdomen (Peritoneal fluid)
• Fluids found around developing fetuses (Amniotic fluid)
• Saliva in dental procedures where blood or broken skin is present
• Any unfixed tissue or organ from humans.
• Any cells or cultures contaminated with HIV
• Human cell cultures used for research purposes
• Any body fluid that has been contaminated with blood
• Any pathogenic microorganism

Most people don't come into regular contact with many of these bodily fluids. However, people in the health industry are at a higher risk of direct contact with contaminated OPIMs, putting them at risk of infection.

OSHA's Bloodborne Pathogens Standard is a regulation that prescribes safeguards to protect workers against health hazards related to bloodborne pathogens. The standard imposes requirements on employers of workers who may be exposed to blood or OPIM. These are:

• Establishing an exposure control plan
• Requiring the use of universal precautions
• Identifying and using engineering and work practice controls
• Providing appropriate PPE
• Making Hepatitis B Vaccination available
• Using signs and labels to communicate hazards
• Providing information and Bloodborne Pathogens training to employees
• Maintaining medical and training record
• Providing medical evaluations for exposure incidents

Bloodborne Pathogens can be transmitted if infected blood or OPIM enters your body through these modes of transmission:

• Parenteral exposure from sharp objects like needles cuts from broken glass,
• Illegal drug use
• Abrasions and human bites.
• A mucous membrane in the mouth, eye, and nose.
• Sexual contact
• Accidental punctures from contaminated needles and other sharps

CDC estimates that workers in the health care industry and anyone whose job involves contact with blood are at the highest risk of occupational exposure. For infection to occur, the following conditions must be met:

• A pathogen must be present.
• A sufficient quantity of pathogens must be present to cause an infection.
• A person must be susceptible to the pathogen in question.
• The pathogen must access the body via an entry site, such as abrasions, punctures, and the respiratory system.

Bloodborne pathogens cannot be spread by casual contacts, such as shaking hands or hugging. However, droplet transmission may occur when another person inhales an infected person's cough or sneezes and pathogens.

Occupational exposure refers to exposure to potentially harmful physical, chemical, biological agents, or environmental hazards such as high noise levels as a result of one's work.

Workplaces where there is a high risk of occupational exposure to hazardous materials are laboratories and medical facilities. For example, a health care professional may be exposed to HIV or another infectious agent through a needlestick injury.

Professions at risk of Bloodborne Pathogens

• Housekeepers in health care facilities.
• Personnel in hospital laundries
• Workers in medical clinics in industrial, educational, and correctional facilities.
• Employees assigned to provide first aid.
• Physicians and physicians' assistants
• Nurses
• Other health departments employees in clinics
• Clinical and diagnostic laboratories staff and employees.
• Tissue bank personnel.
• Employees in blood banks and plasma centers
• Dentists, dental assistants, and dental laboratory technicians.
• Home health care staff and workers.
• The staff of nursing homes
• Hospice employees
• The staff of institutions for the developmentally disabled.
• Employees of funeral homes and mortuaries.
• HIV and HBV research laboratory workers.
• Employees handling infectious waste.
• Medical equipment service and repair personnel.
• Emergency medical technicians
• Paramedics and other emergency medical service providers.
• Firefighters
• Law enforcement personnel
• Correctional officers and staff

Procedures to follow when employees are exposed to blood or OPIM

• Remove contaminated PPE and place it in a biohazard labeled bag.
• Wash exposed areas with soap and water. Immediately flush mucous membranes with water.
• Report the exposure incident to your supervisor.
• If there is a blood spill, arrange for clean-up and decontamination immediately.
• Seek medical attention if first aid is needed or if signs of infection occur.
• Complete the Exposure Incident Forms within 24 hours after exposure.
• Follow instructions for follow-up as outlined in the Exposure Control Plan.

The Human Immunodeficiency Virus is one of the common bloodborne pathogens. Also called HIV, this is the virus that causes acquired immune deficiency syndrome (AIDS). It's persistent in blood, semen, vaginal fluids, pre-ejaculation, and breast milk. Symptoms include fever, headache, sore throat, swollen lymph glands, and rash.

Treatment: No vaccine, hormones for women, Hepatitis C drugs, antiviral medicines.

Acquired Immunodeficiency Syndrome (AIDS)

AIDS or Acquired immunodeficiency syndrome is a chronic, potentially life-threatening condition caused by HIV. The symptoms of AIDS include

• Sweating
• Fatigue
• Shortness of breath
• Dry coughing
• Chronic diarrhea
• White lesions on the tongue and mouth,
• Headache
• Weight loss

Treatment: No vaccine, hormones for women, Hepatitis C drugs, antiviral medicines.

Hepatitis B is a bloodborne disease that results from infection with the Hepatitis B virus or HBV. Although it is usually transmitted through blood, other body fluids from an infected person with the virus can also cause the disease. Symptoms include:

• Fatigue
• Nausea
• Vomiting
• Abdominal pain/discomfort
• Loss of appetite
• Fever
• Dark urine
• Muscle pain
• Jaundice
• Joint pain.

Hepatitis B infection is called "acute" when it occurs within six months after a person is exposed to HBV. This infection can lead to a long-term, chronic Hepatitis B infection if left untreated, and the virus will remain in the victim's body. Hepatitis B can also lead to death, but there is a vaccination to prevent the disease.

Treatment: Hepatitis B vaccination, transplant

Hepatitis C is the most common bloodborne pathogen infection in the United States. Among all the bloodborne diseases, Hepatitis C is the least likely to be transmitted through sexual contact; however, it can be transmitted sexually.

Hepatitis C is persistent in blood, transmitted through blood contact, sexual contact, drug use, and contaminated needle stick, about 1.8%. Symptoms include fatigue, nausea, vomiting, abdominal pain/discomfort, loss of appetite, fever, dark urine, muscle pain, jaundice, and joint pain.

Treatment: No vaccine available

Universal precautions are guidelines followed by medical personnel to protect themselves from patients' infections and vice versa. For example, washing your hands before touching a patient is a simple way to prevent spreading diseases, especially when no other protective materials are available. Using gloves is another practical step in stopping the spread of germs between the first aider and the patient.

Rescuers can prevent cross infection in many ways, such as:

• Wear protective gloves.
• Cover cuts, sores, and wounds with a waterproof bandage.
• If large amounts of the infected person's body fluids are exposed, wear a plastic apron and eyeglasses.
• Use care around needles to prevent pricks.
• Watch out for broken glass.
• If the rescuer does come in direct contact with the injured person's body fluids, he should wash the area as soon as possible with soap and water. Particularly in the case of the eyes, nose, mouth, and open wounds. The rescuer should seek medical attention.
• Use a mask or face shield when administering CPR.
• Clean up the scene of the emergency safely when the rescue is complete.
• Rescuers should consult their doctor to see if a hepatitis B immunization is advisable before encountering possible infection sources.

Personal protective equipment minimizes the risk of exposure to a bloodborne pathogen, especially for Health care workers. They need to consider the possible exposure sources and protect themselves from them before the exposure occurs. Also, more robust protection is required if the exposure extends over a longer period. For this reason, a variety of personal protective equipment (PPE) is available, including:

• Goggles: It should fit around and over the eyes.
• Gloves: To protect the hands
• Face shields: To protect the eyes, mouth, nose, and face. It should cover the forehead and wrap around the sides of the face. It should also extend below the chin.
• Gowns/aprons: To protect clothing and skin. It should be resistant to fluid penetration.
• Masks: To protect the mouth and nose. Mask should cover the nose and mouth fully and should be resistant to fluid penetration.
• Respirators: To protect the respiratory tract from airborne agents, such as influenza.

Fluid-proof safety equipment such as rubber gloves can also prevent the spread of bloodborne pathogens.

PPE Guidelines

1. Always wear PPE in exposure situations.
2. Remove or replace PPE that is damaged, punctured, or lost its ability to protect you from bloodborne pathogens.
3. Remove and dispose of PPE before leaving the work area.
4. PPE should be accessible if you work in an area with routine exposure to blood or OPIM
5. Contaminated equipment should be placed in appropriately labeled bags or containers until it is disposed of, decontaminated, or laundered.

Work practice controls are measures used to change how work practices are carried out to ensure safety. Examples of work practice controls are removing and disposing of PPE as soon as possible after use and isolating areas of contamination to prevent others from being exposed.

Engineering controls are those measures used to isolate or remove hazards from the work environment. Examples of engineering controls include self-sheathing needles, labeling infectious materials, cleaning, disposing of, documenting, and containing.

Sharps with Engineered Sharps Injury Protections (SESIP)

• Retractable needles
• Retractable finger-prick
• Needleless systems.

Proper recapping of needles

• One-handed motion
• Mechanical device

Employers must provide immediate confidential medical evaluation and follow-up when a Health Care Provider has an exposure incident, such as a needle stick. These incidents need to be reported immediately. The source of the possibly infectious materials can also be tested for bloodborne pathogens, giving vital information to the HCP and developing a treatment plan. Infection following exposure to a bloodborne pathogen depends on a few variables, including

• Pathogen present during the exposure
• Type of exposure
• Amount of blood or OPIM involved in the exposure
• The concentration of the virus in the blood during the exposure

Even after taking precautionary measures, you can still be exposed to blood or body fluids. Reporting an exposure incident to your employer or manager will help you get the treatment you need and help your employer identify and reduce exposure causes.

• The employer must follow OSHA standards and document the exposure incident/sharps injuries.
• The employer must keep these reports confidential.
• Seek treatment from a medical professional.
• Required OSHA forms should not delay any medical attention or counseling you may need.
• The employer will continue with forms according to their policies.

What Training Does OSHA Require for BBP?
Under OSHA's bloodborne pathogen standard, OSHA requires employees with occupational exposure to blood or other potentially infectious materials (OPIM) to complete Bloodborne Pathogens training course annually, regardless of the employees' prior training or education.

What is an Employer Control Plan?
An Employer Exposure Control Plan or ECP requires 29 CFR 1910.1030(c) of the Bloodborne Pathogens Standard established by OSHA. The Employer Control Plan aims to establish procedures to eliminate or minimize employee exposure to a bloodborne pathogen.

What is the main focus of the OSHA bloodborne pathogens Standard?
The standard discusses a framework to minimize exposure to bloodborne pathogens such as HIV, HBV, and HCV viruses that could be present in human blood, tissues, and body fluids.

What are the four methods of Compliance with Bloodborne Pathogens Standards?
Health care workers must follow standard Precautions to effectively minimize or eliminate exposure to bloodborne pathogens. These include Universal Precautions, Engineering Controls, Work Practice Controls, and PPE.